INTRODUCTION: Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). AIM: To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. METHODS: A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural education. Both interventions consisted of weekly individual face-to-face sessions for 8 weeks (a total of 8 sessions). The primary outcome was pain intensity. Secondary outcomes were disability, catastrophizing, fear-avoidance, sleep, endurance of back extensor muscles, and patient's perceived impression of change. RESULTS: Seventeen participants entered the PNE and graded exposure group and 20 the Pilates and postural education group. PNE and graded exposure were feasible to implement. Between-group comparisons suggest higher improvements in the PNE group for extensor muscle endurance (p < 0.001, eta2p = 0.29), pain catastrophizing (p < 0.001; eta2p = 0.56) and fear-avoidance related to physical activity (p < 0.001; eta2p = 0.48) and work (p < 0.001; eta2p = 0.47). In the PNE group, at least 13 (76.5%) participants reported being at least "moderately better" against 6 (30%) participants in the Pilates group. CONCLUSION: PNE and graded exposure can be successfully implemented in an occupational context and is potentially more beneficial than Pilates and postural education for extensor muscle endurance, catastrophizing, and fear avoidance and similarly as beneficial for pain intensity and disability. Further studies are needed to confirm these results.

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