Chronic spinal pain (CSP) is an extremely disabling disorder, including non-traumatic chronic low back and neck pain, failed back surgery and chronic whiplash related disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements like muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms, i.e. hyperexcitability of the central nervous system and brain abnormalities play a role in CSP. Therefore, treatments for CSP should not only treat peripheral dysfunctions, but the brain as well. For this reason, a modern neuroscience approach, comprising of therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective paper explains why and how an approach to CSP like this can be applied in physical therapy practice.