Effectiveness of TENS on Hyperalgesia, Pain with Movement, and Function After TKR

描述（由申请人提供）：老年人全膝关节置换术（TKR）后疼痛控制不充分与功能恢复不良、住院时间延长和新慢性疼痛的发生有关。目前的方法不足以控制术后物理治疗期间经历的剧烈疼痛。疼痛控制治疗，解决运动引起的疼痛在恢复期间需要进行调查。本研究的主要目的是测试间歇性、高强度（高振幅）经皮神经电刺激（TENS）对TKR术后痛觉过敏、运动疼痛、主动屈曲和行走功能的影响，TENS作为恢复活动期间现有药物治疗的补充。第二个目的是通过探索预测变量影响术后痛觉过敏和运动诱发疼痛以及TKR后慢性疼痛发展的途径来验证所提出的模型。一项前瞻性、随机、实验设计将用于比较321例计划进行TKR的骨关节炎患者的活性TENS、安慰剂TENS和单独镇痛的效果。假设在TKR后6周的运动期间接受间歇性、高强度TENS的老年人，与接受安慰剂TENS或不接受TENS治疗的老年人相比，运动引起的疼痛明显减少，术后痛觉过敏更少，主动屈曲更大，行走功能增强。干预预计不会显著影响休息时的疼痛。这项研究是一个整体研究项目的下一个阶段，该项目将使用非药物干预作为药物策略的补充，以改善运动疼痛控制，增强功能，并预防新的慢性疼痛综合征的发展。这个项目是创新的，因为它区分了运动疼痛（目前的疼痛治疗在很大程度上不受控制的疼痛类型）和静止疼痛，并针对TENS对手术后运动疼痛的影响。本研究还通过测试TENS对痛觉过敏的影响，将实验（动物模型）科学转化为人类受试者。术后运动疼痛的管理对于老年人功能恢复和避免其他慢性疼痛来源至关重要。通过改善功能状态，老年人可以保持独立性，并可能减少他们的医疗保健利用和成本。

DESCRIPTION (provided by applicant): Inadequate pain control after total knee replacement (TKR) is associated with poor functional recovery, increased length of stay, and development of new chronic pain in older adults. Current methods are inadequate for controlling the severe pain experienced during post-op physical therapy. Pain control treatments that address movement-evoked pain during recovery need to be investigated. The primary purpose of this study is to test the effect of intermittent, intense (high amplitude) transcutaneous electrical nerve stimulation (TENS), applied as a supplement to current pharmacologic therapy during recovery activities, on postoperative hyperalgesia, pain with movement, active flexion, and walking function after TKR. A secondary purpose is to validate the proposed model by exploring the pathways through which predictor variables influence postoperative hyperalgesia and movement-evoked pain, and development of chronic pain after TKR. A prospective, randomized, experimental design will be used to compare the effect of active TENS, placebo TENS, and analgesia alone in 321 patients with osteoarthritis scheduled to have a TKR. It is hypothesized is that older adults who receive intermittent, intense TENS during exercise sessions for 6 weeks after TKR will have significantly less movement-evoked pain, less postoperative hyperalgesia, greater active flexion, and increased walking function than those who receive placebo TENS or no TENS therapy. The intervention is not expected to significantly influence pain at rest. This study is the next phase in an overall program of research on the use of non-pharmacologic interventions as a supplement to pharmacologic strategies to improve pain control with movement, enhance function, and prevent the development of new chronic pain syndromes. This project is innovative because it distinguishes pain with movement (the type of pain largely uncontrolled with current pain treatments) from pain at rest and targets the effect of TENS on pain with movement after surgery. This study also translates bench (animal model) science to human subjects by testing the effect of TENS on hyperalgesia. Management of pain with movement during the post-operative period is critical to return of function and avoidance of additional sources of chronic pain in older adults. By improving functional status, older adults can retain independence and possibly reduce their health care utilization and costs.