Original Research

Preoperative pain neuroscience education for shoulder surgery: A case series

Adriaan Louw, Debra Rico, Leigh Langerwerf, Nicholas Maiers, Ina Diener, Terry Cox
South African Journal of Physiotherapy | Vol 76, No 1 | a1417 | DOI: https://doi.org/10.4102/sajp.v76i1.1417 | © 2020 Adriaan Louw, Debra Rico, Leigh Langerwerf, Nicholas Maiers, Ina Diener, Terry Cox | This work is licensed under CC Attribution 4.0
Submitted: 14 January 2020 | Published: 11 August 2020

About the author(s)

Adriaan Louw, Evidence in Motion, San Antonio, United States of America
Debra Rico, Department of Physical Therapy, Rockhurst University, Kansas City, United States of America
Leigh Langerwerf, Butte Premier Physical Therapy, Chico, United States of America
Nicholas Maiers, Department of Physical Therapy, Des Moines University, Des Moines, United States of America, United States
Ina Diener, Department of Physiotherapy, Stellenbosch University, Cape Town, South Africa
Terry Cox, Department of Physical Therapy, Southwest Baptist University, Bolivar, United States of America

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Background: Central 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.

Objectives: This study examined the response to preoperative PNE in patients preparing for shoulder surgery.

Method: An 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.

Results: Following 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.

Conclusion: A 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 implications: Preoperative PNE may be beneficial to a subgroup of patients scheduled for shoulder surgery.


education; surgery; pain; neuroscience; shoulder


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