Transcutaneous Electrical Nerve Stimulation (TENS) for Postoperative Pain Relief: Difference between revisions
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[[Category:Electrophysical]] |
Latest revision as of 15:23, 26 September 2020
Original Editor - Aminat Abolade
Original Editor - User Name
Top Contributors - Aminat Abolade, Kim Jackson and Leana Louw
Introduction[edit | edit source]
Traditional management of postoperative pain with the use of opiates has resulted in unwanted side effects such as respiratory depression, nausea and vomiting, hypotension and bradycardia, pruritus and inhibition of bowel movements. Investigations on effective management of postoperative pain with minimal side effects has led to the use of Transcutaneous Electrical Nerve Stimulation (TENS) due to its success in pain control.
The effects of extensive use of Transcutaneous Electrical Nerve Stimulation (TENS) to control postoperative pain has been quite controversial and this can be attributable to the varying intensity of postoperative pain and the type of surgical operation performed.[1]
How Transcutaneous Electrical Nerve Stimulation is applied [edit | edit source]
Description[edit | edit source]
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive, non -pharmacologic method of pain relief through electrical stimulation. The use of TENS postoperatively has showed a reduction in the use of analgesics in patients and a reduction in occurrence of postoperative complications such as respiratory depression. Although, reports have showed that some surgical procedures are too painful for TENS to have a significant effect on pain such as in severe postoperative pain after posterior thoracotomy.
Application of TENS as an auxiliary therapeutic method in management of acute and chronic pain of various abdominal and thoracic surgeries occurred since 1970. Its use was based on the Gate Control Theory of Pain and daily repeated application produces analgesic tolerance at spinal opioid receptors and increases the toleration threshold of pain. In addition, TENS results in the release of endorphins, serotonin, analgesic hormones and reduction of cytokine levels and increases blood flow to the muscle tissue. Recent studies have showed that use of TENS in patients resulted in significant pain reduction during respiratory manoeuvres and higher maximal expiratory pressure[2], improvement in pulmonary function, low blood cytokine levels and narcotic consumption[3] and improvement in cognitive functions in patients undergoing spinal surgery[4].
Studies in Postoperative Rehabilitation[edit | edit source]
RESEARCH STUDY | TREATMENT PLAN | RESULT | CONCLUSION | ||||
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Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on postoperative pain in patients who underwent different types of thoracic surgical procedures: posterolateral thoracotomy, muscle-sparing thoracotomy, costotomy, sternotomy, and video-assisted thoracoscopy.[5] |
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Conclusions from this study showed that TENS is not effective for severe pain and should be applied only when postoperative pain is mild to moderate after thoracic surgical procedures. | ||||
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Effects of Transcutaneous Electrical Nerve stimulation (TENS) on persistent postoperative pain in rehabilitation of a patient after a multilevel spinal fusion for spinal stenosis[7] | TENS was used for up to 8 hours a day in combination with a progressive walking exercise programme from pool to land. Progression was determined from shuttle walk test results. |
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Further investigation is needed to confirm the validity of this physiotherapy approach used. | ||||
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Use of TENS in addition to postoperative analgesia twice daily for 3 days. Data for the active and inactive groups were compared using the Mann-Whitney U test and the Wilcoxon matched pairs signed ranks test. |
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Use of TENS did not reduce postoperative pain but TENS had considerable patient appeal and many patients believed that it was effective. |
Implications for use in physiotherapy[edit | edit source]
A lot of investigations have been carried out on the clinical efficacy of TENS for acute and chronic pain management including knee osteoarthritis, rheumatoid arthritis, low back pain, neck pain, post-amputation pain, post-stroke pain, spinal cord injury, diabetic peripheral neuropathy, chronic and recurrent headache, neuropathic pain, and cancer pain. However, there was an extensive variation in the frequency of use and this could be attributable to a lack of knowledge of the modality, and neurophysiological rationale underpinning it, or perhaps a lack of confidence with results and often reviewers are unable to make definitive judgement about clinical efficacy because of inadequate Randomised Controlled Trial (RCT) design, poor reporting and concerns about trial fidelity and TENS technique.[9] Consequently, the use of TENS as an adjunct to analgesic medication in multi-modal management of acute post-surgical pain should be considered.
Resources[edit | edit source]
- Control of postoperative pain by Transcutaneous electrical nerve stimulation after thoracic operations.
- Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial
- Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy
- Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain
- Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty
References[edit | edit source]
- ↑ Cuschieri RJ, Morran CG, McArdle CS. Transcutaneous electrical stimulation for postoperative pain. Annals of the Royal College of Surgeons of England. 1985 Mar;67(2):127.
- ↑ Galli TT, Chiavegato LD, Liebano RE. Effects of TENS in living kidney donors submitted to open nephrectomy: A randomized placebo‐controlled trial. European Journal of Pain. 2015 Jan;19(1):67-76.
- ↑ Fiorelli A, Morgillo F, Milione R, Pace MC, Passavanti MB, Laperuta P, Aurilio C, Santini M. Control of post-thoracotomy pain by transcutaneous electrical nerve stimulation: effect on serum cytokine levels, visual analogue scale, pulmonary function and medication. European Journal of Cardio-Thoracic Surgery. 2012 Apr 1;41(4):861-8.
- ↑ Unterrainer AF, Friedrich C, Krenn MH, Piotrowski WP, Golaszewski SM, Hitzl W. Postoperative and preincisional electrical nerve stimulation TENS reduce postoperative opioid requirement after major spinal surgery. Journal of Neurosurgical Anesthesiology. 2010 Jan 1;22(1):1-5.
- ↑ Benedetti F, Amanzio M, Casadio C, Cavallo A, Cianci R, Giobbe R, Mancuso M, Ruffini E, Maggi G. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. The Annals of thoracic surgery. 1997 Mar 1;63(3):773-6.
- ↑ Elboim-Gabyzon M, Najjar SA, Shtarker H. Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial. Clinical interventions in aging. 2019;14:1841.
- ↑ Pons T, Shipton EA. Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain. Physiotherapy theory and practice. 2011 Apr 1;27(3):238-45.
- ↑ Gilbert JM, Gledhill T, Law N, George C. Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy. British journal of surgery. 1986 Sep;73(9):749-51.
- ↑ Dafny, N. (2014). Pain modulation and mechanisms. In: Neuroscience online. Houston, TX: UTHealth.