Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized,blinded, placebo-controlled trial

This study evaluated the efficacy of transcutaneous electrical nerve stimulation (TENS) in reducing pain and hyperalgesia and increasing function after total knee arthroplasty (TKA). We hypothesized that participants using TENS during rehabilitation exercises would report significantly lower pain during range-of-motion (ROM) activity and fast walking but not at rest, would have less hyperalgesia, and would have better function than participants receiving placebo-TENS or standard care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing, and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses in 317 participants after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1 to 2 times per day at 42 mA (on average) and had less pain postoperatively during active knee extension (P = .019) and fast walking (P = .006) than standard care participants. TENS and placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those who scored high on these factors (P = .002 and P = .03). Both TENS and placebo-TENS participants had less postoperative mechanical hyperalgesia (P = .03–.01) than standard care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively, but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS.     

超声波结合经皮神经电刺激对膝骨关节炎患者膝关节疼痛和功能的影响

摘要目的：探讨超声波结合经皮神经电刺激对膝骨关节炎患者膝关节疼痛和功能的影响。方法：将122例Kellgren-Lawrence（K-L）分级1—3级的膝骨关节炎患者随机分为试验组和对照组,每组各61例。试验组患者在常规康复治疗基础上给予超声波结合经皮神经电刺激治疗,对照组患者在常规康复治疗基础上仅给予超声波治疗。2组患者在治疗前、治疗4周后及治疗结束后第3月时,采用VAS疼痛评分量表、WOMAC膝骨关节炎指数、步行能力评定量表、6min步行距离评定患者的膝关节疼痛和功能状况。结果：治疗前,试验组和对照组各项数据相比差异无显著性意义,治疗4周后,两组患者的VAS评分、WOMAC疼痛和功能评分均有明显下降（P<0.05）;两组患者的步行能力评分和6min步行距离均有明显提高（P<0.05）,WOMAC僵硬评分两组患者均无明显改变（P＞0.05）,且试验组联合治疗下的VAS评分 、WOMAC疼痛和功能评分、步行能力评分和6min步行距离与对照组相比均有显著性意义（P＜0.05）。随访时,两组患者除WOMAC僵硬评分和功能评分外其余指标与治疗前比仍有显著性差异（P<0.05）,试验组的VAS评分 、WOMAC疼痛评分、步行能力评分和6min步行距离均优于对照组（P<0.05）。结论：超声波结合经皮神经电刺激可明显改善膝骨关节炎患者的膝关节疼痛、提高其步行功能和步行距离,但对膝关节僵硬无明显改善作用。