In what follows the reader is provided with a brief overview of the clinical evidence of pain physiology education in patients with chronic musculoskeletal pain. The largest part of the paper is dedicated to practice guidelines on how to apply pain physiology education in patients with chronic musculoskeletal pain. Several groups have studied the clinical effects of pain physiology education in various chronic musculoskeletal pain populations such as chronic low back pain (Moseley, 2002, Moseley, 2003b, Moseley, 2004, Moseley,

2005, Moseley, 2004 and Ryan et al., 2010), fibromyalgia (Ittersum et al., Submitted for publication, Ittersum van et al., in press and Van Oosterwijck et al., submitted for publication, chronic whiplash associated disorders (Van Oosterwijck et al., 2011) and chronic fatigue syndrome with chronic widespread PLX3397 concentration pain (Meeus et al., 2010a). In find more patients with chronic low back pain, pain physiology education alters pain perceptions and, in conjunction with physiotherapy, it improves functional and symptomatic outcomes (Moseley, 2002, Moseley, 2003b, Moseley et al., 2004 and Moseley, 2005). A recent randomized controlled trial indicates that, in the short term, pain physiology education alone is more effective

for pain relief and improving pain self-efficacy than a combination of pain physiology education and group exercise classes for patients with chronic low back pain (Ryan et al., 2010). Altered pain perceptions are directly associated with altered movement performance in those with chronic low back pain, even if there is no opportunity for the patients to be physically active during the treatment (Moseley, 2002 and Brosschot, 2002). This implies that motor performance may be directly limited by pain perceptions. Indeed, a case series study of patients with chronic whiplash associated disorders showed improvements

in illness perceptions, pain thresholds and movement performance (Van Oosterwijck et al., 2011). In patients with chronic fatigue syndrome, pain physiology education alters pain perceptions such as catastrophizing, and pain behaviour (Meeus et al., ID-8 2010a). In another randomized controlled clinical trial, we showed that simply providing the detailed information booklet explaining pain physiology and central sensitization, did not change illness perceptions or health status in patients with fibromyalgia (Ittersum et al. submitted for publication). However, when the same written education about pain physiology was combined with two educational sessions (one face-to-face session and one by telephone) of individually-tailored pain physiology education, vitality, physical functioning, mental and general health of patients with fibromyalgia improved (Van Oosterwijck et al. submitted for publication).