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

描述(由申请人提供)：全膝关节置换术(TKR)后疼痛控制不足与老年人功能恢复差、住院时间延长和出现新的慢性疼痛有关。目前的方法不足以控制术后物理治疗期间所经历的剧烈疼痛。需要研究在康复期间解决运动引起的疼痛的疼痛控制治疗。本研究的主要目的是测试间歇性、强(高幅度)经皮神经电刺激(TENS)对TKR术后痛觉过敏、运动疼痛、主动屈曲和步行功能的影响。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、实验设计将在321名计划进行TKR的骨性关节炎患者中比较活性TENS、安慰剂TENS和单独止痛的效果。它的假设是，与接受安慰剂TENS或不接受TENS治疗的老年人相比，在TKR后6周的运动期间接受间歇性、高强度TENS治疗的老年人将显著减少运动诱发的疼痛，较少术后痛觉过敏，更多的主动屈曲，并增加步行功能。预计这项干预不会显著影响休息时的疼痛。这项研究是关于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，并防止新的慢性疼痛综合征发展的总体研究计划的下一个阶段。该项目具有创新性，因为它将运动疼痛(目前疼痛治疗基本上无法控制的疼痛类型)与休息疼痛区分开来，并针对手术后运动疼痛的TENS效果。这项研究还通过测试TENS对痛觉过敏的影响，将BASE(动物模型)科学翻译成人类受试者。术后活动疼痛的处理对于老年人恢复功能和避免慢性疼痛的其他来源至关重要。通过改善功能状态，老年人可以保持独立性，并可能降低他们的医疗保健利用率和成本。

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.