Riassunto dello studio

Sixty-nine patients with chronic post-TKA pain were randomized to neuromuscular exercise+pain neuroscience education (PNE) (n=36) or PNE alone (n=33). The primary outcome of interest for this secondary analysis was temporal summation of pain (TSP) at the index knee. Secondary outcomes included TSP extra-segmentally, pressure pain thresholds (PPT) locally and extra-segmentally, conditioned pain modulation (CPM), PainDETECT, fear-avoidance beliefs (FABQ-PA), and pain catastrophizing (PCS). Outcomes were assessed at baseline, 3, 6, and 12 months. Overall, the results of the study revealed a significant between-group improvement favoring exercise+PNE for TSP at the index knee (mean difference −1.45, 95% CI −2.48 to −0.42; p=0.006), with no between-group differences for other mechanistic or psychosocial outcomes. In addition, both groups showed within-group improvements in PainDETECT, FABQ-PA, and PCS, and change in PCS was associated with better KOOS4. These findings suggest exercise+PNE can attenuate central pain amplification (TSP) whereas broader clinical gains may relate to reducing catastrophizing.