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、住院时间延长和新发慢性疼痛相关。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，解决运动诱发的疼痛在恢复过程中需要进行调查。本研究的主要目的是测试间歇性强（高振幅）经皮神经电刺激（TENS）作为恢复活动期间当前药物治疗的补充对TKR术后痛觉过敏、运动疼痛、主动屈曲和行走功能的影响。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。将采用前瞻性随机实验设计，在321例计划接受TKR的骨关节炎患者中比较活性TENS、安慰剂TENS和单独镇痛的效果。据推测，与接受安慰剂TENS或未接受TENS治疗的老年人相比，在TKR后6周的运动过程中接受间歇性、高强度TENS治疗的老年人运动诱发疼痛、术后痛觉过敏、主动屈曲和行走功能显著减少。预计干预不会显著影响静息疼痛。这项研究是一项整体研究计划的下一阶段，该计划旨在使用非药物干预措施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。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不受控制的疼痛类型）与休息疼痛区分开来，并针对TENS对手术后运动疼痛的影响。这项研究还通过测试TENS对痛觉过敏的影响将实验室（动物模型）科学转化为人类受试者。在术后期间，通过运动来管理疼痛对于恢复功能和避免老年人慢性疼痛的额外来源至关重要。通过改善功能状态，老年人可以保持独立，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.