Toward a shared framework for therapeutic pain education: a Delphi-based international consensus

IMPORTANCE: Persistent pain is a global cause of disability, affecting daily life and physical, psychological, and social functioning. While biomedical approaches may alleviate symptoms, they often overlook psychological, behavioral, and contextual contributors. Recently, therapeutic pain education has emerged as a key non-pharmacological strategy; however, consensus on its core content and implementation is still lacking. OBJECTIVE: The objective was to reach an international expert consensus on the core components of therapeutic education programs for individuals with persistent pain. DESIGN: The study consisted of a 3-round Delphi consensus study. SETTING: An international, online Delphi modality was performed. PARTICIPANTS: Twenty-one multidisciplinary experts from 10 countries (high- to middle-income ratio: 19/2) were included in the present study. INTERVENTION(S) OR EXPOSURE(S): Participation consisted of a structured Delphi process of 1 open-ended round and 2 structured rounds using a 4-point Likert scale, organized across 8 predefined domains. MAIN OUTCOME AND MEASURE(S): The main outcome was expert agreement on core components of therapeutic pain education, defined as an Aiken V value ≥0.7 with their 95% confidence interval exceeding this threshold. The process was organized around 8 domains: topic areas, patient/learner characteristics, materials and resources, activities, dosage and frequency, learning outcomes, context/environment, and adherence assessment. RESULTS: The experts, with a mean of 20 years of clinical experience (SD = 9.6) and 15 years of research experience (SD = 6.4), reached agreement on 35 items. Experts highlighted core content such as neuroplasticity, pain-related beliefs, emotional regulation, and behavior change. They recommended assessing motivation, readiness to change, expectations, tailoring interventions to patient profiles, using explicit, evidence-based materials, including graded exposure and pacing, adjusting dosage according to engagement, ensuring a safe, welcoming, private environment, and assessing changes in beliefs, functioning, and lifestyle. CONCLUSION: This study provides an internationally validated framework for designing and implementing therapeutic education programs for individuals with persistent pain. RELEVANCE: By translating expert consensus into practical components, it bridges the gap between theory and clinical practice, supporting consistent, patient-centered strategies and informing future implementation and research.