Function-Oriented Rehabilitation in Chronic Spine and Neuropathic Pain: A Mechanism-Informed Review

Chronic spine-related and neuropathic pain are among the leading causes of long-term disability worldwide, posing a significant challenge for rehabilitation services. Contemporary pain science has demonstrated that persistent pain frequently involves central sensitization and behavioral mechanisms that cannot be adequately addressed through symptom-focused or purely structural approaches. Consequently, rehabilitation strategies must extend beyond pain reduction and prioritize functional recovery, participation, and quality of life. This narrative integrative review synthesizes international evidence on rehabilitation strategies for chronic spine-related and neuropathic pain, with an emphasis on function-oriented and mechanism-informed approaches. Key domains analyzed include pain neurobiology, exercise therapy, pain neuroscience education, psychologically informed rehabilitation, self-management strategies, and interdisciplinary care models. The findings highlight that meaningful functional improvement can occur even when pain persists, particularly when rehabilitation targets fear-avoidance behaviors, enhances self-efficacy, and promotes active patient engagement. Exercise therapy and interdisciplinary rehabilitation consistently demonstrate strong functional benefits, while pain education and behavioral integration act as critical facilitators of adherence and sustained activity. The dissociation between pain intensity and functional outcomes reinforces the need to redefine treatment success in terms of disability reduction and participation rather than analgesia alone. These findings are applicable across diverse healthcare systems and support the implementation of scalable, evidence-based rehabilitation strategies in different international contexts.