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和新的慢性疼痛综合征的发展有关。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。该项目是使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整体研究计划的下一个阶段。通过评估经皮神经电刺激（TENS）治疗减轻老年人TKR后疼痛、改善功能和预防新慢性疼痛综合征的新方法，该应用符合NINR战略计划的研究重点领域，促进健康和预防疾病。本研究的目的是：1)测试间歇性，高强度（高振幅）TENS的疗效，在恢复活动期间间歇性地作为当前药物治疗的补充，用于TKR术后痛觉过敏（即疼痛致敏）和运动诱发性疼痛；2)确定疼痛强度对TKR术后功能及新发慢性疼痛综合征的影响；3)通过探索预测变量影响术后痛觉过敏、运动诱发疼痛和功能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例患者（每组106例）的活性TENS与安慰剂TENS和标准治疗的疗效。TENS将在TKR后6周的锻炼期间使用。痛觉过敏将使用定量感官测试来测量，疼痛强度使用口头0-20数值评定量表，功能使用主动屈曲和爱荷华步态测试，慢性疼痛综合征使用简短疼痛量表。在GEE分析中，将测量和控制多受试者特征、手术变量和康复变量。据推测，TENS通过减轻痛觉过敏来减轻运动带来的疼痛。将术后必需活动期间的剧烈疼痛减到最小，将改善功能恢复，防止新的慢性疼痛综合征的发生。这个项目的创新之处在于，它区分了运动疼痛（目前的疼痛治疗基本上无法控制的疼痛类型）和静止疼痛，并使用了一种新的TENS方法来针对手术后运动引起的疼痛。本研究通过测试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。膝关节手术后疼痛的管理对于老年人功能恢复和避免新的慢性疼痛综合征的发展至关重要。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。膝关节手术后疼痛的处理是恢复功能和避免发展的关键

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.