Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report

• Published in: Physiotherapy theory and practice 2015-10, Vol.31 (7), p.496-508
• Main Authors: Louw, Adriaan, Puentedura, Emilio J, Diener, Ina, Peoples, Randal R
• Format: Article
• Language: English
• Subjects: Adult; Biomechanical Phenomena; Brain - physiopathology; Brain Mapping - methods; Catastrophization; Disability Evaluation; Female; Health Knowledge, Attitudes, Practice; Humans; Low Back Pain - diagnosis; Low Back Pain - physiopathology; Low Back Pain - psychology; Low Back Pain - therapy; Lumbar Vertebrae - physiopathology; Magnetic Resonance Imaging; Neurosciences - education; Pain Measurement; Pain Perception; Patient Education as Topic; Predictive Value of Tests; Psychometrics; Radiculopathy - diagnosis; Radiculopathy - physiopathology; Radiculopathy - psychology; Radiculopathy - therapy; Range of Motion, Articular; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0959-3985; 1532-5040
• DOI: 10.3109/09593985.2015.1038374

Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8 cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: (1) deactivation of the periaqueductal gray area; (2) deactivation of the cerebellum; and (3) increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.