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Combined neuromuscular training and pain education reduced elevated pain responses in individuals with persistent pain after knee replacement. 

A study published in June 2025 issue of European Journal of Pain emphasized that around 15%–20% of individuals undergoing surgery experience chronic pain following total knee arthroplasty (TKA), with underlying causes remaining unclear but potentially linked to central sensitization and psychosocial influences.  

They performed a secondary analysis of a randomized controlled trial (RCT) involving 69 individuals with chronic pain at least 1 year after TKA and an average daily pain score of ≥ 4 on a numerical rating scale. Participants were randomly assigned to either 12 weeks of group-based neuromuscular exercise combined with 2 sessions of group-based pain neuroscience education (PNE) or two sessions of group-based PNE alone. Measured outcomes included temporal summation of pain (TSP), pressure pain thresholds at the index knee and forearm, conditioned pain modulation (CPM), PainDETECT scores, fear-avoidance beliefs, and pain catastrophizing.  

The results showed a significant between-group difference in TSP at the index knee from baseline to 12 months, favoring the neuromuscular exercise and PNE group (−1.45, 95% CI −2.48 to −0.42; P= 0.006), indicating reduced facilitation of TSP following intervention. No significant differences between groups were found for the other measured outcomes.  

Investigators concluded that neuromuscular exercise combined with PNE significantly decreased the TSP at the index knee, indicating a reduction in central pain.   

Source: onlinelibrary.wiley.com/doi/10.1002/ejp.70064