Pain Neuroscience Education for the Management of Chronic Pain in Elite Volleyball Players With Chronic Shoulder Pain

This study represents a theory-informed intervention examining chronic shoulder pain in elite athletes from a modern pain science perspective. Instead of focusing solely on peripheral tissue pathology, the research is grounded in the biopsychosocial model of pain, emphasizing the role of central pain processing, pain beliefs, and maladaptive cognitive responses such as catastrophizing. In high-level volleyball players, where repetitive overhead loading and performance demands often lead athletes to continue training despite persistent symptoms, pain may become strongly influenced by cognitive and educational factors. Within this context, the study investigates whether modifying the understanding and interpretation of pain through Pain Neuroscience Education (PNE) can influence both the sensory and cognitive dimensions of the pain experience.

Methodologically, the study was designed as a prospective randomized controlled trial. Elite volleyball players with chronic shoulder pain were randomly allocated to either an education-based intervention group or a control group. Both groups maintained their regular sports training routines, ensuring that any observed effects could be attributed to the educational intervention rather than changes in physical load. The intervention consisted of a structured six-week PNE program delivered in repeated sessions, focusing on explaining pain mechanisms, central sensitization, and the non-linear relationship between tissue damage and pain. Outcomes were selected to reflect both physical and cognitive domains of pain: pain intensity, pain-related knowledge, and pain catastrophizing were measured before and after the intervention period to evaluate multidimensional changes associated with the educational approach.

Inclusion criteria

• Being an elite volleyball player actively competing in a professional club
• Experiencing shoulder and/or arm pain for at least three months
• Providing voluntary informed consent to participate in the study

Exclusion criteria

• Participating in volleyball at an amateur level
• Presence of pain in regions other than the shoulder and arm
• History of cancer or pregnancy
• Pain originating from neurological, cardiogenic, or rheumatological conditions
• Failure to complete the pain neuroscience education (PNE) program