Transcutaneous Electrical Nerve Stimulation (TENS) for Postoperative Pain Relief

Original Editor - Aminat Abolade

Original Editor - User Name

Top Contributors - Aminat Abolade, Kim Jackson and Leana Louw  

Introduction

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.

Description

Studies in Postoperative Rehabilitation

RESEARCH STUDY	TREATMENT PLAN	RESULT	CONCLUSION
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.	Assessment of the effectiveness of TENS was carried out based on two factors: the time from the beginning of treatment to the request for further analgesia and the total medication intake during the first 12 hours after operation. Three treatment groups: TENS, Placebo TENS and Control were used and each patient group was randomly subdivided into them.	TENS treatment was not effective in the posterolateral thoracotomy group while its use as an adjunct to analgesics was effective in the muscle-sparing thoracotomy, costotomy, and sternotomy groups. When TENS was applied without analgesics being used, it was very effective in patients having video-assisted thoracoscopy.	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.
Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on acute postoperative pain intensity and mobility after Hip Fracture	Twenty-four hours after surgery, the standard rehabilitation care began which included five-daily 30 minutes physical therapy treatments. Intensity of pain at rest, at night and during ambulation were evaluated using the Numeric Rating Scale, Functional Ambulation Classification instrument, time to complete five sit-to-stand tests and two-minute walk test. Wilcoxon score rank tests was used to analyse the data.	Remarkable loss of pain during walking and higher level of mobility in the active TENS group compared to the sham TENS group but no further effects were noted on pain intensity at rest and at night and on five times sit-to-stand performance.	Inclusion of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain management while walking and functional gait recovery. Further investigations on the effects of TENS on long-term functional outcomes should be done.
Effects of Transcutaneous Electrical Nerve stimulation (TENS) on persistent postoperative pain in rehabilitation of a patient after a multilevel spinal fusion for spinal stenosis	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.	Reduction in pain and improved walking distance.	Further investigation is needed to confirm the validity of this physiotherapy approach used.
Effects of Transcutaneous Electrical Nerve stimulation (TENS) on postoperative pain relief following inguinal herniorrhaphy	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.	An infected wound and a basal pulmonary collapse occurred in patients with inactive TENS machine. There was no significant difference between the groups with active or inactive TENS machines for either pain score, peak flow or pethidine requirement. Pain diminished significantly with time after operation, Peak expiratory flow decreased markedly after operation and then rose gradually.	Use of TENS did not reduce postoperative pain but TENS had considerable patient appeal and many patients believed that it was effective.

 

Resources

• 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