Transcutaneous Electrical Nerve Stimulation (TENS) for Postoperative Pain Relief: Difference between revisions

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Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacologic strategy that is used to treat postoperative pain during cardiac operations,cholecystectomy,cesarean delivery, and thoracotomy. Further, in a systematic review,' Bjordal and colleagues' showed decreases in analgesic consumption in patients using TENS postoperatively. In addition, treatment with TENS results in a lower incidence of postoperative complications, such as paralytic ileum and atelectasis, and improves pulmonary function. However, some surgical procedures seem to be too painful for TENS to have a significant effect on the pain, as an example, posterior thoracotomy results in severe postoperative pain that is unaffected by TENS.  
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacologic strategy that is used to treat postoperative pain during cardiac operations,cholecystectomy,cesarean delivery, and thoracotomy. Further, in a systematic review,' Bjordal and colleagues' showed decreases in analgesic consumption in patients using TENS postoperatively. In addition, treatment with TENS results in a lower incidence of postoperative complications, such as paralytic ileum and atelectasis, and improves pulmonary function. However, some surgical procedures seem to be too painful for TENS to have a significant effect on the pain, as an example, posterior thoracotomy results in severe postoperative pain that is unaffected by TENS.  


Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a complementary therapeutic option to control chronic and acute pain of various procedures such as abdominal and thoracic surgeries since 1970. One of the mechanisms of the analgesia produced by TENS was described by Melzak and Wall (1967) in the mid-1960s. It is based on the Gate Control theory of pain, in which the modulation of pain results from the activation of descending inhibitory pathways.<ref>Dafny, N. (2014). Pain modulation and mechanisms. In: Neuroscience online. Houston, TX: UTHealth. </ref> TENS is a safe and simple method whose daily repeated application produces analgesic tolerance at spinal opioid receptors and increases the toleration threshold of pain. Also, TENS leads to the release of endorphins and serotonin and analgesic hormones and reduction of cytokine levels. Furthermore, electrical stimulation indirectly improves muscle spasm by increasing blood flow to muscle tissue. In the 2015 study by Galli, Chiavegato, and Liebano conducted on 74 kidney donors, patients in TENS group had significantly lower pain during respiratory maneuvers and higher maximal expiratory pressure compared with the control group. In another study, Fiorelli et al. (2012) applied TENS after thoracotomy for 5 consecutive days and found that pulmonary function (forced expiratory volume in 1 second [FEV1] to forced volume capacity [FVC] ratio) was significantly better and blood cytokine levels and narcotic consumption were significantly lower in the TENS group than the placebo group.<ref>Fiorelli, A., Morgillo, F., Milione, R., Pace, M. C., Passavanti, M. B., Laperuta, P., & Santini, M. (2011). 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, 41(4), 861–868. </ref> In addition to the pain relief action of TENS, Unterrainer et al. (2010) reported the effectiveness of TENS in improving cognitive functions in patients undergoing spinal surgery.<ref>Jahangirifard, A., Razavi, M., Ahmadi, Z. H., & Forozeshfard, M. (2018). [https://www.sciencedirect.com/science/article/abs/pii/S1524904216302302 Effect of TENS on postoperative pain and pulmonary function in patients undergoing coronary artery bypass surgery]. ''Pain Management Nursing'', ''19''(4), 408-414.</ref>
Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a complementary therapeutic option to control chronic and acute pain of various procedures such as abdominal and thoracic surgeries since 1970. One of the mechanisms of the analgesia produced by TENS was described by Melzak and Wall (1967) in the mid-1960s. It is based on the Gate Control theory of pain, in which the modulation of pain results from the activation of descending inhibitory pathways.<ref>Dafny, N. (2014). Pain modulation and mechanisms. In: Neuroscience online. Houston, TX: UTHealth. </ref> TENS is a safe and simple method whose daily repeated application produces analgesic tolerance at spinal opioid receptors and increases the toleration threshold of pain. Also, TENS leads to the release of endorphins and serotonin and analgesic hormones and reduction of cytokine levels. Furthermore, electrical stimulation indirectly improves muscle spasm by increasing blood flow to muscle tissue. In the 2015 study by Galli, Chiavegato, and Liebano conducted on 74 kidney donors, patients in TENS group had significantly lower pain during respiratory maneuvers and higher maximal expiratory pressure compared with the control group. In another study, Fiorelli et al. (2012) applied TENS after thoracotomy for 5 consecutive days and found that pulmonary function (forced expiratory volume in 1 second [FEV1] to forced volume capacity [FVC] ratio) was significantly better and blood cytokine levels and narcotic consumption were significantly lower in the TENS group than the placebo group.<ref>Fiorelli, A., Morgillo, F., Milione, R., Pace, M. C., Passavanti, M. B., Laperuta, P., & Santini, M. (2011). [https://academic.oup.com/ejcts/article/41/4/861/644124 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, 41(4), 861–868. </ref> In addition to the pain relief action of TENS, Unterrainer et al. (2010) reported the effectiveness of TENS in improving cognitive functions in patients undergoing spinal surgery.<ref>Jahangirifard, A., Razavi, M., Ahmadi, Z. H., & Forozeshfard, M. (2018). [https://www.sciencedirect.com/science/article/abs/pii/S1524904216302302 Effect of TENS on postoperative pain and pulmonary function in patients undergoing coronary artery bypass surgery]. ''Pain Management Nursing'', ''19''(4), 408-414.</ref>


Hence, simultaneous use of TENS with pharmacologic therapies for analgesia should produce a greater reduction in postoperative pain and a concomitantly decreasing medicine intake, reducing side effects, and improving treatment for pain.<ref name=":0" />
Hence, simultaneous use of TENS with pharmacologic therapies for analgesia should produce a greater reduction in postoperative pain and a concomitantly decreasing medicine intake, reducing side effects, and improving treatment for pain.<ref name=":0" />

Revision as of 20:15, 15 September 2020

Original Editor - Aminat Abolade

Top Contributors - Aminat Abolade, Kim Jackson and Leana Louw  

Introduction[edit | edit source]

ElectricalMusclestimulation.jpg

Conventional approaches to the management of post-operative pain remains inadequate. Intermittent ‘on-demand’ administration of opiates results in fluctuating plasma levels and poor pain relief; increasing the frequency of administration and the amount of opiate may improve pain control but results in unwanted side effects. Intravenous opiate infusion may provide better analgesia but with the risk of respiratory depression.[1]

The success of Transcutaneous Electrical Stimulation in the management of chronic pain along with its absence of side effects, particularly respiratory depression, has led to its recent use in the management of post-operative pain. Transcutaneous Electrical Nerve stimulation (TENS) is an effective adjunctive therapy for postoperative pain; however, effects of different frequencies of stimulation have not been systematically investigated.[2]

Description[edit | edit source]

Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacologic strategy that is used to treat postoperative pain during cardiac operations,cholecystectomy,cesarean delivery, and thoracotomy. Further, in a systematic review,' Bjordal and colleagues' showed decreases in analgesic consumption in patients using TENS postoperatively. In addition, treatment with TENS results in a lower incidence of postoperative complications, such as paralytic ileum and atelectasis, and improves pulmonary function. However, some surgical procedures seem to be too painful for TENS to have a significant effect on the pain, as an example, posterior thoracotomy results in severe postoperative pain that is unaffected by TENS.

Transcutaneous Electrical Nerve Stimulation (TENS) has been used as a complementary therapeutic option to control chronic and acute pain of various procedures such as abdominal and thoracic surgeries since 1970. One of the mechanisms of the analgesia produced by TENS was described by Melzak and Wall (1967) in the mid-1960s. It is based on the Gate Control theory of pain, in which the modulation of pain results from the activation of descending inhibitory pathways.[3] TENS is a safe and simple method whose daily repeated application produces analgesic tolerance at spinal opioid receptors and increases the toleration threshold of pain. Also, TENS leads to the release of endorphins and serotonin and analgesic hormones and reduction of cytokine levels. Furthermore, electrical stimulation indirectly improves muscle spasm by increasing blood flow to muscle tissue. In the 2015 study by Galli, Chiavegato, and Liebano conducted on 74 kidney donors, patients in TENS group had significantly lower pain during respiratory maneuvers and higher maximal expiratory pressure compared with the control group. In another study, Fiorelli et al. (2012) applied TENS after thoracotomy for 5 consecutive days and found that pulmonary function (forced expiratory volume in 1 second [FEV1] to forced volume capacity [FVC] ratio) was significantly better and blood cytokine levels and narcotic consumption were significantly lower in the TENS group than the placebo group.[4] In addition to the pain relief action of TENS, Unterrainer et al. (2010) reported the effectiveness of TENS in improving cognitive functions in patients undergoing spinal surgery.[5]

Hence, simultaneous use of TENS with pharmacologic therapies for analgesia should produce a greater reduction in postoperative pain and a concomitantly decreasing medicine intake, reducing side effects, and improving treatment for pain.[2]

Related article[edit | edit source]

References[edit | edit source]

  1. ↑ Cuschieri, R. J., Morran, C. G., & McArdle, C. S. (1985). Transcutaneous electrical stimulation for postoperative pain. Annals of the Royal College of Surgeons of England, 67(2), 127.
  2. ↑ 2.0 2.1 Desantana JM, Sluka KA, Lauretti GR. High and low frequency TENS reduce postoperative pain intensity after laparoscopic tubal ligation: a randomized controlled trial. Clin J Pain. 2009;25(1):12-19. doi:10.1097/AJP.0b013e31817d1070
  3. ↑ Dafny, N. (2014). Pain modulation and mechanisms. In: Neuroscience online. Houston, TX: UTHealth. 
  4. ↑ Fiorelli, A., Morgillo, F., Milione, R., Pace, M. C., Passavanti, M. B., Laperuta, P., & Santini, M. (2011). 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, 41(4), 861–868. 
  5. ↑ Jahangirifard, A., Razavi, M., Ahmadi, Z. H., & Forozeshfard, M. (2018). Effect of TENS on postoperative pain and pulmonary function in patients undergoing coronary artery bypass surgery. Pain Management Nursing, 19(4), 408-414.
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