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Article

Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes

by
Andreu Sastre-Munar
1,*,
Antonia Pades-Jiménez
1 and
Natalia Romero-Franco
1,2
1
Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
2
Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma de Mallorca, Spain
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(17), 9701; https://doi.org/10.3390/app15179701
Submission received: 30 July 2025 / Revised: 30 August 2025 / Accepted: 1 September 2025 / Published: 3 September 2025
(This article belongs to the Special Issue Advances in Sports Science and Biomechanics)
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Abstract

In sport, pain is often normalized, leading athletes to train or compete despite discomfort. This can shape their response to pain, with catastrophizing potentially triggering fear of movement, avoidance behaviors, and increased pain. While previous research has examined the relationship between pain and catastrophizing in individuals with chronic pain, few studies have explored these effects in the sports population. This study investigated the effects of a pain neuroscience educational program on catastrophizing and injury rates in youth female and male athletes. This parallel randomized trial included an intervention group (IG) and a control group (CG), both undergoing a 12-week program on healthy habits in sport. The IG received additional pain neuroscience information. Catastrophizing levels were collected before and after using the Pain Catastrophizing Scale. Injury rates were registered during the study. The results revealed a decrease in catastrophizing levels in the IG compared to baseline (p = 0.028, d = 0.32, 95%CI [0.03, 0.61]). In the IG, only males showed improvements (p = 0.041, d = 0.47, 95%CI [0.08, 0.86]). Injury rates were similar between groups (CG = 26.2%, IG = 27.8%; p > 0.05). Pain education may reduce catastrophizing in youth athletes, particularly males, although effects may vary by sex and context.

1. Introduction

Catastrophizing involves a negative and exaggerated interpretation of pain, which can have adverse effects on the experience of pain and athlete performance [1]. In the realm of sports, maintaining a pessimistic outlook during the injury recovery process has been linked to delayed return to play and decreased physical functioning of athletes [2]. The Fear-Avoidance in athletes [3] provides a valuable framework for understanding this outcome in athletes, suggesting that those who catastrophize about pain may develop fear of movement, engage in avoidance behaviors, and subsequently experience more disability and even prolonged recovery [3,4]. Studies showed that youth athletes who sustained an anterior cruciate ligament (ACL) reinjury report higher levels of fear compared to those with a prior ACL injury but lower fear levels. Moreover, youth athletes with an ACL injury fail to regain their pre-injury performance level four years after the injury [5]. t should be noted that catastrophizing is not only relevant following injury but may also affect healthy youth athletes. Anticipatory thoughts and negative pain expectations can contribute to altered pain processing and may promote central sensitization, a condition in which the nervous system becomes hypersensitive, resulting in heightened pain responses even to normally non-painful stimuli [6]. High levels of catastrophizing could hinder the effectiveness of rehabilitation approaches for injuries and impact the sports performance of athletes [7].
Moreover, catastrophizing serves as a predictor of adverse pain-related outcomes, encompassing pain severity, pain behaviors, and disability [2]. Pain is defined by the International Association for the Study of Pain as a subjective sensory and emotional experience often caused by actual or potential tissue injury. Influenced by biological, psychological, and social factors [8]. Within the sports context, pain is normalized, and athletes often train and compete while experiencing pain to pursue their goals [9,10,11]. This practice significantly impacts the prevalence of pain in athletes, with reported rates ranging from 20% to 82.9% in studies including heterogeneous age groups, with mean participant ages of 13.7, 16.9, and 20.1 years [12,13,14,15].
In the literature, various interventions have been proposed to manage the pain in elite athletes. Two key conceptual foundations that guide these approaches are the biopsychosocial model and psychological frameworks [16,17]. Psychological therapies theoretically target central mechanisms involved in pain modulation, such as catastrophic interpretations. These therapies also consider cognitive and behavioral factors that may hinder effective engagement in pain management and rehabilitation, such as performance concerns [16]. Among these, cognitive behavioral therapy is the most extensively studied approach, aiming to change maladaptive thoughts and behaviors to reduce psychological distress and improve pain management [16,17,18]. Besides, the biopsychosocial model has a contemporary understanding of pain, including the interaction of biological, psychological, and social factors. Pain neuroscience education (PNE) explain the neurophysiology of pain and the role of cognitive factors in pain perception. Evidence supports PNE to reduce pain and fear-avoidance behaviors [16,17,19].
Within the biopsychosocial model and psychological frameworks, catastrophizing is recognized as a key target for intervention due to its role in amplifying pain experience. Current research suggests that managing pain in athletes is most effective when using a biopsychosocial approach [16].
Given the central role of catastrophizing in amplifying pain, and its recognition as a key target within the biopsychosocial model, PNE has shown to reduce catastrophizing in population with chronic pain or conditions, such as individuals with fibromyalgia [20,21,22]. Although its application in athletic populations remains limited, the high incidence of injury and social pressure in elite sport suggests interventions targeting maladaptive pain beliefs as an appropriate approach [19]. Catastrophizing has been linked, not only to increased pain perception, but also to fear-avoidance behaviors, altered motor control, and reduced confidence in movement [3,4]. These conditions may contribute to injury risk or prolonged recovery [3]. Given the established link between pain and catastrophizing, and the proven benefits of PNE in reducing such cognitive distortions [23,24,25,26,27], implementing PNE in athletes could reduce catastrophic thoughts in athletes and the risk of injury by improving body awareness.
On the other hand, few studies have assessed sex-differences when exploring catastrophizing in sports population. Some previous studies have shown that female athletes have often higher catastrophizing values than male athletes [2,28]. Prior researchers suggest that sex differences in catastrophizing start at a young age. It has been theorized that societal influences could contribute to this phenomenon. As an example, young females are frequently socialized to openly express pain and receive more caregiver comfort when displaying heightened distress [28,29]. However, to the authors knowledge, no study has systematically examined sex differences in catastrophizing among youth athletes. A brief search of the main scientific database using the terms “catastrophizing”, “youth athletes”, and “sex differences” did not identify any relevant studies. Examining potential sex differences is crucial to understand how educational interventions might specifically affect male and female athletes and thus, develop tailored approaches effective for both. Additionally, studying a youth athlete population is essential to prevent chronic pain and maladaptive coping strategies later in life [30].
Based on the arguments and due to frequent and normalized nature of pain in sports contexts, this study aimed to evaluate the effects of a PNE program on the level of catastrophizing and incidence of injuries in youth athletes. We also explored the sex-based differences. We hypothesize that those athletes who received the PNE program will reduce the catastrophizing levels and thus, the number of injuries will decrease. Additionally, female athletes will demonstrate higher levels of catastrophizing than males throughout all phases of the study.

2. Materials and Methods

2.1. Design

A parallel randomized trial was designed, with two groups: intervention group (IG) and control group (CG). For 12 weeks, all participants received an educational program focused on healthy sports training routines (such as rest, nutrition, body care, and recovery). The participants from IG received additional information related to pain neuroscience (encompassing the biological, psychological, and perceptual aspects of pain in a sports context). This research was conducted at the High-Performance Sport Center of Balearic Islands during the 2022–2023 season, spanning from February to May. The trial was previously registered on ClinicalTrials.gov (ID: NCT05645562) and approved by the Ethical Committee of the University of Balearic Islands (reference: 280CER22). This study was developed according to the CONSORT guidelines.

2.2. Participants

The sample size was determined by using the GRANMO application, version 7.12 (Institut Municipal d’Investigació Mèdica, Barcelona, Spain). The calculation was based on the formula for comparing two independent means [31]:
n = 2 × (Zα/2 + Zβ)2 × σ2 ÷ Δ2
where Zα/2 = 1.96 (for a 5% significance level), Zβ = 0.84 (for 80% power), σ = 4.8 (standard deviation), and Δ = 3.5 (minimum detectable difference in the Pain Catastrophizing Scale, as main variable), like previous studies [32]. This resulted in a required sample of 33 athletes per group (IG and CG). A dropout rate of 20% was anticipated. The 3.5-point difference was selected based on its clinical relevance and alignment with previously reported minimal clinically important difference (MCID) values for the PCS, which range from 1.9 to 13.6 points depending on the population and method used [33].
As eligibility criteria, participants should be at least 14 years old and have a minimum of 2 years of sports experience. They should not have experienced any injuries within the last 6 months or undergone any surgeries during the previous 12 months to the study beginning. The injury was defined as “tissue damage or other derangement of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy” [34]. All athletes who trained in the sports center were invited to participate in the study through email from their regional sports federation. Prior to the start of the study, all participants provided their informed consent or their legal guardians or parents in case of minors. Additionally, athletes were randomly divided to the IG and CG using OxMaR software (version 2014, United Kingdom), which generated a computer-based random sequence. Allocation was performed by a third person who was not involved in participant recruitment, assessment, or intervention delivery, ensuring allocation concealment. No stratification by sex or sport type was performed. The athletes did not know about the existence of two groups and were not informed of the specific aims of the intervention to minimize expectation bias. The person who taught the information about healthy sports training routines also was blinded about the athletes’ group and the specific aims of the study, but the professional who conducted the information about pain neuroscience did not. The outcome assessors were blinded to avoid recognizing the group and assessment timing (pre- or post-intervention) to prevent measurement bias.

2.3. Procedures

One week prior to the 12-week educational program, body mass and height of all athletes were evaluated by using a digital weight scale with a precision of ±100 g (Tefal®, Rumilly, France) and an adult height scale (model t201-t4, Asimed®, Linkenheim-Hochstetten, Spain), respectively. During this session, athletes also fulfilled an online questionnaire (Jotform®, San Francisco, CA, USA) with the following sections: (i) a section to inform about age, sex, sports experience (years), and history of previous injuries; (ii) a section about pain catastrophism through the Pain Catastrophizing Scale (PCS); (iii) a section on the history of injuries. The PCS was also fulfilled after the 12-week period of intervention.

2.3.1. Pain Catastrophism Scale (PCS)

All athletes informed about their level of pain catastrophizing through PCS. This scale is compounded by thirteen 4-point Likert items, ranging from 0 (not at all) to 4 (all the time) to evaluate general catastrophizing (from 0 = minimal catastrophizing; to 52 = maximal catastrophizing). This tool also allows to explore three sub-scales: rumination (from 0 = minimal; to 16 = maximal), helplessness (from 0 = minimal; to 12 = maximal), and magnification (from 0 = minimal; to 24 = maximal). The PCS demonstrated a reliability score with a Cronbach’s alpha of 0.818 in the Spanish sports population [35].

2.3.2. Injury Registration

During the time of the intervention, all athletes were asked to weekly fulfill an online questionnaire to monitor new injuries. To collect this information, the Oslo Sports Trauma Research Center questionnaire on health problems proposed was used. This questionnaire captured any type of health problem (acute injury, overuse injury, or illness) regardless of whether it resulted in time loss. If athletes reported anything other than full participation without problems, the questionnaire asked them to specify whether the problem was an illness or an injury. For injuries, athletes reported the body area affected. In addition, the number of days of complete time loss (defined as the total inability to train or compete) was recorded [36].

2.3.3. Educational Program

It was reviewed for content validity by experts in sports medicine and pedagogy prior to delivery. The educational program was run by health professionals with 7 years of experience in sport. The 12-week program was compounded by four 30 to 40-min workshops, with three weeks apart, and conducted in groups of 10 to 15 athletes. The four workshops were organized as follows: 1st workshop, with theoretical content about the importance of the rest; 2nd workshop, with theoretical content about dietary habits; 3rd workshop, with theorical content about recovery techniques; 4th workshop, with theorical content about the principles of the training. Only athletes from IG received additional information related to pain biology (1st workshop); differentiation between benign and harmful pain (2nd workshop); understanding of the multifaceted nature of pain in the context of sports (3rd and 4th workshop) (Supplementary Table S1). The contents of each workshop were taught through metaphors, drawings and diagrams made by the researcher with visual support (Microsoft PowerPoint version 2312, USA), and were based on previous scientific literature [16,20,37,38,39,40,41,42,43].

2.4. Statistical Analysis

Descriptive statistics for numerical variables are presented as mean and SD, while categorical variables are shown as percentages. To assess the normality of the data, the Kolmogorov–Smirnov test was employed. The baseline characteristics of athletes were compared by using independent sample Student t-test. To identify within-group differences in catastrophizing values (general and subscales), paired-sample t-tests were utilized. To detect between-group differences, an independent sample t-test was applied. Since there were no between-group differences at baseline, we employed a two-way repeated-measures analysis of variance (ANOVA) with the Bonferroni post hoc test. This approach was utilized to assess interactions between groups and time, as well as to explore effects within and between groups. A 95% confidence interval (CI95%) was calculated for all differences, and effect sizes (ES) were determined and interpreted by using Cohen’s procedures, categorized as small (d ≤ 0.2), moderate (0.2 > d ≤ 0.8), or large (d > 0.8) [44]. Chi-Square was used to obtain differences in the percentage of athletes injured during the intervention among groups. All analyses were performed according to the intention-to-treat (ITT) principle, with all participants included in the groups to which they were initially assigned, regardless of adherence or dropout. IBM SPSS Statistics, version 21.0 (Chicago, IL, USA), was used for data analysis, and statistical significance was defined at p < 0.05.

3. Results

A total of 78 athletes (15.65 ± 1.02 years old, 50% females, 1.74 ± 0.09 m, 67.42 ± 16.44 kg) completed the study (Figure 1).
Socio-demographic, anthropometric, sport experience and number of injuries and pain data are shown in Table 1. There were no between-group differences at baseline in any variable (p > 0.05).
Regarding between-group comparisons and their interactions over time, they showed no differences in catastrophizing level and its subscales (p > 0.05). Nevertheless, intragroup analysis showed that the IG significantly decreased the total catastrophizing level compared to baseline (p = 0.028, d = 0.32, 95% IC = 0.23; 3.76). In terms of the catastrophizing subscales, no differences were found in rumination, magnification, and helplessness compared to baseline in any group (p > 0.05) (Table 2).
When exploring results of catastrophizing levels according to sex, only IG male athletes experienced a statistically significant reduction in catastrophizing level compared to baseline (p = 0.041, d = 0.47, 95% CI = 0.11; 5.11). No other within- and between-group differences were observed for catastrophizing and subscales in male and female athletes (p > 0.05) (Table 2).
During the educational program, a total of 21 athletes had an injury (CG = 26.2%; IG = 27.8%). The number of injuries did not show differences between groups and sex (p > 0.05).
Regarding pain catastrophizing levels at baseline, we found that female athletes (N = 38: 5.23 ± 2.97) had higher levels of helplessness than male athletes (N = 39: 3.53 ± 2.90) (p = 0.013, d = 0.58, 95% IC = −3.03; −0.36). No differences were found between sex at baseline values in catastrophizing, rumination and magnification (p > 0.05).

4. Discussion

The main findings of this study were that a 12-week educational program with pain neuroscience contents helped to improve the catastrophizing levels of youth athletes, particularly in males. Although no significant differences were found between IG and CG, the IG showed a reduction in catastrophic thoughts following the PNE program. Specifically, male athletes in the IG improved their catastrophizing levels compared to baseline, with a mean reduction of 2.0 points on the PCS. It is important to highlight that, at the start of the study, female athletes showed higher values of helplessness than male athletes. Regarding injuries, the PNE program did not lead to a significant difference in injury rates between the intervention and control groups.
Although the intra-group analysis showed that the PNE program reduced catastrophizing levels in athletes, this effect was not observed in the between-group comparison. In contrast, previous literature has reported that PNE reduces catastrophizing in individuals with chronic pain [17,45]. A key distinction in our study lies in the participant profile: the intervention targeted healthy youth athletes, a population often exposed to socio-cultural pressures due to the constant demands of performance training. Although a previous study [17] reported positive effects of PNE on sport injuries, the studies cited to support this claim do not involve athletic populations, limiting the direct applicability of these findings to athletes [46,47]. Additionally, a case study [48] involving a weightlifter demonstrated reductions in kinesiophobia following PNE, but as a single-case report and knowing the link between catastrophizing and kinesiophobia, its findings cannot be broadly applied. These inconsistencies highlight the need for further research targeting athlete populations to better understand the effectiveness of PNE in this context.
The lack of between-group differences observed in this study may be attributed to the inclusion criteria, which required participants to have no injuries in the past six months and no surgeries in the past 12 months. These criteria may have contributed to low baseline catastrophizing scores (CG = 11.95 ± 8.23; IG = 11.58 ± 5.97). This is consistent with a previous study that observed that both currently injured and recently injured athletes had higher levels of catastrophizing than those without any injury [49]. This suggests that our study may have had a limited margin for improvement.
In the IG, athletes demonstrated a significant reduction in their total pain catastrophizing levels after the PNE program. It is important to highlight that, when analyzed by sex, this reduction was observed only in male athletes. For female athletes, the PNE program did not result in a significant effect. To the best of our knowledge, there are no studies to date exploring sex differences in the effects of pain education programs on pain catastrophizing levels. The absence of effects on pain catastrophizing levels among female athletes may be explained by higher pain perception compared to males and by specific socio-cultural demands for females in the context of sport. Studies reported that socialization processes shape pain expression, with men typically encouraged to suppress pain while women are more permitted to acknowledge it. Although not directly assessed in this study, such cultural stereotypes may contribute to the observed sex differences [28,29]. Existing literature suggests that females may be more susceptible to the impact of pain due to societal factors, such as a youth culture that discourages the expression of emotions and caregiving [28,29]. Consequently, the educational program may not have been as effective among female athletes, possibly due to deeply ingrained cultural influences that a three-month educational program may not sufficiently address. Our results suggest the necessity of tailoring educational approaches specifically designed for females, by considering differences in pain interpretation and catastrophism. Further research is needed to understand the sex-specific responses observed.
Regarding the lack of differences observed in terms of injuries, we should highlight the multifactorial nature of injuries. Some aspects such as athlete performance weakness, heightened fatigue levels, or an extensive training volume are recognized as potential risk factors [50]. However, our study focused the educational program in health habits in sport and pain neuroscience without addressing these performance-related factors associated with injury risk. Future study designs could therefore benefit from incorporating systematic monitoring of training load and fatigue to better capture their interaction with injury risk.
Previous studies have consistently reported higher overall levels of pain catastrophizing in females, particularly in the domains of rumination and helplessness [2,51,52]. Our study is in line with literature, indicating that female athletes exhibited elevated levels of helplessness compared to male athletes, potentially influenced by societal expectations associated with gender roles in pain perception. Helplessness, characterized by a belief that nothing can alleviate the pain experience, has been shown in prior research to be less prevalent in males, who often employ behavioral distraction and problem focused coping mechanisms. In contrast, females tend to adopt a diverse range of coping strategies, including seeking social support, positive self-affirmations, emotion-focused techniques, and cognitive reinterpretation [53,54].
Conversely, our study did not find sex-based differences in rumination levels, a result at odds with existing literature. These disparities may be attributed to variations in sample composition across different studies [2,51,52]. Prior investigations into sex differences in catastrophizing levels and subscales have predominantly focused on collegiate students [47,48]. Although Sullivan et al. explored athletes in their study, sedentary participants were also recruited [2].
Additionally, some previous studies used different questionnaires to assess levels of catastrophizing such as the Coping Strategies Questionnaire [52], which could contribute to divergent results. To enhance comparability between studies, future research should aim for homogeneity in athlete samples and standardized questionnaire usage.

Limitations and Future Research Directions

We acknowledge several limitations of this study. Firstly, the inclusion of athletes from diverse sports disciplines may have influenced the results. However, we attempted to reduce variability by selecting participants with similar ages and performance levels. Additionally, the specific sample composition (young athletes from a high-performance center) may limit result generalizability to other athlete populations. Secondly, logistical constraints led to group sessions (10–15 athletes) instead of face-to-face interactions advocated in literature [48,55]. This approach maintained study feasibility. Thirdly, our study did not consider psychological variables like anxiety or depression. Despite enrolling athletes without pre-existing injuries, future studies should explore these variables for a more comprehensive understanding the impact of a PNE program. Moreover, the absence of a follow-up period limited our ability to evaluate the sustainability of the observed effects. Finally, repeated questionnaire contact might have introduced a Hawthorne effect, whereby athlete responses were influenced by their awareness of being monitored [56].
For practical implications, it is advisable for health and sports professionals to provide information concerning pain neuroscience because it can help youth athletes to reduce catastrophizing levels. These advancements may contribute to mitigating the negative impact of catastrophizing on athletes.
For future studies, we recommend incorporating an analysis of sex differences to gain deeper insights into the distinctions between sexes in the context of catastrophizing and sports. Additionally, when devising educational programs, future studies should account for the diversity within sport and gender populations to assess the applicability and effectiveness across varied contexts.

5. Conclusions

The 12-week PNE program reduced catastrophizing levels in youth athletes, particularly among males. Although female athletes initially exhibited higher levels of helplessness than males, they did not experience significant reductions in catastrophizing. These findings underscore the importance of designing future PNE programs that address sex-specific differences to enhance their effectiveness in sports settings.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app15179701/s1, Table S1: Pain Neuroscience Educational program.

Author Contributions

Conceptualization, A.S.-M. and A.P.-J.; methodology, A.S.-M. and N.R.-F.; validation, N.R.-F.; formal analysis, A.S.-M. and N.R.-F.; investigation, A.S.-M. and A.P.-J.; resources, A.S.-M. and A.P.-J.; data curation, A.S.-M. and N.R.-F.; writing—original draft preparation, A.S.-M.; writing—review and editing, N.R.-F.; visualization, A.S.-M. and A.P.-J.; supervision, N.R.-F.; project administration, A.S.-M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. Although the High-Performance Sport Center provided access to training facilities as part of its regular operations, no in-kind support (e.g., staff involvement, financial contribution, or influence on study design or conduct) was received.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and was previously registered on ClinicalTrials.gov (ID: NCT05645562) and approved by the Ethical Committee of Balearic Islands University (reference: 280CER22).

Informed Consent Statement

Written informed consent has been obtained from the participants to publish this paper.

Data Availability Statement

The data are not publicly available due to participant confidentiality but may be obtained from the corresponding author upon reasonable request and with a confidentiality agreement.

Acknowledgments

This research was supported by Balearic High Performance Sport Center.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
ACLAnterior Cruciate Ligament
CGControl Group
CIConfidence Interval
ESEffect Size
IGIntervention Group
PCSPain Catastrophizing Scale
PNEPain Neuroscience Education
SDStandard Deviation

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Applsci 15 09701 g001
Figure 1. Flow diagram.
Figure 1. Flow diagram.
Applsci 15 09701 g001
Table 1. Sociodemographic, anthropometric and percentage of athletes injured.
Table 1. Sociodemographic, anthropometric and percentage of athletes injured.
CG,
All Athletes
(n = 42)		GC, Male Athletes
(n = 21)		CG, Female Athletes
(n = 21)		IG,
All Athletes (n = 36)		IG, Male Athletes
(n = 18)		IG Female Athletes
(n = 18)
Age (years) ¥15.28 (0.97)15.47 (1.03)15.09 (0.89)16.08 (0.91)16.00 (0.90)16.16 (0.92)
Weight (kg) ¥67.12 (20.83)69.07 (13.14)65.17 (26.62)67.76 (9.30)72.25 (9.79)63.27 (6.30)
Height (m) ¥1.73 (0.09)1.78 (0.10)1.69 (0.07)1.76 (0.08)1.80 (0.08)1.72 (0.08)
Sport Experience (yrs) ¥8.09 (3.37)8.85 (3.07)7.33 (3.55)9.58 (3.73)9.55 (4.43)9.61 (2.99)
Injury during season (%)Yes (26.2%)Yes (38.1%)Yes (14.3%)Yes (28.6%)Yes (27.8%)Yes (29.4%)
CG, control group; IG, intervention group; SD, standard deviation; ¥, values given as mean (SD).
Table 2. Catastrophism levels of all athletes.
Table 2. Catastrophism levels of all athletes.
Control GroupIntervention GroupBetween-Group Differences
All
Athletes		PRE
Mean (SD)		POST
Mean (SD)		Intra-Group
Differences		PRE
Mean (SD)		POST
Mean (SD)		Intra-Group
Differences
Mean (95%CI)ES d (95%CI)Mean (95%CI)ES d (95%CI)Mean (95%CI)ES d (95%CI)
Catastrophism11.95 (8.23)11.55 (8.28)0.40 (−2.06; 2.81)0.0511.58 (5.97)9.58 (6.38)2.00 (0.23; 3.07) *0.321.96 (−1.37; 5.30)0.26
Rumination4.80 (3.69)4.17 (3.66)0.62 (−0.52; 1.78)0.174.06 (3.17)3.19 (2.47)0.86 (−0.14; 1.86)0.270.98 (−0.42; 2.38)0.26
Magnification2.82 (2.16)2.92 (2.08)−0.10 (−0.71; 0.51)0.053.06 (1.97)2.58 (1.99)0.47 (−0.25; 1.19)0.240.34 (−0.56; 1.25)0.16
Helplessness4.32 (3.43)4.45 (3.41)−0.12 (−1.18; 0.93)0.044.47 (2.58)3.80 (2.72)0.66 (−0.23; 1.56)0.250.64 (−0.78; 2.07)0.04
Males
Catastrophism9.95 (8.17)9.80 (7.63)0.14 (−2.98; 3.27)0.0210.72 (6.20)8.11 (4.85)2.61 (0.11; 5.10) *0.471.70 (−2.53; 5.93)0.26
Rumination4.00 (3.82)3.81 (3.80)0.19 (−1.27; 1.65)0.054.39 (3.58)3.00 (2.40)1.39 (−0.36; 3.13)0.380.81 (−1.29; 2.91)0.25
Magnification2.52 (2.20)2.62 (1.96)−0.09 (−0.89; 0.70)0.052.66 (2.00)2.17 (1.65)0.50 (−0.54; 1.54)0.260.45 (−0.73; 1.64)0.24
Helplessness3.43 (3.28)3.38 (2.71)0.47 (−1.23; 1.33)0.023.66 (2.49)2.94 (1.86)0.72 (−0.39; 1.84)0.280.57 (−1.10; 1.7)0.19
Females
Catastrophism13.80 (8.01)14.15 (8.52)−0.35 (−4.86; 4.16)0.0412.44 (5.77)11.05 (7.46)1.39 (1.34; 4.11)0.213.09 (−2.20; 8.39)0.38
Rumination5.50 (3.48)4.95 (3.51)0.55 (−1.59; 2.69)0.163.72 (2.76)3.39 (2.59)0.33 (−0.79; 1.46)0.121.56 (−0.49; 3.61)0.44
Magnification3.10 (2.12)3.50 (2.16)−0.40 (−1.55; 0.75)0.193.44 (1.91)3.00 (2.24)0.44 (−0.67; 1.56)0.210.50 (−0.95; 1.95)0.22
Helplessness5.20 (3.42)5.70 (3.71)−0.50 (−2.28; 1.28)0.145.28 (2.47)4.67 (3.19)0.61 (−0.91; 1.13)0.211.03 (−1.26; 3.33)0.29
CI, confidence interval; ES, effect size; NS, non-significant; SD, standard deviation; * p < 0.05; Catastrophism (0–52 score); Rumination (0–16 score); Magnification (0–12 score); Helplessness (0–24 score). The bold font in the table was used to visually distinguish the three sections, all participants, males, and females, for easier readability.
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Sastre-Munar, A.; Pades-Jiménez, A.; Romero-Franco, N. Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes. Appl. Sci. 2025, 15, 9701. https://doi.org/10.3390/app15179701

AMA Style

Sastre-Munar A, Pades-Jiménez A, Romero-Franco N. Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes. Applied Sciences. 2025; 15(17):9701. https://doi.org/10.3390/app15179701

Chicago/Turabian Style

Sastre-Munar, Andreu, Antonia Pades-Jiménez, and Natalia Romero-Franco. 2025. "Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes" Applied Sciences 15, no. 17: 9701. https://doi.org/10.3390/app15179701

APA Style

Sastre-Munar, A., Pades-Jiménez, A., & Romero-Franco, N. (2025). Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes. Applied Sciences, 15(17), 9701. https://doi.org/10.3390/app15179701

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