Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: a randomized, blinded, placebo-controlled trial
Open accessAbstract
This study evaluated the efficacy of transcutaneous electrical nerve stimulation (TENS) in reducing pain and hyperalgesia and increasing function after total knee arthroplasty (TKA). We hypothesized that participants using TENS during rehabilitation exercises would report significantly lower pain during range-of-motion (ROM) activity and fast walking but not at rest, would have less hyperalgesia, and would have better function than participants receiving placebo-TENS or standard care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing, and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses in 317 participants after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1 to 2 times per day at 42 mA (on average) and had less pain postoperatively during active knee extension (P=.019) and fast walking (P=.006) than standard care participants. TENS and placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those who scored high on these factors (P=.002 and P=.03). Both TENS and placebo-TENS participants had less postoperative mechanical hyperalgesia (P=.03-.01) than standard care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively, but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS.
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Catastrophizing uniquely influences the experience of pain.
“Although catastrophizing uniquely influences the experience of pain, it also overlaps and interacts with other psychosocial processes including depression, anxiety, distress, fear of pain, self-efficacy, optimism, and other positive factors 32, 306, 333, 334.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [306]
Catastrophizing overlaps and interacts with other psychosocial processes including depression, anxiety, distress, fear of pain, self-efficacy, optimism, and other positive factors.
“it also overlaps and interacts with other psychosocial processes including depression, anxiety, distress, fear of pain, self-efficacy, optimism, and other positive factors 32, 306, 333, 334.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [306]
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- Authors
- Rakel, B. A., Zimmerman, B. M., Geasland, K., Embree, J., Clark, C. R., Noiseux, N. O., Callaghan, J. J., Herr, K., Walsh, D., & Sluka, K. A.
- Affiliations
- University of Iowa (US)
- University of Ulster (GB)
- Corresponding author
- Rakel, Barbara A.
- ORCID
- Venue
- Pain
- Published
- 2014-12
- Volume
- 155
- Issue
- 12
- Pages
- 2599-2611
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC4250415
- OpenAlex
- W2044972804
- Cited by
- 115
- References
- 81
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 6 · 2023: 5 · 2022: 16 · 2021: 11 · 2020: 10 · 2019: 12 · 2018: 11 · 2017: 15 · 2016: 6 · 2015: 5
- FWCI
- 11.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Iowa Research Online (The University of Iowa) (submittedVersion)
- Funders
- National Institute of Nursing Research (R01 NR009844)
- National Institute of Health
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Keywords
- transcutaneous electrical nerve stimulation, total knee arthroplasty, postoperative pain, hyperalgesia, rehabilitation, walking speed, pain catastrophizing, trait anxiety, depression, placebo effect, analgesia, quantitative sensory testing
- MeSH terms
- Aged, Analgesics, Opioid, Depression, Double-Blind Method, Transcutaneous Electric Nerve Stimulation, Female, Humans, Hyperalgesia, Male, Middle Aged, Oxycodone, Pain, Pain Measurement, Postoperative Complications, Psychiatric Status Rating Scales, Retrospective Studies, Range of Motion, Articular, Outcome Assessment, Health Care, Pain Threshold, Arthroplasty, Replacement, Knee
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