This randomized controlled trial investigates whether adding Pain Neuroscience Education (PNE) to standard pre-operative physiotherapy improves outcomes after lumbar laminectomy. Chronic low back pain often involves central sensitization, where the nervous system continues amplifying pain signals even after the structural problem is surgically corrected, contributing to persistent neuropathic pain and disability after spine surgery.
The study will enroll 44 male and female patients aged 35-60 scheduled for elective one- or two-level lumbar laminectomy, with a pre-surgical waiting period of at least three weeks. Participants will be randomized into two equal groups. The experimental group will receive a three-week "nervous system priming" program: three 45-minute sessions combining PNE (explaining pain biology and neuroplasticity through culturally adapted metaphors) with standard exercises (ankle pumps, quad sets, gluteal sets, isometric abdominal sets, heel slides, and walking), plus a home program. The control group will receive identical standard exercises and session structure, but without PNE, using placebo counselling instead.
Outcomes will be measured using the painDETECT questionnaire (neuropathic pain) and the Oswestry Disability Index (functional disability), assessed at baseline, three weeks post-operatively, and three months post-operatively. The study will run for seven months following ethical approval.
The research addresses a gap in current perioperative care, which is typically reactive and rarely incorporates neurophysiological education into prehabilitation. If PNE proves effective, it could reduce post-laminectomy neuropathic pain and disability, decrease dependency on painkillers and prolonged rehabilitation, and inform more effective pre-surgical protocols for spine surgery patients.
Male and female patients
Adults aged 35-60 years.
Scheduled for elective, primary 1- or 2-level lumbar laminectomy/decompression for radiculopathy due to stenosis or herniation.
A pre-surgical waiting period of at least 3 weeks.
Severe cognitive impairment
Unstable medical conditions
Lower limb or spinal fractures or severe joint deformities
Previous lumbar spine surgery.
Parallel
Experimental Group - Pain Neuroscience Education + Standard Pre-operative Protocol
Procedure/SurgeryThis group receives a 3-week pre-surgical program of three individual 45-minute sessions with a neuro-physical therapist, plus a daily home program. It combines Pain Neuroscience Education (PNE), delivered in Urdu using culturally adapted metaphors (e.g., the "broken alarm" analogy for central sensitization) developed through expert panel review, with standard exercises. Each session includes 15-20 minutes of education, 20-25 minutes of exercise (ankle pumps, quad sets, gluteal sets, isometric abdominal sets, heel slides, walking), and 5 minutes of home practice. PNE aims to reframe pain as nervous-system sensitization rather than ongoing tissue damage, reducing fear-avoidance before surgery.
Control Group - Standard Pre-Operative Care
Procedure/SurgeryThis group follows the identical 3-week format-three individual 45-minute sessions with a neuro-physical therapist plus a prescribed daily home program-but without Pain Neuroscience Education. Instead, participants receive placebo counselling and an explained consent form in place of actual pain education, maintaining single-blinding. The exercise protocol matches the experimental group exactly: ankle pumps (10 reps), quad sets (hold 5 counts, 10 reps), gluteal sets (hold 5 counts, 10 reps), isometric abdominal sets (hold 5 counts, 10 reps), heel slides (10 reps, 3x/day), and walking (10 minutes, 3x/day). This group serves as the comparator to isolate the added effect of PNE.
Neuropathic Pain
Neuropathic pain will be assessed using the pain DETECT Questionnaire, a 9-item screening tool with 85% specificity for identifying neuropathic pain components. Scores below 12 indicate the neuropathic component is unlikely, 13-18 suggest it's possible, and 19 or higher indicates it is highly likely present. Assessments will occur at baseline, 3 weeks post-operatively, and again at 3 months to track sustained effects.
Neuropathic Pain
Neuropathic pain will be assessed using the pain DETECT Questionnaire, a 9-item screening tool with 85% specificity for identifying neuropathic pain components. Scores below 12 indicate the neuropathic component is unlikely, 13-18 suggest it's possible, and 19 or higher indicates it is highly likely present. Assessments will occur at baseline, 3 weeks post-operatively, and again at 3 months to track sustained effects.
Disability
Functional disability will be measured using the Oswestry Disability Index (ODI), a 10-item questionnaire with excellent reliability (ICC \>0.90) and validity. Each section scores 0-5, with total percentage scores interpreted as: 0-20% minimal disability, 21-40% moderate, 41-60% severe, 61-80% crippled, and 81-100% bed-bound. A change of 10 points or more is considered the minimally clinically important difference (MCID). ODI will also be assessed at baseline, 3 weeks post-operatively, and 3 months post-operatively.
Disability
Functional disability will be measured using the Oswestry Disability Index (ODI), a 10-item questionnaire with excellent reliability (ICC \>0.90) and validity. Each section scores 0-5, with total percentage scores interpreted as: 0-20% minimal disability, 21-40% moderate, 41-60% severe, 61-80% crippled, and 81-100% bed-bound. A change of 10 points or more is considered the minimally clinically important difference (MCID). ODI will also be assessed at baseline, 3 weeks post-operatively, and 3 months post-operatively.
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