Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school students either received a PNE lecture (n = 220); usual curriculum school pain education (UC) (n = 198) or PNE followed by two booster (PNEBoost) sessions (n = 250). Prior to, immediately after and at six-month follow-up, pain knowledge and fear of physical activity was measured. Six months after the initial intervention school, physical education, recess and sports attendance/participation as well as healthcare choices for pain (doctor visits, rehabilitation visits and pain medication use) were measured. Students receiving PNEBoost used 30.6% less pain medication in the last 6 months compared to UC (p = 0.024). PNEBoost was superior to PNE for rehabilitation visits in students experiencing pain (p = 0.01) and UC for attending school in students who have experienced pain > 3 months (p = 0.004). In conclusion, PNEBoost yielded more positive behavioral results in middle school children at six-month follow-up than PNE and UC, including significant reduction in pain medication use.

Objectives: To compare if a video-delivered pain neuroscience education (PNE) session yield comparable results to a live-PNE session delivered to middle school students in terms of pain knowledge and attitudes and beliefs regarding pain. Methods: Two hundred and fifty-one 5 th through 8 th grade middle school students were randomly assigned to receive a live (n = 147) or video-delivered (n = 104) presentation (30 minutes). Prior to and immediately following the lectures, students completed a knowledge of pain questionnaire (Neurophysiology of Pain Questionnaire-NPQ) and beliefs regarding pain questionnaire (Health Care Provider's Pain and Impairment Relationship Scale-HC-PAIRS). Results: Both video (p < 0.001) and live presentations (p < 0.001) yielded significant increases in pain knowledge and both showed large effect sizes (video 0.81 and live 0.82) as well. Pain beliefs questions of "You can control how much pain you feel" and "Your brain decides if you feel pain, not your tissues" both had significant changes (both groups p < 0.001), with moderate effect size for both groups (video .45 and .56; live .51 and 68). Conclusion: A 30-minute video-delivered PNE resulted in similar changes to a live, in-person PNE session. The results from this study may help PNE approaches for middle schools to become standardized, costeffective and scalable. Larger trials with long-term follow-up are needed to determine if video-delivery PNE is effective in altering behavior change.