The effect of pain neuroscience education on chronic postsurgical pain after total knee arthroplasty: a randomized controlled trial
DOI:
https://doi.org/10.2340/17453674.2024.41346Keywords:
Arthroplasty, Chronic pain, Knee, Osteoarthrosis, Pain Neuroscience Education, RCTAbstract
Background and purpose: Chronic postsurgical pain after total knee arthroplasty (TKA) is frequent and may be reduced by pain neuroscience education (PNE), teaching people about pain from a neurobiological perspective. This study investigated primarily the effectiveness of 2 individual sessions of PNE versus usual care on pain levels 3 months postoperatively in patients undergoing TKA. Secondary outcomes were physical functioning, stiffness, health-related quality of life, pain catastrophizing, attention to pain, and levels of anxiety and depression.
Methods: A prospective single-center, parallel-group randomized controlled trial was undertaken including patients aged 18 years or older scheduled for primary TKA. 68 patients were randomly assigned to PNE or usual care. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score 3 months postoperatively. Outcomes were measured preoperatively, at 2 weeks (acute phase), and at 3 and 12 months postoperatively.
Results: We found no statistically significant difference (0.4 points; 95% confidence interval [CI] –1.7 to 2.4) in WOMAC pain scores 3 months after TKA between the PNE and control group. We found a statistically significant difference between the 2 groups for attention to pain at 3 months in favor of PNE (P = 0.02).
Conclusion: This RCT showed that PNE was not superior to usual care in terms of reducing pain at 3 months after TKA. Attention to pain, as a secondary outcome, was significantly lower in the PNE group compared with usual care. Other secondary outcome measures showed no significant differences.
Downloads
References
Carr A J, Robertsson O, Graves S, Price A J, Arden N K, Judge A, et al. Knee replacement. Lancet 2012; 379 (9823): 1331-40. doi: 10.1016/S0140-6736(11)60752-6.
Beswick A D, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012; 2 (1): e000435,2011-000435. Print 2012. doi: 10.1136/bmjopen-2011-000435.
Petersen K K, Simonsen O, Laursen M B, Nielsen T A, Rasmussen S, Arendt-Nielsen L. Chronic postoperative pain after primary and revision total knee arthroplasty. Clin J Pain 2015; 31 (1): 1-6. doi: 10.1097/AJP.0000000000000146.
Moseley G L, Butler D S. Fifteen years of explaining pain: the past, present, and future. J Pain 2015; 16 (9): 807-13. doi: 10.1016/j.jpain.2015.05.005.
Van der Gucht E, Dams L, Haenen V, Godderis L, Morlion B, Bernar K, et al. Effectiveness of perioperative pain science education on pain, psychological factors and physical functioning: a systematic review. Clin Rehabil 2021; 35 (10): 1364-82. doi: 10.1177/02692155211006865.
Lepri B, Romani D, Storari L, Barbari V. Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: a systematic review. Int J Environ Res Public Health 2023; 20 (5): 4098. doi: 10.3390/ijerph20054098.
Watson J A, Ryan C G, Cooper L, Ellington D, Whittle R, Lavender M, et al. Pain neuroscience education for adults with chronic musculoskeletal pain: a mixed-methods systematic review and meta-analysis. J Pain 2019; 20 (10): 1140.e1,1140.e22. doi: 10.1016/j.jpain.2019.02.011.
Bülow K, Lindberg K, Vaegter H B, Juhl C B. Effectiveness of pain neurophysiology education on musculoskeletal pain: a systematic review and meta-analysis. Pain Med 2021; 22 (4): 891-904. doi: 10.1093/pm/pnaa484.
Lluch E, Duenas L, Falla D, Baert I, Meeus M, Sanchez-Frutos J, et al. Preoperative pain neuroscience education combined with knee joint mobilization for knee osteoarthritis. Clin J Pain 2018; 34 (1): 44-52. doi: 10.1097/AJP.0000000000000511.
Louw A, Puentedura E J, Reed J, Zimney K, Grimm D, Landers M R. A controlled clinical trial of preoperative pain neuroscience education for patients about to undergo total knee arthroplasty. Clin Rehabil 2019; 33 (11): 1722-31. doi: 10.1177/0269215519857782.
Louw A, Zimney K, Reed J, Landers M, Puentedura E J. Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: a case series. Physiother Theory Pract 2019; 35 (6): 543-53. doi: 10.1080/09593985.2018.1455120.
Wu C W, Morrell M R, Heinze E, Concoff A L, Wollaston S J, Arnold E L, et al. Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores. Semin Arthritis Rheum 2005; 35: 197-201. doi: 10.1016/j.semarthrit.2005.06.002.
Kellgren J H, Lawrence J S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (4): 494-502. doi: 10.1136/ard.16.4.494.
Bellamy N, Buchanan W W, Goldsmith C H, Campbell J, Stitt L W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheum 1988; 15 (12): 1833-40.
Devji T, Guyatt G H, Lytvyn L, Brignardello-Petersen R, Foroutan F, Sadeghirad B, et al. Application of minimal important difference in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations. BMJ Open 2017;7:e015587. doi:10.1136/bmjopen-2016-015587.
Van Damme S, Crombez G, Vlaeyen J, Goubet L, Van den Broeck A, Van Houdenhove B. De pain catastrophizing scale: Psychometrische karakteristieken en normering. Gedragstherapie 2000; 33 (3): 209-20.
McCracken L M. “Attention” to pain in persons with chronic pain: a behavioral approach. Behav Ther 1997; 28 (2): 271-84. doi: 10.1016/S0005-7894(97)80047-0.
Zigmond A S, Snaith R P. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (6): 361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
Vander Zee K I, Sanderman R, Heyink J W, de Haes H. Psychometric qualities of the RAND 36-item health survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996; 3 (2): 104. doi: 10.1207/s15327558ijbm0302_2.
Siddall B, Ram A, Jones M D, Booth J, Perriman D, Summers S J. Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis. Pain 2022; 163 (1): e20-30. doi: 10.1097/j.pain.0000000000002308.
Lewis G, Rice D, McNair P, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2015; 114 (4): 551-61. doi: 10.1093/bja/aeu441.
Burns L C, Ritvo S E, Ferguson M K, Clarke H, Seltzer Z, Katz J. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. J Pain Res 2015; 8: 21-32. doi: 10.2147/JPR.S64730.
Sobol–Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: a systematic review and meta–analysis. Eur J Pain 2016; 20 (10): 1573-86. doi: 10.1002/ejp.886
Birch S, Stilling M, Mechlenburg I, Hansen T B. No effect of cognitive behavioral patient education for patients with pain catastrophizing before total knee arthroplasty: a randomized controlled trial. Acta Orthop 2020; 91(1): 98–103. doi: 10.1080/17453674.2019.1694312
Nijs J, Roussel N, Van Wilgen C P, Köke A, Smeets R. Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther 2013; 18 (2): 96-102. doi: 10.1016/j.math.2012.11.001.
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Dominique C Baas, Johanna C van Aalderen-Wichers, Tjeerd H van der Goot, Ronald J Verhagen
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.