Electrical Evoked Potentials After Perioperative Pain Neuroscience Education or Back School Education - A Subgroup Analysis of a Randomized Controlled Trial

Sep 30, 2026

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Biopsychosocial pain neuroscience education (PNE) is increasingly used to prepare patients for surgery, with hypothesized effects on pain coping and descending nociceptive inhibition. This predefined EEG subgroup analysis compared perioperative PNE (PPNE) with perioperative biomedical back school education (PBSE) using conditioned pain modulation (CPM). Among 23 randomized patients with low back-related leg pain, cortical evoked responses were measured by EEG before and 6 weeks after two education sessions. CPM reduced waveform amplitude at the non-symptomatic sural nerve, but no significant PPNE-versus-PBSE treatment effects emerged in CPM-related effects. Exploratory results indicate PPNE was not linked to differential modulation of EEG-evoked potentials during CPM at 6 weeks post-surgery.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Clinical context of lumbar spine surgery and chronic post-surgical pain

Role of biopsychosocial factors and PNE in perioperative care

Article Electrical Evoked Potentials After Perioperative Pain Neuroscience Education or Back School Education: A Subgroup Analysis of a Randomized Controlled Trial Lisa Goudman 1,2,3,4,5,6, *, Eva Huysmans 4,5,7, Wouter Van Bogaert 4,5,7,8, Iris Coppieters 5,9, Kelly Ickmans 5,7,10, Jo Nijs 5,7,11, Ronald Buyl 8,12 and Maarten Moens 1,2,3,5,13 Academic Editor: Michael Froelich Received: 30 November 2025 Revised: 19 December 2025 Accepted: 27 December 2025 Published: 5 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 STIMULUS Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 2 Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium 3 Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 4 Research Foundation-Flanders (FWO), Leuvenseweg 38, 1000 Brussels, Belgium 5 Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 6 Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71, Boca Raton, FL 33431, USA 7 Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium 8 Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 9 Laboratory for Brain-Gut Axis Studies (LaBGAS), Translation Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Oude Markt 13, 3000 Leuven, Belgium 10 Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium 11 Department of Health and Rehabilitation, Unit of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden 12 Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 13 Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium * Correspondence: [lisa.goudman@vub.be](lisa.goudman@vub.be) Abstract Background/Objectives: Biopsychosocial pain neuroscience education (PNE) has recently gained attention in preparing patients for surgery. PNE is expected to influence pain coping strategies and descending nociceptive inhibition. The goal of this study was to compare cortical evoked responses during experimental pain processing using a conditioned pain modulation (CPM) paradigm between patients receiving perioperative PNE (PPNE) or perioperative biomedical back school education (PBSE) . Methods: This predefined EEG subgroup analysis included only participants with complete EEG recordings at baseline and 6 weeks. Of these, twenty-three patients with low back-related leg pain, scheduled for lumbar spine surgery, were randomized to either two sessions of PPNE or two sessions of PBSE. All patients were stimulated electrically at the median nerve of the symptomatic side and the sural nerve of the symptomatic and non-symptomatic side before and 6 weeks after the educational sessions, while evoked potentials were recorded by electroencephalography (EEG) . Subsequently, this protocol was repeated during the application of the CPM paradigm by immersing the hand contralateral to the symptomatic side into cold water. Results: A significant decrease in the amplitude of the waveforms during CPM was found

FAQs

What is the study comparing regarding perioperative education?

The study compares perioperative pain neuroscience education (PPNE) with perioperative biomedical back school education (PBSE) using conditioned pain modulation (CPM) and EEG outcomes.

How were cortical responses measured and when?

Participants received either PPNE or PBSE and underwent electrical stimulation while EEG recorded evoked potentials before and 6 weeks after the educational sessions.

What were the main EEG findings during CPM?

CPM produced a significant decrease in waveform amplitude at the non-symptomatic sural nerve, but there were no significant differences across other test locations.

Did PPNE show differential effects compared with PBSE at follow-up?

No. CPM effect waveforms (subtracted waveforms) showed no significant treatment effects between PPNE and PBSE groups at 6 weeks post-surgery.

Sep 30, 2026

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