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The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series

Adriaan Louw, PT, PhD,1 Ina Diener, PT, PhD,2 Emilio J. Puentedura, PT, DPT, PhD3

1International Spine and Pain Institute, Story City, IA, USA, 2University Stellenbosch and University Western Cape, Stellenbosch, South Africa, 3University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy

Abstract

Background

Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes.

Methods

A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy.  Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS.

Results

Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients.

Conclusions

The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.

keywords: 
pain, neuroscience, Education, Preoperative, Surgery
Volume 9 Article 11
doi: 
10.14444/2011