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

Abstract

This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) 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 on 317 subjects 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 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) 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 scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) 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.

Pain sensitivity profiles in patients with advanced knee osteoarthritis

“…The primary aim results have been reported elsewhere [44]. Data from the preoperative (baseline) clinic visit only were used for this study.…”

“…The distance walked was then assessed with a measuring tape. Further details on this and the ROM procedures can be found in a prior publication [44]. …”

“…Using baseline visit data collected as part of a larger randomized control trial, the TANK (TENS After New Knee) study [44], we sought to determine the factor structure of baseline pain sensitivity measures in this clinical population, identify specific clusters of individuals with similar pain sensitivity (QST) profiles, and ultimately compare clinical characteristics and quality of life across profiles. We hypothesized that patients with advanced knee OA would continue to differentiate into pain sensitivity clusters but with less heterogeneity than those observed in a healthy population [22].…”

Fast Track Surgery Program in Knee Replacement

“…Combination therapy also reduces the required dose of individual medication which further lowers the incidence of medication adverse events. Other alternative modalities such as cryotherapy, through the application of cool water to the surgical site or transcutaneous electrical nerve stimulation (TENS) are also taken into consideration, as studies have shown to reduce the acute pain after surgery [42,43].…”

Evaluating efficacy and feasibility of transcutaneous electrical nerve stimulation for postoperative pain after video-assisted thoracoscopic surgery: A randomized pilot trial

“…Transcutaneous electrical nerve stimulation (TENS) for control of postoperative pain has been used after various procedures, including cardiac surgeries [8e12], cholecystectomy [13e15], cesarean section [16,17], liposuction [18], total knee arthroplasty [19], and thoracotomy [20e25]. Treating pain with TENS is based on 2 theories.…”