Thirty-nine patients with chronic low back pain and possible PTSD were randomized to receive pain neuroscience education (PNE; n=18) or traditional education (n=21), each followed by the same 10-station exercise circuit once weekly for 4 weeks. The primary outcome of interest was PTSD symptom severity (PCL-5); disability (RMDQ) and pain (NPRS) were co-primary in the analysis plan. Secondary outcomes included pain self-efficacy (PSEQ), pain attitudes (SOPA subscales), pain catastrophizing (PCS), pressure pain thresholds, exercise difficulty score, and 12-month low-back-pain–related healthcare utilization. Outcomes were assessed at baseline, 4 weeks (post-treatment), 8 weeks (follow-up), and healthcare utilization to 12 months. Overall, the results of the study revealed that, after adjusting for baseline catastrophizing, PNE produced greater improvements in PTSD symptoms, self-efficacy, and pain beliefs, higher low-back pressure pain thresholds, and higher exercise difficulty; more PNE patients met MCIDs for disability at 4 and 8 weeks. At 12 months, PNE patients had ~76% lower median LBP-related healthcare costs. In short, PNE—delivered by physical therapists alongside exercise—appears to shift threat-focused pain cognitions, improve PTSD symptoms and function short-term, and reduce downstream utilization.