Background and Rationale
Rotator cuff tears (RCT) are a leading cause of shoulder pain and disability,
particularly in aging populations. The prevalence of RCT increases with age, affecting
approximately 28% of individuals aged 40 and rising to 60-80% in those aged 80. Surgical
repair, such as mini-open rotator cuff repair, is often required for medium to large
tears or when conservative treatments fail. While surgery aims to reduce pain and restore
function, postoperative recovery can be challenging due to severe pain, fear of movement
(kinesiophobia), and psychosocial factors like anxiety and depression. These factors can
hinder rehabilitation and delay recovery.
Pain Neuroscience Education (PNE) is an evidence-based approach that teaches patients
about the biological and psychological mechanisms of pain. By helping patients understand
how pain is processed by the nervous system, PNE reduces fear, catastrophizing, and
negative beliefs about pain, thereby improving outcomes. While PNE has been shown to be
effective in chronic pain conditions, its application in acute postoperative settings,
particularly for rotator cuff repair, remains underexplored.
Study Objectives
This study aims to:
Evaluate the effectiveness of combining PNE with conventional rehabilitation in improving
pain management, physical function, and psychosocial outcomes in patients undergoing
mini-open rotator cuff repair.
Compare the effects of delivering PNE before surgery versus after surgery. Assess the
impact of PNE on secondary outcomes, including kinesiophobia, depression, pressure pain
threshold, conditioned pain modulation, sleep quality, postural alignment, and functional
level.
Study Design
This is a randomized controlled trial with three parallel groups:
Group 1 (Control): Conventional rehabilitation only. Group 2 (Preoperative PNE):
Conventional rehabilitation + PNE delivered before surgery.
Group 3 (Postoperative PNE): Conventional rehabilitation + PNE delivered after surgery.
Methodology
Participants: Adults aged 18-65 with a diagnosed medium-sized rotator cuff tear scheduled
for mini-open surgical repair.
Intervention:
PNE: A structured educational program consisting of 2-3 sessions (45-60 minutes each)
that explain the neurobiology of pain, the role of the central nervous system, and
strategies to reduce pain-related fear and catastrophizing.
Conventional Rehabilitation: A standardized postoperative rehabilitation program focusing
on pain management, range of motion, strength training, and functional recovery.
Outcome Measures:
Primary Outcomes: Pain intensity (measured by Visual Analog Scale), shoulder function
(measured by Constant-Murley Score), and kinesiophobia (measured by Tampa Scale of
Kinesiophobia).
Secondary Outcomes: Depression (measured by Beck Depression Inventory), pressure pain
threshold, conditioned pain modulation, sleep quality (measured by Pittsburgh Sleep
Quality Index), postural alignment, and functional level.
Timeline: Participants will be assessed at baseline (pre-surgery), immediately after PNE
(if applicable), and at 6 and 12 weeks post-surgery.
Statistical Analysis
Data will be analyzed using intention-to-treat principles. Repeated-measures ANOVA will
be used to compare outcomes across groups and time points. Subgroup analyses will explore
the effects of PNE timing (preoperative vs. postoperative).
Significance
This study addresses a critical gap in the management of rotator cuff tears by
investigating the role of PNE in enhancing postoperative recovery. If effective, PNE
could be integrated into standard rehabilitation protocols to improve pain management,
reduce fear of movement, and accelerate functional recovery. The study also aims to
determine the optimal timing for PNE delivery, providing valuable insights for clinical
practice.
