Effect of preoperative pain neuroscience education on pain catastrophizing and early recovery following upper extremity orthopaedic surgery: a randomized controlled trial.

BACKGROUND

Pain Neuroscience Education (PNE) aims to reconceptualize pain by addressing its neurophysiological and biopsychosocial dimensions to improve perioperative outcomes.

AIM: To investigate the effect of preoperative PNE on postoperative pain catastrophizing in patients undergoing upper extremity orthopaedic surgery. Secondary outcomes included preoperative anxiety, pain intensity, central sensitization, upper extremity function, and health-related quality of life.

METHODS

Thirty-three patients were randomized to a PNE group (n = 17), receiving a single session supported by metaphors and visuals, or a control group (n = 16). Both groups received standard preoperative care. Pain catastrophizing was the predefined primary outcome. Anxiety was assessed before and after education, while pain intensity, pain catastrophizing, central sensitization, function, and quality of life were assessed preoperatively and four weeks postoperatively.

RESULTS

Groups were comparable at baseline. No significant between-group differences were observed in postoperative pain catastrophizing, although both groups demonstrated significant within-group improvements over time. Likewise, preoperative anxiety decreased significantly within the PNE group (p = 0.012), no significant between-group difference was observed. Compared with the control group, participants receiving PNE demonstrated significantly greater improvements in central sensitization (p = 0.004), upper extremity function (p = 0.008), and the physical component of health-related quality of life (p = 0.023) at four weeks after surgery.

CONCLUSION

Although PNE did not improve pain catastrophizing, it was associated with greater improvements in central sensitization, function, and physical quality of life. These findings suggest that multi-session or more comprehensive PNE protocols may be needed to achieve meaningful psychological benefits.