The effect of pain neuroscience education on preoperative anxiety and postoperative recovery in patients scheduled for orthopedic surgery

The aim of this study was to investigate the effects of Pain Neuroscience Education (PNE) administered during the preoperative period in individuals scheduled for orthopedic surgery on preoperative anxiety levels and postoperative outcomes including pain perception, functional recovery, and quality of life. The study was conducted using a convenience sampling method and completed with a total of 33 participants aged between 18 and 65 years who were scheduled for upper extremity surgery. Participants were randomly assigned to either the PNE group or the control group. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Specifically, the "state anxiety" subscale was used to evaluate the level of anxiety before and after the PNE intervention. Pain-related parameters were assessed using the McGill Pain Questionnaire (MPQ), Visual Analog Scale (VAS), Pain Catastrophizing Scale (PCS), and Central Sensitization Inventory (CSI). Upper extremity functions were evaluated using the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), while quality of life was assessed with the 12-Item Short Form Health Survey (SF-12). Anxiety was measured before and after the educational session, whereas other parameters were evaluated preoperatively and at the first postoperative month. The participants were divided into two groups: the PNE group (n=17), which received a single session of Pain Neuroscience Education during the preoperative period, and the control group (n=16), which was provided with an informative brochure. The results indicated that preoperative anxiety levels significantly decreased in the PNE group (p<0.05). Furthermore, pain intensity and pain-related maladaptive cognitions were significantly reduced in the PNE group at the first postoperative month (p<0.05). In terms of functional recovery, DASH scores revealed a significant improvement in upper extremity usage and participation in daily activities in the PNE group (p<0.05). Additionally, a significant improvement was observed in the physical subscale of the SF-12 quality of life measure (p<0.05), while no significant change was detected in the mental subscale (p>0.05). In the control group, no significant differences were found in terms of preoperative anxiety, central sensitization, functionality, or quality of life (p>0.05); however, a significant reduction in pain-related parameters was observed when comparing preoperative and first postoperative month values (p<0.05). Our study demonstrated that PNE had a positive impact on central sensitization, functionality, and the physical aspect of quality of life when comparing pre- and post-intervention outcomes between the groups. In conclusion, this study suggests that a single session of PNE administered during the preoperative period may not directly affect anxiety or all postoperative pain-related parameters, but it may contribute to improved postoperative functional recovery and enhanced satisfaction with the physical aspect of health. The limited effect observed in some variables may be attributed to the single-session nature of the intervention. Future studies are recommended to adopt a randomized controlled design involving multiple sessions and larger sample sizes to explore the broader impact of PNE in surgical populations.