## 1 Introduction  
### Background  
In the last two decades, pain neuroscience education (PNE) has become an acknowledged intervention to reconceptualize patients' understanding of the biology of chronic musculoskeletal pain [1]. PNE describes a variety of interventions that have a common aim of educating chronic pain patients about the origins of pain, the biopsychosocial aspects of its etiology, and its underlying biological functions [1]. Although there is no gold standard postulated to define key educational contents and delivery formats of PNE interventions, they frequently comprise aspects of pain neurophysiology, including explanations of noicception and nociceptive pathways, neurons, synapses, action potential, spinal inhibition and facilitation, peripheral sensitization, central sensitization, and plasticity of the nervous system [2]. Communication of educational content is commonly characterized by a simplistic scientific language that is supported by the use of pictures, drawings, booklets, or metaphors [1; 3]. A well-known and recognized example of how to provide PNE content is the booklet \"Explain Pain\" written by [PERSON] and [PERSON] [4]. PNE is associated with positive effects on chronic musculoskeletal pain conditions [5; 6; 7] including chronic low back pain [8; 9; 10; 11; 12], fibromyalgia [13; 14], and chronic fatigue syndrome [13], as well as hip and knee osteoarthritis [15]. The most relevant treatment outcomes positively affected by PNE include pain perception [5; 6; 10; 14; 15], knowledge of pain biology [5], physical function [5; 7; 14], and disability [5; 6; 8; 10; 12; 13]. Moreover, PNE has been demonstrated to positively influence aspects of pain control including kinesophobia [16], pain catastrophizing [16], anxiety [14], and depression [14]. In this regard, an adjunct combination of PNE with other multimodal treatment approaches (i.e., exercise or manual therapy) has been shown to be the most promising [6; 9; 14; 17] and has previously been described as PNE+ [18]. Favored delivery formats of PNE should be conducted via oral treatment sessions integrating reinforcement elements [13], and a volume of four to eight sessions over a period of seven to twelve weeks is recommended [10]. In recent years, a variety of qualitative systematic reviews addressing the barriers and facilitators of pain management have been published. In particular, qualitative meta-aggregations of barriers to nurse-led pain management in cancer [19], critical care [20], and intensive care [21] have been conducted. The key findings of these reviews suggest that a lack of knowledge and skills (i.e., pain assessment skills) [19; 20; 21], the absence of standardized guidelines and protocols for pain evaluation [19; 20; 21], time restrictions and limited staff numbers [19; 20; 21], and the perception that nurses play a subordinate role in pain management [19] are major barriers to nurse-led pain management. On the other hand, the ongoing education of nurses (professional pain assessment and management training), effective collaboration between physicians and nurses, and patient pain score discussions during nurse-to-nurse handovers have been identified as facilitators of pain assessment and management in critical care [20]. However, these qualitative reviews provide information on aspects of pain assessment and management in patients with critical health conditions rather than information about broader aspects of barriers and facilitators of PNE in chronic musculoskeletal pain conditions. [PERSON] et al. [22] conducted a qualitative review that aimed to identify barriers and facilitators of a biopsychosocial approach in musculoskeletal pain practice by systematically reviewing primary qualitative studies addressing the perspectives of relevant healthcare professionals.