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

TENS 对 TKR 后痛觉过敏、运动疼痛和功能的有效性

• 批准号: 7634509
• 负责人: Barbara Rakel
• 金额: $ 54.54万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7634509
• 关键词: Abdomen; Absence of pain sensation; Address; Age; Analgesics; Animal Model; Animals; Characteristics; Complex Regional Pain Syndromes; Control Groups; Degenerative polyarthritis; Development; Dose; Effectiveness; Elderly; Exercise; Experimental Designs; Goals; Hyperalgesia; Intervention; Left; Length; Length of Stay; Methods; Modeling; Movement; Operative Surgical Procedures; Orthopedic Procedures; Pain; Pain management; Pathway interactions; Patients; Persons; Phase; Physical therapy; Placebos; Population; Postoperative Period; Randomized; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Personnel; Rest; Risk; Schedule; Science; Source; Syndrome; Testing; Time; Transcutaneous Electric Nerve Stimulation; Translating; Walking; Work; base; chronic pain; cost; efficacy testing; experience; functional outcomes; functional status; health care service utilization; human subject; improved; improved functioning; innovation; knee replacement arthroplasty; prevent; programs; prospective; standard care

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.

描述（由申请人提供）：全膝关节置换术（TKR）后疼痛控制不充分与老年人的功能恢复不良、住院时间延长以及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经历的严重疼痛。需要研究解决恢复过程中运动引起的疼痛的疼痛控制治疗方法。本研究的主要目的是测试间歇性、强烈（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）对术后痛觉过敏、运动疼痛、主动屈曲和 TKR 后步行功能的影响。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。将采用前瞻性、随机实验设计来比较活性 TENS、安慰剂 TENS 和单独镇痛对 321 名计划接受 TKR 的骨关节炎患者的效果。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 的老年人，运动引起的疼痛明显减少，术后痛觉过敏减少，主动屈曲程度提高，行走功能增强。预计干预措施不会显着影响静息疼痛。这项研究是总体研究计划的下一阶段，该研究计划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（当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 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（动物模型）科学应用于人类受试者。术后期间通过运动控制疼痛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率和成本。