Neuroscience Education and Spinal Manipulation on Health Locus of Control in Low Back Pain

The purpose of this study is to evaluate the effects of combining Pain Neuroscience Education (PNE) with spinal manipulation for individuals suffering from chronic low back pain. Participants will be randomly assigned to one of two groups: one group will receive the combined intervention (neuroscience education plus spinal manipulation), while the control group will receive spinal manipulation alone. The primary goal of the researchers is to investigate whether this combined approach can help patients change their health locus of control-shifting from an external belief (that their health depends on external factors or clinicians) to an internal belief (that they have control over their own recovery and pain management). The total study period will last 3 months, consisting of 4 weeks of intervention followed by an 8-week follow-up period to assess long-term changes in pain intensity, disability, and health beliefs.

Inclusion Criteria: * Both sexes. * Aged between 18 and 60 years. * Diagnosed with non-specific chronic low back pain (lasting 3 months or longer). * Functional disability score of 4 points or higher on the Roland-Morris Disability Questionnaire. * Has not received manual therapy for their condition within the previous 3 months. * Able to understand Portuguese well enough to complete the study questionnaires. Exclusion Criteria: * Pregnant women. * Main area of pain is not located in the lumbar spine. * Main pain is located in the leg. * Less than 6 months post-surgery in the lumbar spine, lower limbs, or abdominal region. * Has undergone any invasive procedure for pain relief within the last 3 months. * Scoliosis. * Rheumatological diseases. * Progressive neurological disease. * Disorders related to red flags, such as malignancy/cancer, acute trauma (e.g., car or motorcycle accidents), fractures, infection, or spinal cord/cauda equina compression. * Chronic low back pain persisting after previous spinal surgery.