New approaches to transcutaneous electrical nerve stimulation studied

Current post-operative pain control methods have proved inadequate for those who have undergone total knee replacement (TKR), according to University of Iowa College of Nursing researcher.

Barbara Rakel, Ph.D., assistant professor of nursing, was recently awarded a $2.1 million grant from the National Institute of Nursing Research to study the use of balanced nonpharmacologic and pharmacologic strategies to improve movement-evoked pain and enhance function in TKR patients.

Rakel's study will evaluate a new approach to transcutaneous electrical nerve stimulation (TENS), a decades-old pain control therapy which involves application of electric impulses to nerve endings through electrodes placed on the skin.

This project distinguishes pain with movement -- the type of pain largely uncontrolled with current pain treatments -- from pain at rest. It uses a new TENS approach to target movement-evoked pain after surgery. Rakel will test the effectiveness of intense (high amplitude) TENS, applied intermittently as a supplement to current drug therapy during recovery activities.

The aim is to decrease pain, improve function and prevent the development of new chronic pain syndromes in older adults after TKR.

The study will compare the effectiveness of active TENS to placebo TENS and standard care in 321 patients. TENS will be used during exercise sessions for six weeks after TKR. Various methods will be used to measure pain sensitivity, pain intensity, function and chronic pain syndrome. This study translates bench (animal model) science to human subjects by testing the effect of TENS on severe pain sensitivity.

Rakel teaches in the Systems and Practice Area of Study in the UI College of Nursing.

The UI College of Nursing educates nurses at the undergraduate, graduate and doctoral levels, providing both clinical experience and research opportunities. Ranked No. 1 in nursing administration education and adult and gerontologic nursing among the nation's public universities, the college also excels in child and family health, informatics and genetics. Known for the development of evidence-based protocols for care that are used throughout the nursing community, UI College of Nursing scientists seek to improve clinical outcomes and enhance nursing practice worldwide.