Pain neuroscience education for the management of chronic pain in elite volleyball players with chronic shoulder pain: a randomized controlled trial

Abstract

Background The aim of this study was to examine the effects of pain neuroscience education (PNE) on pain intensity, pain knowledge, and pain catastrophizing in elite volleyball players with chronic shoulder pain. Methods In this randomized controlled prospective study, participants were allocated to a PNE group (n = 16, mean age +/- SD = 20.56 +/- 1.26 years, 7 females) or a control group (n = 24, mean age +/- SD = 23.96 +/- 4.89 years, 11 females). Participants in both groups continued their regular sports training programs. In addition, the PNE group received PNE sessions for six weeks, consisting of two sessions per week, each lasting 45 min. Pain intensity was assessed using the Visual Analog Scale (VAS), pain knowledge was evaluated using the Revised Pain Neurophysiology Questionnaire (R-PNQ), and pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). A mixed-model ANOVA was used to analyze time and group effects. Results No significant differences were observed between groups at baseline for any outcome (all p > 0.05). Significant time & times; group interactions were found for resting pain (p < 0.001, eta p & sup2; = 0.42) and activity-related pain (p = 0.003, eta p & sup2; = 0.21). A significant interaction was also observed for pain knowledge (p < 0.001, eta p & sup2; = 0.42). For pain catastrophizing, significant and large interaction effects favoring the PNE group were identified for the rumination (p < 0.001, eta p & sup2; = 0.59), magnification (p < 0.001, eta p & sup2; = 0.60), and helplessness (p < 0.001, eta p & sup2; = 0.68) subscales, as well as for the total PCS score (p < 0.001, eta p & sup2; = 0.76). Conclusions The findings suggest that PNE may contribute to reductions in pain intensity and pain catastrophizing in elite volleyball players with chronic shoulder pain, while also supporting improvements in pain-related knowledge. PNE may represent a useful adjunct strategy in the management of chronic shoulder pain in elite volleyball players. Clinical trial registration ClinicalTrials.gov NCT07393347, registered on 23/01/ 2026. Retrospectively registered via this link ( https://register.clinicaltrials.gov/prs/beta/studies/S000GOZR00000039/recordSummary ).