Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized,blinded, placebo-controlled trial |
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| Institution: | 1. The University of Iowa College of Nursing, Iowa City, IA, USA;2. Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, IA, USA;3. Department of Orthopedics and Rehabilitation, The University of Iowa College of Medicine, Iowa City, IA, USA;4. School of Health Sciences, University of Ulster, Northern Ireland, UK;5. Department of Physical Therapy and Rehabilitation Science, The University of Iowa College of Medicine, Iowa City, IA, USA;1. Pain Research Laboratory, Institute of Nautical Medicine, Jiangsu Key Laboratory of Inflammation and Molecular Drug Target, Nantong University, Nantong, Jiangsu, China;2. Department of Nutrition, School of Public Health, Nantong University, Nantong, Jiangsu, China;3. Departments of Anesthesiology and Neurobiology, Duke University Medical Center, Durham, NC 27710, USA;1. Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104, USA;2. Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina 98122, Italy;3. Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-0810, USA;1. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;3. Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY, USA;4. Medical University of South Carolina, Charleston, SC, USA;5. Department of Emergency Medicine, Oregon Health & Science University, Portland, SC, USA;6. Department of Emergency Medicine, George Washington University Medical Center, Washington, DC, USA;7. Department of Emergency Medicine, University of Colorado, Aurora, CO, USA;8. Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA;9. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;1. Danish Pain Research Center, Aarhus University, Aarhus, Denmark;2. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;1. Department of Neurosciences, School of Medicine and Dentistry, University of the Basque Country, Bilbao, Spain;2. Movement Disorders and Autonomic Unit, Neurology Service, Cruces University Hospital, Basque Health Service (Osakidetza), Spain;1. Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;2. European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;3. Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK;4. Cancer Clinic, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway;5. Division of Palliative Care Medicine Department of Oncology, University of Alberta, Edmonton, AB, Canada;6. Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;7. Anesthesia and Intensive Care & Pain Relief and Palliative Care Unit, la Maddalena Cancer Center, Palermo and University of Palermo, Palermo, Italy |
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| Abstract: | 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. |
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| Keywords: | Transcutaneous electrical nerve stimulation Postoperative pain Total knee arthroplasty |
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