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The effectiveness of transcutaneous electrical nerve stimulation (TENS) on postoperative pain with movement

Posted on:2003-12-14Degree:Ph.DType:Thesis
University:The University of IowaCandidate:Rakel, Barbara AnnFull Text:PDF
GTID:2464390011489462Subject:Health Sciences
Abstract/Summary:
The current therapy of intravenous PCA opioid administration is frequently inadequate for controlling pain after abdominal surgery, particularly during movements such as walking and deep breathing which directly impact recovery. This suggests supplemental strategies are needed. Recent evidence shows high frequency, high intensity TENS reduces movement-evoked pain by decreasing hyperalgesia. The purpose of this study was to test the effectiveness of intermittent, intense TENS as a supplement to pharmacologic analgesia on pain with movement and pain at rest after abdominal surgery and determine if its use during walking and vital capacity maneuvers improves these activities. TENS was compared to placebo TENS and pharmacologic analgesia alone (control) using a slit plot design with TENS intensity as an independent variable. Subjects' self-report of pain intensity was assessed (using a vertical, 21-point NRS), along with walking function (using three objective components: gait speed, gait distance, and level of assistance) and vital capacity. Repeated measures ANOVA procedures with Tukey follow-up tests revealed significant differences in 33 subjects' pain intensity scores during gait speed (p < .05) and vital capacity maneuvers (p < .01). TENS resulted in significantly better scores than the control during both activities and significantly less pain than placebo TENS during vital capacity. Significant differences were also found for gait speed (p < .05) and gait distance (p < .01) with TENS resulting in significantly better gait speeds and greater gait distances than the control and significantly greater gait distances than placebo TENS. However, effect sizes were small (.07--.58). Vital capacity and pain intensity at rest were not significantly different. The intensity of the TENS sensation subjects used varied widely but no significant differences were found between subjects who used high and low TENS intensities. These results suggest that TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia. However, the small effect sizes suggest selective use is most appropriate. The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia. Further research is needed to investigate the impact of TENS on hyperalgesia around human surgical incisions.
Keywords/Search Tags:TENS, Pain, Vital capacity, Effect, Gait
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