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: 7849100
• 负责人: Barbara Rakel
• 金额: $ 1.15万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-14 至 2010-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7849100
• 关键词: Abdomen; Address; Age; Analgesics; Animal Model; Animals; Area; Brief Pain Inventory; Characteristics; Complex Regional Pain Syndromes; Control Groups; Development; Disease; Dose; Effectiveness; Elderly; Equilibrium; Exercise; Experimental Designs; Gait; Goals; Health; Hyperalgesia; Intervention; Iowa; Knee; Left; Length; Measures; Methods; Modeling; Movement; Numeric Rating Scale; 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; Science; Sensory; Source; Strategic Planning; Syndrome; Testing; Time; Transcutaneous Electric Nerve Stimulation; Translating; Walking; Work; base; chronic pain; comparative efficacy; cost; efficacy testing; experience; functional outcomes; functional status; health care service utilization; human subject; improved; improved functioning; innovation; knee replacement arthroplasty; novel strategies; prevent; programs; prospective; standard care

DESCRIPTION (provided by applicant): Inadequate pain control after total knee replacement (TKR) is associated with poor functional recovery and the development of new chronic pain syndromes in older adults. Current methods are inadequate for controlling the severe pain experienced during postoperative physical therapy. This project is the next phase in an overall program of research on the use of balanced non-pharmacologic and pharmacologic strategies to improve movement-evoked pain and enhance function. This application fits with the NINR Strategic Plan's Area of Research Emphasis, Promoting Health and Preventing Disease, by evaluating a new approach to transcutaneous electrical nerve stimulation (TENS) therapy to decrease pain, improve function, and prevent the development of new chronic pain syndromes in older adults after TKR. The aims of this study are to: 1) test the efficacy of intermittent, intense (high amplitude) TENS, applied intermittently as a supplement to current pharmacologic therapy during recovery activities, on postoperative hyperalgesia (i.e. pain sensitization) and movement-evoked pain after TKR; 2) determine the effect of pain intensity on function and the development of new chronic pain syndromes after TKR; and 3) validate the proposed model by exploring the pathways through which predictor variables influence postoperative hyperalgesia, movement-evoked pain, and function. A prospective, randomized, experimental design will be used to compare the efficacy of active TENS to placebo TENS and standard care in 321 patients (106 per group). TENS will be used during exercise sessions for 6 weeks after TKR. Hyperalgesia will be measured using quantitative sensory testing, pain intensity using a verbal 0-20 numeric rating scale, function using active flexion and the Iowa Gait Test, and chronic pain syndrome using the Brief Pain Inventory. Multiple subject characteristics, surgical variables, and rehabilitation variables will be measured and controlled for in the GEE analyses. It is hypothesized that TENS decreases pain with movement by reducing hyperalgesia. Minimizing the severe pain experienced during required activities in the immediate postoperative period will improve functional recovery and prevent the development of new chronic pain syndromes. Innovative aspects of this project are that it distinguishes pain with movement (the type of pain largely uncontrolled with current pain treatments) from pain at rest and uses a new TENS approach to target movement-evoked pain after surgery. This study translates bench (animal model) science to human subjects by testing the effect of TENS on hyperalgesia. Management of pain after knee surgery is critical to return of function and avoiding the development of new chronic pain syndromes in older adults. By improving functional status, older adults can retain independence and possibly reduce their health care utilization and costs. Management of pain after knee surgery is critical to return of function and avoiding the development of new chronic pain syndromes 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功能恢复不良和新的慢性疼痛综合征的发生有关。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。该项目是利用平衡的非药物和药物策略来改善运动引起的疼痛和增强功能的总体研究计划的下一阶段。该应用程序通过评估经皮神经电刺激 (TENS) 疗法的新方法来减少疼痛、改善功能并防止老年人在 TKR 后出现新的慢性疼痛综合征，符合 NINR 战略计划的研究重点领域，即促进健康和预防疾病。本研究的目的是：1) 测试间歇性、强烈（高振幅）TENS（在恢复活动期间间歇性应用作为当前药物治疗的补充）对 TKR 术后痛觉过敏（即疼痛敏化）和运动诱发疼痛的疗效； 2) 确定疼痛强度对功能的影响以及 TKR 后新的慢性疼痛综合征的发展； 3）通过探索预测变量影响术后痛觉过敏、运动引起的疼痛和功能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 与安慰剂 TENS 和标准护理对 321 名患者（每组 106 名）的疗效。 TENS 将在 TKR 后 6 周的锻炼期间使用。痛觉过敏将使用定量感觉测试来测量，疼痛强度将使用言语0-20数字评级量表来测量，功能将使用主动屈曲和爱荷华步态测试来测量，慢性疼痛综合征将使用简要疼痛量表来测量。在 GEE 分析中将测量和控制多个受试者特征、手术变量和康复变量。据推测，TENS 通过减少痛觉过敏来减轻运动时的疼痛。尽量减少术后立即进行所需活动时所经历的剧烈疼痛将改善功能恢复并防止新的慢性疼痛综合征的发展。该项目的创新之处在于，它将运动疼痛（当前疼痛治疗很大程度上无法控制的疼痛类型）与休息疼痛区分开来，并使用新的 TENS 方法来针对手术后运动引起的疼痛。这项研究通过测试 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。膝关节手术后的疼痛管理对于老年人功能恢复和避免出现新的慢性疼痛综合征至关重要。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。膝关节手术后疼痛的管理对于功能恢复和避免发展至关重要 老年人新的慢性疼痛综合症。通过改善功能状态，老年人可以保留 独立性，并可能减少他们的医疗保健利用率和成本。