Article Figures & Data
Figures
- Fig. 1
Cumulative presentation of leg pain in the case series patient population.
- Fig. 2
Low back pain (LBP) scores for all patients prior to therapeutic neuroscience education (TNE), immediately after and the 1, 3 and 6 month follow ups.
- Fig. 3
Leg pain scores for all patients prior to therapeutic neuroscience education (TNE), immediately after and the 1, 3 and 6 month follow ups.
- Fig. 4
Pain Catastrophizing Scale (PCS) scores for all patients prior to therapeutic neuroscience education (TNE), immediately after and the 1, 3 and 6 month follow ups. * denotes change exceeded minimal detectable change (MDC) of 9.1 points.
- Fig. 5
Oswestry Disability Index (ODI) scores for all patients prior to therapeutic neuroscience education (TNE), and at 1, 3 and 6 month follow ups. * denotes change exceeded minimal detectable change (MDC) of 10%.
- Fig. 6
Fingertip-to-Floor Test measures for all patients prior to therapeutic neuroscience education (TNE), and immediately afterwards. * denotes change exceeded minimal detectable change (MDC) of 4.5 cm. Patient was a high-level professional dancer who could easily put her palms flat on the floor. A step was gradually increased until the patient had her longest finger, dominant hand just touch the floor. Step height (30 cm) was thus subtracted from a zero score (touching the floor).
- Fig. 7
Straight leg raise (SLR) for all patients prior to therapeutic neuroscience education (TNE), and immediately afterwards. * denotes change exceeded minimal detectable change (MDC) of 5.7 degrees.
- Fig. 8
Patient self-report beliefs about lumbar surgery and their radiculopathy before and immediately after therapeutic neuroscience education (TNE). Scores below 5 indicate disagreement with the statements, whereas scores above 5 indicate agreement with the statements.
Tables
- Table 2
Patient self-report psychometric measures prior to therapeutic neuroscience education (TNE) and prior to lumbar surgery for radiculopathy
Patient ODI % FABQ – W FABQ – PA PCS NPQ 1 44 0 23 27 13 2 44 10 10 21 15 3 48 31 17 47 12 4 48 23 22 22 13 5 18 12 18 11 12 6 48 10 15 24 12 7 36 38 23 28 12 8 74 0 24 47 15 9 26 19 22 23 10 10 22 15 13 4 15 Average 40.8 15.8 18.7 25.4 12.9 ODI: Oswestry Disability Index; FABQ-W: Fear Avoidance Beliefs
Questionnaire – Work Subscale; FABQ-PA: Fear Avoidance Beliefs
Questionnaire – Physical Activity Subscale; PCS: Pain Catastrophization
Scale; NPQ: Neurophysiology of Pain Questionnaire.
Patient 1 2 3 4 5 6 7 8 9 10 Average Score I feel prepared and ready for surgery 10 10 1 6 2 8 7 8 3 7 6.2 I am afraid of the upcoming surgery 2 6 4 9 10 1 3 8 5 5 5.3 I know what to ex-pect after back surgery 4 6 0 3 6 9 2 6 9 7 5.2 Back pain after surgery is to be ex-pected 5 2 0 8 8 8 8 6 2 7 5.4 Leg pain after surgery is to be ex-pected 5 2 0 7 7 2 7 0 0 4 3.4 I can control the amount of post-op-erative pain 5 8 3 8 6 8 3 2 5 7 5.5 Back surgery will ‘fix my pain’ 10 9 10 9 5 9 7 9 10 7 8.5 Scores are on a 10-point scale (strongly disagree [0] – strongly agree [10]) with each statement.
Patient Fingertip-to-Floor (cm) SLR (degrees) 1 36.5 43 2 31.5 48 3 53 18 4 30 43 5 2 70 6 10.5 38 7 19.5 33 8 47 31 9 −30* 148* 10 10 78 Average 21 55 ↵* Patient was a high-level professional dancer who could easily put her palms flat on the floor. A step was gradually increased until the patient had her longest finger, dominant hand just touch the floor. Step height (30 cm) was thus subtracted from a zero score (touching the floor).
- Table 5
Content of the Preoperative Neuroscience Educational Tool (PNET) program and booklet.
Section Topic Main Theme 1 The decision to have back surgery Several studies have shown that uncertainty prior to surgery is associated with poor outcomes. The purpose of the PNET is not to discourage surgery, but rather embrace the surgical decision and make positive choices associated with favorable recovery. 2 The nervous system's anatomy, physiology and pathways The essence of TNE is explaining the biology and physiology of nerves to patients. The session aimed to make patients understand how nerves can be viewed as an alarm system aimed at providing information to the brain from the tissues. 3 Peripheral nerve sensitization A key element of the preoperative neuroscience educational tool is for patients to understand that pain may be from faulty tissue but also (likely more so) from increased nerve sensitivity. The section aimed to have patients understand how the nervous system modulates sensitivity to protect when facing LBP, surgery, failed treatments, fear and anxiety. 4 Surgical experiences and environmental issues on nerve sensitivity Several studies have indicated that the surgical experience is stressful, and this section aimed to make patients aware how surgery, hospital experiences, anxiety and interaction with medical personnel may increase sensitivity around the time of the surgery. 5 Calming the nervous system down The patient is provided information on how the heightened nerve sensitivity can be decreased with the surgery, knowledge, movement and medication. Emphasis is placed on a knowledgeable brain down-regulating nociception and thus modulating the pain experience. 6 Recovery after back surgery The last section summarized sections 1-5 with various explanations of what to expect during the recovery phase. References Scientific evidence for the booklet content Patients were provided with a list of references titled as scientific evidence for the material in the preoperative neuroscience educational tool as a means to underscore the fact that the program is based on evidence and research. Q & A Page Questions to ask the surgeon prior to surgery A Q & A page was provided at the end as a means to write down remaining questions to ask the surgeon prior to surgery. The fact that knowledge would help ease pain and uncertainty would likely increase pain was once again emphasized as a means to encourage patients to develop a greater understanding of what to expect before, during and after the surgical experience
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