This systematic review and dose–response meta-analysis included 26 randomized controlled trials with a total of 1852 patients diagnosed with chronic spinal pain. The study investigated the effectiveness of pain neuroscience education (PNE) combined with exercise in reducing pain intensity and disability. Pooled outcomes of interest included pain intensity, disability, quality of life, pressure pain thresholds, and central sensitization inventory. The meta-analysis revealed that PNE added to exercise had a statistically significant impact on pain intensity and disability. A dose–response analysis indicated that 200 minutes of PNE was necessary to achieve a clinically meaningful improvement in pain, while 150 minutes was required for disability. These findings suggest that incorporating PNE into rehabilitation programs for chronic spinal pain can optimize patient outcomes, but the evidence remains of low certainty.