Pain affects over 60% of older adults (1) and compromises multiple domains of life, including physical function, muscle health, and cognition (2). Despite this burden, pain in older populations remains underreported and undertreated, often due to the persistent misconception that it is a normal part of aging (3). Pain science education (PSE) is supported by strong evidence in adult populations (4, 5), yet research specific to older adults—particularly using digital delivery—is limited (6). Consequently, there is insufficient guidance on tailoring PSE content and delivery to meet the needs of this group.

Older adults often present with multimorbidity, distinct pain-related beliefs, and varied daily contexts. In many regions, lower educational attainment and limited digital literacy further complicate effective delivery (3). Instructionally, older adults benefit from approaches that integrate prior experiences, emphasize practical application, use relatable examples, and incorporate repetition (7). Cultural adaptation is also critical, as aligning educational content with individuals’ values, beliefs, and practices enhances relevance and engagement (8,9).

To optimize PSE, physiotherapists should actively involve older adults as co-creators in the design, development, and implementation of interventions. This participatory approach can improve relevance, adherence, and overall impact. PSE can be delivered across diverse settings—including community programs, outpatient clinics (6), hospitals, and nursing homes (7,8) —requiring flexible, context-sensitive strategies. Employing a mix of delivery formats (e.g., paper-based, synchronous, and asynchronous digital methods) can broaden access and accommodate varying literacy levels, personal circumstances, and healthcare environments.

Effective implementation depends on adaptability to local contexts and healthcare systems. Key barriers include low educational levels, entrenched biomedical perspectives, and limited digital literacy—particularly in resource-constrained settings. Addressing the digital divide is essential and may involve caregiver support, simplified technologies, user training, and ongoing assistance to ensure technology facilitates rather than hinders engagement. Time constraints in clinical settings also pose challenges, which can be mitigated through appropriate resource allocation and streamlined strategies.

Physiotherapists must be equipped with practical tools and real-world examples to support the transition toward a biopsychosocial model of care. Hybrid delivery approaches and community engagement are essential to enhance reach, acceptability, and sustainability of interventions.

As populations age and healthcare demands grow, physiotherapists face increasing pressure to deliver effective, scalable care. This symposium brings together clinical and research experts from diverse economic contexts to demonstrate how PSE can be tailored to older adults’ beliefs, needs, and characteristics across cultures, settings, and health systems, using a range of delivery approaches.

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2. Oliveira D, Costa J, Marques M, Silva AG. Chronic musculoskeletal pain and its association with cognitive function and sarcopenia in older adults: Characterization and change over three months. Journal of Pain 2025, 29:105341.

3.  Heleno E, Andias R, Silva AG. What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise? Patient Educ Couns. 2021. 104(12):3072-3078.

4. Louw A, Puentedura E, Schmidt S, Zimney K. Therapeutic Neuroscience Education: Teaching People about Pain. A Guide for Clinicians (2nd Edition). Orthopedic Physical Therapy Products, 2018.

5. Louw A, Zimney K, Puentedura EJ, Diener I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. In Physiotherapy Theory and Practice 32(5):332–355.

6. Silva AG, Santos AJ, Andias R, Rocha NP. Effectiveness of digital pain management for older adults with musculoskeletal pain: systematic review with meta-analysis. Front Pain Res. 2025; 6:1657014.

7. Ahmad NA, Rauf MF, Zaid NN, Zainal A, Shahdan TS, Razak FH. Effectiveness of Instructional Strategies Designed for Older Adults in Learning Digital Technologies: A Systematic Literature Review.SN Comput Sci. 2022;3(2):130.

8. Heleno E, Andias R, Neto M, Silva AG. (2023). A Feasibility Study of Pain Neuroscience Education and Exercise for Community-Dwelling Older Adults with Chronic Pain. Journal of Geriatric Physical Therapy, 46(1), 26–35.

9. Louw A, Puentedura EJ, Reed J, Zimney K, Grimm D, Landers MR. A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clinical Rehabilitation 2019, 33(11) 1722–1731

10. Louw A, Zimney K, Reed J, Landers MR, Puentedura EJ. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series, Physiotherapy Theory and Practice, 2018, 35(6):543-553.