Study protocol for a randomized controlled trial of neuromuscular exercise and pain neuroscience education in patients with chronic pain after total knee arthroplasty

Abstract

Purpose: Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performance in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, we initiated the Neuromuscular Exercises and Pain Neuroscience Education for chronic Pain (the NEPNEP trial) with the purpose of investigating whether a 12-week neuromuscular exercise (NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone in a population of patients with chronic pain after primary TKA.