Table 5.

Content of the Preoperative Neuroscience Educational Tool (PNET) program and booklet.

Section	Topic	Main Theme
1	The decision to have back surgery	Several studies have shown that uncertainty prior to surgery is associated with poor outcomes. The purpose of the PNET is not to discourage surgery, but rather embrace the surgical decision and make positive choices associated with favorable recovery.
2	The nervous system's anatomy, physiology and pathways	The essence of TNE is explaining the biology and physiology of nerves to patients. The session aimed to make patients understand how nerves can be viewed as an alarm system aimed at providing information to the brain from the tissues.
3	Peripheral nerve sensitization	A key element of the preoperative neuroscience educational tool is for patients to understand that pain may be from faulty tissue but also (likely more so) from increased nerve sensitivity. The section aimed to have patients understand how the nervous system modulates sensitivity to protect when facing LBP, surgery, failed treatments, fear and anxiety.
4	Surgical experiences and environmental issues on nerve sensitivity	Several studies have indicated that the surgical experience is stressful, and this section aimed to make patients aware how surgery, hospital experiences, anxiety and interaction with medical personnel may increase sensitivity around the time of the surgery.
5	Calming the nervous system down	The patient is provided information on how the heightened nerve sensitivity can be decreased with the surgery, knowledge, movement and medication. Emphasis is placed on a knowledgeable brain down-regulating nociception and thus modulating the pain experience.
6	Recovery after back surgery	The last section summarized sections 1-5 with various explanations of what to expect during the recovery phase.
References	Scientific evidence for the booklet content	Patients were provided with a list of references titled as scientific evidence for the material in the preoperative neuroscience educational tool as a means to underscore the fact that the program is based on evidence and research.
Q & A Page	Questions to ask the surgeon prior to surgery	A Q & A page was provided at the end as a means to write down remaining questions to ask the surgeon prior to surgery. The fact that knowledge would help ease pain and uncertainty would likely increase pain was once again emphasized as a means to encourage patients to develop a greater understanding of what to expect before, during and after the surgical experience