title: 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 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.
authors.affiliation: The University of Iowa College of Nursing, Iowa City, IA, USA Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, IA, USA Department of Orthopedics and Rehabilitation, The University of Iowa College of Medicine, Iowa City, IA, USA School of Health Sciences, University of Ulster, Northern Ireland, UK Department of Physical Therapy and Rehabilitation Science, The University of Iowa College of Medicine, Iowa City, IA, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Rakel
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Zimmerman
authors.forename: Katharine
authors.initials: K
authors.lastname: Geasland
authors.forename: Jennie
authors.initials: J
authors.lastname: Embree
authors.forename: Charles R
authors.initials: CR
authors.lastname: Clark
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.forename: Keela
authors.initials: K
authors.lastname: Herr
authors.forename: Deirdre
authors.initials: D
authors.lastname: Walsh
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Sluka
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003863:Depression / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000209:etiology* / Q000534:rehabilitation*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects / Q000502:physiology; D011183:Postoperative Complications / Q000503:physiopathology / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D016059:Range of Motion, Articular / Q000187:drug effects; D012189:Retrospective Studies; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone
keywords: Postoperative pain; Total knee arthroplasty; Transcutaneous electrical nerve stimulation