Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial.
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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DOI：
10.1016/j.pain.2014.09.025
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发表时间：
2014-12
期刊：
影响因子：
7.4
通讯作者：
Sluka KA
中科院分区：
文献类型：
--
作者：
Rakel BA;Zimmerman BM;Geasland K;Embree J;Clark CR;Noiseux NO;Callaghan JJ;Herr K;Walsh D;Sluka KA
本研究评价TENS在减轻全膝关节置换术(TKA)术后疼痛和痛敏及提高功能方面的疗效。我们假设在康复练习中使用TENS的参与者将：1)报告在活动范围(ROM)和快步行走期间疼痛显著减少，但不是在休息时；2)痛觉过敏较少；以及3)功能比接受安慰剂-TENS或标准护理的参与者更好。我们还假设，根据心理特征(特质焦虑、疼痛灾变和抑郁)和治疗组的不同，ROM疼痛的变化会有所不同。这项前瞻性、随机化研究对317名单侧原发全膝关节置换术患者进行了意向治疗分析。评估人员，盲目分配治疗，测量术后和术后6周的疼痛、功能(关节活动度和步态速度)和痛敏(定量感觉测试)。还评估了止痛药的摄入、焦虑、抑郁和疼痛灾变。TENS参与者以平均42 mA的速度每天使用它1-2次，术后主动伸膝(p=0.019)和快速行走(p=0.006)的疼痛比标准护理参与者要少。TENS和安慰剂TENS没有显著差异。在焦虑和疼痛灾变方面得分低的TENS参与者在6周时比那些在这些因素上得分高的参与者在关节活动区疼痛方面的缓解程度更大(p=0.002和0.03)。与标准护理参与者相比，TENS和安慰剂-TENS参与者术后机械性痛敏较少(p=0.03-0.01)。在康复训练中补充药物镇痛剂TENS可减轻术后运动疼痛，但存在安慰剂效应，其作用在6周后消失。焦虑和疼痛灾害性低的患者可能从TENS中受益最多。
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.
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