Pain beliefs, treatment expectations, and treatment experiences in spinal pain – a scoping review of qualitative studies

To provide a comprehensive overview of qualitative studies on three key perspectives of patients with nonspecific back and neck pain – pain beliefs, treatment expectations, treatment experiences, and their interaction. Literature search was conducted in PubMed and CINAHL and included articles from inception to 1 October 2025. Two reviewers screened the records for eligibility in a two-step process. Data were charted and synthesized narratively. Twenty-four studies involving a total of 666 participants were included. Most patients held biomedical pain beliefs and sought a specific diagnosis for their condition. Such a diagnosis influenced treatment expectations, which were in turn linked to previous treatment experiences. A need for pain validation, often expected to be confirmed through diagnostic imaging, emerged as an overarching theme. This need can be addressed by the health professionals’ empathy and genuine interest in participatory engagement, their perceived competence, e.g. reflected by a thorough physical examination, and their guidance toward patient self-management considering individual barriers. Patients’ beliefs, expectations, and experiences were connected by an underlying need for validation of their pain experience. Incorporating empathetic, individually tailored pain validation, distinct from solicitousness and mere reassurance, into spinal management might improve treatment satisfaction and outcomes. What is this article about? This review reports on what people with nonspecific back or neck pain believe regarding their pain, what they expect from treatment, and how they have experienced past treatments. The review included 24 studies with a total of 666 participants. What were the results? Many patients believed that their pain had a physical (biomedical) cause, such as a problem with bones or muscles. Because of this, they often wanted a clear medical diagnosis. These beliefs, along with previous treatment experiences, shaped what they expected from treatment. A key theme was the desire for their pain to be taken seriously and validated, often through imaging like X-rays or magnetic resonance imaging (MRI). Patients felt taken seriously when health professionals showed empathy, listened attentively, conducted thorough physical examinations, and collaborated with them to develop personalized strategies for managing the pain themselves. What do these results mean? Patients’ beliefs, expectations, and experiences are closely linked to their need for validation of their pain. When health professionals respond to this need in an individual and empathetic way – not just by offering generic reassurance – it can improve how satisfied patients are with their care and possibly lead to better outcomes.