Chronic Non-Specific Low Back PainNCT07305597
Effects of Virtual Reality-Assisted Pain Neuroscience Education on Chronic Nonspecific Low Back Pain
A study testing Core Stabilization Exercises, Classic Pain Neuroscience Education and Virtual Reality-supported pain neuroscience education program in people with Chronic Non-Specific Low Back Pain, run by Kirsehir Ahi Evran Universitesi at 2 sites in Turkey (Türkiye).
Trial summary
Chronic nonspecific low back pain is a multifactorial condition involving not only biomechanical but also psychological and neurocognitive components, in which factors such as kinesiophobia and pain catastrophizing contribute to pain persistence and disability. Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Chronic Non-Specific Low Back Pain
- What is being tested?
- Core Stabilization Exercises, Classic Pain Neuroscience Education and Virtual Reality-supported pain neuroscience education program
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 51 participants
- Where
- 2 sitesTurkey (Türkiye)
- Study dates
- 15 Feb 2026to 30 May 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Be between the ages of 18 and 65
- Have a diagnosis of nonspecific low back pain with a history of low back pain lasting at least 3 months
- Have no specific pathologies that could cause low back pain (e.g., tumor, infection, fracture, inflammatory disease)
- Be able to walk independently and have the capacity to exercise
- Mini Mental State Examination score >23
Who cannot join
- Individuals who have undergone lumbar surgery within the last year,
- Individuals with central or peripheral neurological disorders (e.g., multiple sclerosis, peripheral neuropathy, Parkinson's disease),
- Those with vestibular, visual, or balance disorders (those at risk of dizziness or nausea during virtual reality applications),
- Those with serious cardiopulmonary or systemic diseases,
- Those with psychiatric disorders or a diagnosis of severe depression, those who are pregnant
- Individuals with a history of dizziness, epilepsy, or visual disturbances associated with virtual reality use
Trial locations and contacts
2 sites in 1 country.
Turkey (Türkiye)2 sites
Kırşehir Ahi Evran University
Center, Kirşehi̇r, 40100
Kırşehir Ahi Evran University
Kırşehir
About this study
Official title: Effects of Virtual Reality-Assisted Pain Neuroscience Education on Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial
Chronic nonspecific low back pain is a multifactorial condition involving not only biomechanical but also psychological and neurocognitive components, in which factors such as kinesiophobia and pain catastrophizing contribute to pain persistence and disability. Pain Neuroscience Education (PNE) aims to reconceptualize pain, reduce fear-avoidance behaviors, and improve function, particularly when combined with exercise, although traditional educational methods may be limited in explaining abstract concepts. Virtual reality (VR) offers an interactive and engaging platform that may enhance the effectiveness of PNE by facilitating cognitive restructuring and increasing motivation, with evidence of short-term benefits on pain and kinesiophobia. Integrating VR-supported PNE with core stabilization exercises may simultaneously address biomechanical and cognitive processes, thereby providing a more comprehensive rehabilitation approach. Accordingly, this study aims to examine the effects of adding VR-supported pain education to core stabilization exercises on pain, kinesiophobia, pain catastrophizing, functional status, and balance in individuals with chronic nonspecific low back pain.
Read the detailed description
Chronic nonspecific low back pain (CNSLBP) is a complex condition that cannot be explained solely by biomechanical factors and also involves psychological and neurocognitive components. Kinesiophobia, pain catastrophizing, and maladaptive pain beliefs have been shown to play a significant role in the chronification of pain and the increase in disability. Therefore, the Pain Neuroscience Education (PNE) approach, which focuses on the neurophysiology of pain, helps individuals reconceptualize pain, reduces fear-avoidance behaviors, and supports functional improvement. When applied in combination with exercise, PNE has been reported to provide additional benefits in reducing pain intensity, kinesiophobia, and catastrophizing. However, conventional educational methods may be limited in conveying abstract neurophysiological concepts.
At this point, virtual reality (VR) technology may enhance the effectiveness of pain education by providing an interactive and engaging learning environment. VR has been reported to facilitate cognitive restructuring in individuals with chronic pain and to increase motivation for participation. Moreover, VR-supported rehabilitation interventions have been shown to have short-term positive effects on pain and kinesiophobia in chronic pain conditions.
Core stabilization exercises are an effective method for improving postural control and functional stability in low back pain by regulating the activation of muscles surrounding the spine. However, purely physical approaches may be insufficient in adequately addressing the psychological dimensions of pain. Integrating VR-supported PNE into an exercise program may broaden the scope of rehabilitation by simultaneously influencing both biomechanical and cognitive processes. Therefore, this study aims to investigate the effects of adding VR-supported pain education to core stabilization exercises on pain, kinesiophobia, pain catastrophizing, functional status, and balance in individuals with CNSLBP. This holistic approach is expected to provide an innovative contribution to conventional exercise protocols and to shed light on the biopsychosocial management of chronic low back pain.
- Conditions
- Chronic Non-Specific Low Back Pain
- Being tested
- Core Stabilization Exercises, Classic Pain Neuroscience Education, Virtual Reality-supported pain neuroscience education program
- Keywords
- chronic non-spesific low back pain, virtual reality, pain neuroscience education
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Core Stabilization ExercisesOther
Individuals in this group will undergo classical pain education (based on visual presentation or face-to-face instruction) along with core stabilization exercises targeting the muscles surrounding the spine. The exercises will be organized according to protocols reported in the literature as safe and effective and will include the following elements:
- Exercises that activate the transversus abdominis and multifidus muscles (e.g., abdominal bracing, bird-dog, plank, side bridge)
- Posture and spinal control exercises
- Stretching and mobilization movements (lumbar flexion/extension, hip flexor stretches)
- Each exercise will be performed in 2-3 sets of 10-15 repetitions, with the load increased according to participant tolerance.
Classic Pain Neuroscience EducationOther
During the application process, participants will be provided with traditional educational materials (e.g., verbal explanations or informational brochures) on the physiological basis of pain, movement safety, and pain management related to exercise. This training will not include virtual reality support.
Virtual Reality-supported pain neuroscience education programOther
Details of the Virtual Reality-supported pain neuroscience education program:
- Introductory Session (Week 1)
- 20-30 minutes of pain education modules in the VR environment
- Information on the neurophysiological basis of pain, catastrophizing, and fear-avoidance behaviors
- Reinforcement with interactive questions and short exercises
- Weekly Reinforcement (Weeks 2-6)
- 10-15 minutes of short VR modules each week
- Integration with core exercise sessions
| Study group | Role | What they receive |
|---|---|---|
| Core Stabilization + Classic Pain Neuroscience Education | Experimental | Individuals in this group will undergo classical pain education (based on visual presentation or face-to-face instruction) along with core stabilization exercises targeting the muscles surrounding the spine. The exercises will be organized according to protocols reported in the literature as safe and effective and will include the following elements:
* Exercises that activate the transversus abdominis and multifidus muscles (e.g., abdominal bracing, bird-dog, plank, side bridge)
* Posture and spinal control exercises
* Stretching and mobilization movements (lumbar flexion/extension, hip flexor stretches)
* Each exercise will be performed in 2-3 sets of 10-15 repetitions, with the load increased according to participant tolerance.
During the application process, participants will be provided with classic educational materials (e.g., verbal explanations or informative brochures) about the physiological basis of pain, movement safety, and exercise-related pain management. Thi Receives: Other: Core Stabilization Exercises; Other: Classic Pain Neuroscience Education |
| Core Stabilization + Virtual Reality-Assisted Pain Neuroscience Education | Experimental | Individuals in this group will receive SG-supported pain education in addition to the Group 1 protocol. Program details:
1. Initial Session (Week 1)
* 20-30 minutes of pain education modules in the SG environment
* Information on the neurophysiological basis of pain, catastrophizing, and fear-avoidance behaviors
* Reinforcement with interactive questions and short exercises
2. Weekly Reinforcement (Weeks 2-6)
* 10-15 minutes of short SG modules each week
* Integration with core exercise sessions Receives: Other: Core Stabilization Exercises; Other: Virtual Reality-supported pain neuroscience education program |
What is being measured
The primary outcome is the main question the study is designed to answer.
Severity of Pain
A visual analog scale will be used to assess patients' current pain intensity. This scale is one of the most commonly used scales for assessing pain intensity during rest, activity, and at night. The scale features a 10 cm line on which the patient can mark their pain intensity. Patients are asked to indicate the degree of their pain intensity on the line, ranging from no pain (left side) to unbearable pain (right side).
Measured: 6 week
Secondary outcomes (4)
Balance
To determine the balance level of individuals with CNSLBP, the Biodex Balance System, which has been reported to be a reliable and valid assessment tool, will be used. Balance assessment on the Biodex Balance System is performed separately under dynamic and static conditions. The system consists of a balance platform that can tilt up to approximately 20° and has a 360° range of motion. The platform moves in the mediolateral (M-L) and anteroposterior (A-P) directions. Under dynamic conditions, the device calculates the degree of platform tilt, whereas under static conditions it measures deviations of the center of pressure. The difficulty level of the test is adjusted by changing the surface stability of the platform. On the balance platform, stability levels range from 12 (minimum stability) to 0 (maximum stability). In this study, the surface stability was set at Level 6. The Biodex Balance System quantifies balance loss using the average of the M-L and A-P scores, with higher scores
Measured: 6 week
Functional Status
The level of disability resulting from low back pain will be assessed using the Oswestry Disability Index (ODI). The ODI was developed by Fairbank et al. in 1980, and its Turkish validity and reliability were established by Yakut et al. The ODI is one of the most widely used instruments for determining the extent to which daily living activities and functional status are affected by pain in individuals with low back pain.
Measured: 6 week
Pain Catastrophizing
The Pain Catastrophizing Scale (PCS) is a 13-item questionnaire designed to assess the extent of catastrophic thoughts and feelings related to pain in individuals experiencing pain. Each item is rated on a 5-point scale, with higher scores indicating greater levels of catastrophizing. Subscale scores are calculated by summing the scores of the corresponding items, and the total score is obtained by summing all items. PCS scores range from 0 to 52.
Measured: 6 week
Kinesiophobia
Participants' fear of movement or re-injury was assessed using the Tampa Kinesiophobia Scale. The scale is a self-report-based assessment tool used to determine the level of kinesiophobia. Consisting of 17 items, the scale is scored on a 4-point Likert scale. A higher total score on the scale indicates a higher level of kinesiophobia. The Turkish version of the TKS, which has undergone validation and reliability testing, was used in this study.
Measured: 6 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Dec 2025
- Study start15 Feb 2026
- Primary completion25 May 2026
- Study completion30 May 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Chronic Non-Specific Low Back PainStudies of the same condition, open and under way.
- More trials run by Kirsehir Ahi Evran UniversitesiThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Randomized dontrolled trial
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 51 participants (actual)
Sponsor and investigators
- Lead sponsor
- Kirsehir Ahi Evran Universitesi
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, İrem CANLI, Kirsehir Ahi Evran Universitesi
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07305597
- Sponsor's protocol ID
- 23591230588=
- Status last verified
- Jan 2026
- First submitted
- 13 Dec 2025
- Last updated
- 5 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 5 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Virtual Reality-Assisted Pain Neuroscience Education on Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07305597
- Acronym / sponsor ID
- 23591230588=
- Conditions
- Chronic Non-Specific Low Back Pain
- Keywords
- chronic non-spesific low back pain, virtual reality, pain neuroscience education
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 51 participants (actual)
- Lead sponsor
- Kirsehir Ahi Evran UniversitesiUniversity, hospital or other
- Study start
- 15 Feb 2026 (actual)
- Primary completion
- 25 May 2026 (actual)
- Study completion
- 30 May 2026 (actual)
- First posted
- 26 Dec 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Chronic nonspecific low back pain is a multifactorial condition involving not only biomechanical but also psychological and neurocognitive components, in which factors such as kinesiophobia and pain catastrophizing contribute to pain persistence and disability. Pain Neuroscience Education (PNE) aims to reconceptualize pain, reduce fear-avoidance behaviors, and improve function, particularly when combined with exercise, although traditional educational methods may be limited in explaining abstract concepts. Virtual reality (VR) offers an interactive and engaging platform that may enhance the effectiveness of PNE by facilitating cognitive restructuring and increasing motivation, with evidence of short-term benefits on pain and kinesiophobia. Integrating VR-supported PNE with core stabilization exercises may simultaneously address biomechanical and cognitive processes, thereby providing a more comprehensive rehabilitation approach. Accordingly, this study aims to examine the effects of adding VR-supported pain education to core stabilization exercises on pain, kinesiophobia, pain catastrophizing, functional status, and balance in individuals with chronic nonspecific low back pain.
Detailed description
Chronic nonspecific low back pain (CNSLBP) is a complex condition that cannot be explained solely by biomechanical factors and also involves psychological and neurocognitive components. Kinesiophobia, pain catastrophizing, and maladaptive pain beliefs have been shown to play a significant role in the chronification of pain and the increase in disability. Therefore, the Pain Neuroscience Education (PNE) approach, which focuses on the neurophysiology of pain, helps individuals reconceptualize pain, reduces fear-avoidance behaviors, and supports functional improvement. When applied in combination with exercise, PNE has been reported to provide additional benefits in reducing pain intensity, kinesiophobia, and catastrophizing. However, conventional educational methods may be limited in conveying abstract neurophysiological concepts.
At this point, virtual reality (VR) technology may enhance the effectiveness of pain education by providing an interactive and engaging learning environment. VR has been reported to facilitate cognitive restructuring in individuals with chronic pain and to increase motivation for participation. Moreover, VR-supported rehabilitation interventions have been shown to have short-term positive effects on pain and kinesiophobia in chronic pain conditions.
Core stabilization exercises are an effective method for improving postural control and functional stability in low back pain by regulating the activation of muscles surrounding the spine. However, purely physical approaches may be insufficient in adequately addressing the psychological dimensions of pain. Integrating VR-supported PNE into an exercise program may broaden the scope of rehabilitation by simultaneously influencing both biomechanical and cognitive processes. Therefore, this study aims to investigate the effects of adding VR-supported pain education to core stabilization exercises on pain, kinesiophobia, pain catastrophizing, functional status, and balance in individuals with CNSLBP. This holistic approach is expected to provide an innovative contribution to conventional exercise protocols and to shed light on the biopsychosocial management of chronic low back pain.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
- Model description
- Randomized dontrolled trial
| Arm | Type | Receives |
|---|---|---|
| Core Stabilization + Classic Pain Neuroscience Education | Experimental | Other: Core Stabilization Exercises, Other: Classic Pain Neuroscience EducationIndividuals in this group will undergo classical pain education (based on visual presentation or face-to-face instruction) along with core stabilization exercises targeting the muscles surrounding the spine. The exercises will be organized according to protocols reported in the literature as safe and effective and will include the following elements: * Exercises that activate the transversus abdominis and multifidus muscles (e.g., abdominal bracing, bird-dog, plank, side bridge) * Posture and spinal control exercises * Stretching and mobilization movements (lumbar flexion/extension, hip flexor stretches) * Each exercise will be performed in 2-3 sets of 10-15 repetitions, with the load increased according to participant tolerance. During the application process, participants will be provided with classic educational materials (e.g., verbal explanations or informative brochures) about the physiological basis of pain, movement safety, and exercise-related pain management. Thi |
| Core Stabilization + Virtual Reality-Assisted Pain Neuroscience Education | Experimental | Other: Core Stabilization Exercises, Other: Virtual Reality-supported pain neuroscience education programIndividuals in this group will receive SG-supported pain education in addition to the Group 1 protocol. Program details: 1. Initial Session (Week 1) * 20-30 minutes of pain education modules in the SG environment * Information on the neurophysiological basis of pain, catastrophizing, and fear-avoidance behaviors * Reinforcement with interactive questions and short exercises 2. Weekly Reinforcement (Weeks 2-6) * 10-15 minutes of short SG modules each week * Integration with core exercise sessions |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Be between the ages of 18 and 65
- Have a diagnosis of nonspecific low back pain with a history of low back pain lasting at least 3 months
- Have no specific pathologies that could cause low back pain (e.g., tumor, infection, fracture, inflammatory disease)
- Be able to walk independently and have the capacity to exercise
- Mini Mental State Examination score >23
Key exclusion criteria (6 listed)
- Individuals who have undergone lumbar surgery within the last year,
- Individuals with central or peripheral neurological disorders (e.g., multiple sclerosis, peripheral neuropathy, Parkinson's disease),
- Those with vestibular, visual, or balance disorders (those at risk of dizziness or nausea during virtual reality applications),
- Those with serious cardiopulmonary or systemic diseases,
- Those with psychiatric disorders or a diagnosis of severe depression, those who are pregnant
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Core Stabilization ExercisesIndividuals in this group will undergo classical pain education (based on visual presentation or face-to-face instruction) along with core stabilization exercises targeting the muscles surrounding the spine. The exercises will be organized according to protocols reported in the literature as safe and effective and will include the following elements: * Exercises that activate the transversus abdominis and multifidus muscles (e.g., abdominal bracing, bird-dog, plank, side bridge) * Posture and spinal control exercises * Stretching and mobilization movements (lumbar flexion/extension, hip flexor stretches) * Each exercise will be performed in 2-3 sets of 10-15 repetitions, with the load increased according to participant tolerance. | Other | Core Stabilization + Classic Pain Neuroscience Education, Core Stabilization + Virtual Reality-Assisted Pain Neuroscience Education |
| Classic Pain Neuroscience EducationDuring the application process, participants will be provided with traditional educational materials (e.g., verbal explanations or informational brochures) on the physiological basis of pain, movement safety, and pain management related to exercise. This training will not include virtual reality support. | Other | Core Stabilization + Classic Pain Neuroscience Education |
| Virtual Reality-supported pain neuroscience education programDetails of the Virtual Reality-supported pain neuroscience education program: 1. Introductory Session (Week 1) * 20-30 minutes of pain education modules in the VR environment * Information on the neurophysiological basis of pain, catastrophizing, and fear-avoidance behaviors * Reinforcement with interactive questions and short exercises 2. Weekly Reinforcement (Weeks 2-6) * 10-15 minutes of short VR modules each week * Integration with core exercise sessions | Other | Core Stabilization + Virtual Reality-Assisted Pain Neuroscience Education |
Primary outcome
Severity of Pain
Time frame: 6 week
A visual analog scale will be used to assess patients' current pain intensity. This scale is one of the most commonly used scales for assessing pain intensity during rest, activity, and at night. The scale features a 10 cm line on which the patient can mark their pain intensity. Patients are asked to indicate the degree of their pain intensity on the line, ranging from no pain (left side) to unbearable pain (right side).
4 secondary outcomes
Balance
Time frame: 6 week
Functional Status
Time frame: 6 week
Pain Catastrophizing
Time frame: 6 week
Kinesiophobia
Time frame: 6 week
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Jun 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Core Stabilization Exercises, Classic Pain Neuroscience Education and Virtual Reality-supported pain neuroscience education program in people with Chronic Non-Specific Low Back Pain, run by Kirsehir Ahi Evran Universitesi at 2 sites in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 5 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Severity of Pain (time frame: 6 week). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Jun 2026.