Abstract
BackgroundCentral sensitisation, in addition to high levels of fear-avoidance and pain catastrophisation may exist in a subgroup of patients with shoulder pain. Pain neuroscience education (PNE) has been shown to positively influence sensitivity of the nervous system, as well as reduce fear and catastrophisation prior to lumbar and total knee surgery. To date, no study has examined the application of PNE prior to shoulder surgery.ObjectivesThis study examined the response to preoperative PNE in patients preparing for shoulder surgery.MethodAn exploratory pre–post case series was conducted. Twelve patients scheduled for surgery completed various pre-education measurements including shoulder pain, fear-avoidance, pain catastrophisation, beliefs and expectations regarding surgery, active shoulder flexion and pressure pain thresholds for the involved and uninvolved shoulder and the dominant-sided knee. Patients underwent a standard 30-min, one-on-one PNE session with a physiotherapist prior to surgery.ResultsFollowing education, all measures improved with some failing to reach significance: self-reported pain (p = 0.125), pain catastrophisation (p = 0.250) and pain pressure threshold of the uninvolved shoulder (p = 0.68) and knee (p = 0.097). Fear-avoidance (p = 0.013), active shoulder flexion (p = 0.013) and pain pressure threshold for the involved shoulder (p = 0.004) significantly improved.ConclusionA small patient group improved beyond minimal detectable change and/or minimal clinical important difference after education. No significant shifts of the preoperative beliefs occurred after education.Clinical implicationsPreoperative PNE may be beneficial to a subgroup of patients scheduled for shoulder surgery.
Highlights
It is well established that a patient’s beliefs and cognitions, especially regarding pain, influence his or her pain experience and outcome related to treatment (Kovacs et al 2011; Vlaeyen & Linton 2000)
This study examined the response to preoperative pain neuroscience education (PNE) in patients preparing for shoulder surgery
A small patient group improved beyond minimal detectable change and/or minimal clinical important difference after education
Summary
It is well established that a patient’s beliefs and cognitions, especially regarding pain, influence his or her pain experience and outcome related to treatment (Kovacs et al 2011; Vlaeyen & Linton 2000). High levels of fear-avoidance and pain catastrophisation in chronic low back pain have been shown to predict poorer outcomes (Fritz, George & Delitto 2001; Vlaeyen & Linton 2000). The efficacy of PNE for chronic musculoskeletal pain increases when used with other therapeutic treatments especially movement, that is, exercise (Louw et al 2016d; Wood & Hendrick 2019). Pain neuroscience education (PNE) has been shown to positively influence sensitivity of the nervous system, as well as reduce fear and catastrophisation prior to lumbar and total knee surgery. No study has examined the application of PNE prior to shoulder surgery
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