Author: Tsang, Hin-cheung
Title: Analgesic effects of auricular transcutaneous electrical nerve stimulation (TENS) after abdominal hysterectomy
Degree: M.Sc.
Year: 2008
Subject: Hong Kong Polytechnic University -- Dissertations.
Transcutaneous electrical nerve stimulation.
Postoperative care.
Department: Department of Rehabilitation Sciences
Pages: xiv, 105 leaves : ill. (some col.) ; 30 cm.
Language: English
Abstract: Despite the progress in medical knowledge, technology and health care management, postoperative pain remains a major clinical issue. Opioid analgesics are the mainstay of pharmacological treatment for postoperative pain. Although they are effective in relieving pain at rest, they are inadequate to relieve movement-evoked pain e.g. during activities like coughing and mobilization. Moreover, their usage is limited by the adverse side effects. Therefore, the use of non-pharmacological means of analgesia has been advocated. Transcutaneous electrical nerve stimulation (TENS) is a common pain relieving modality used in physiotherapy. TENS applied to auricular acupuncture points known as auricular TENS was found to increase the pain threshold in normal healthy subjects while needling auricular acupuncture points was found to reduce analgesic consumption in patients after surgery. This study examined the effectiveness of auricular TENS in relieving postoperative pain. The present study was a prospective randomized, double-blind, controlled trial. Forty-eight women with a mean age of 45.27, underwent total abdominal hysterectomy were randomly assigned to either one of the two treatment groups or the control group (n=16 each). All patients were operated under a standardized general anesthesia protocol and were treated with standardized postoperative analgesics. The study was performed on the first day after operation. Auricular TENS was applied to five therapeutic points ("uterus", "abdomen", "sympathetic", "shenmen" and "subcortex") in the "True TENS group" and five inappropriate points ("teeth", "tongue", "mandible", "eye" and "face") in the "Sham TENS" group. Each point was stimulated at frequency of 1 Hz for 90 seconds with current intensity up to patients' maximum tolerance level. Patients in the control group did not receive auricular TENS. Postoperative pain at rest (VAS-rest), upon huffing (VAS-huff) and coughing (VAS-cough) as well as the peak expiratory flow rate (PEFR) were assessed before and at 0, 15 and 30 minutes after auricular TENS. Repeated measures analysis of variance (ANOVA) was used for data analysis. The mean scores of VAS-rest, VAS-huff, VAS-cough and the mean PEFR were all comparable among the three study groups before intervention was given. Auricular TENS applied to therapeutic points resulted in a significant decrease in the scores of VAS-rest, VAS-huff and VAS-cough (all p<0.005). The score reduction occurred in a gradual and progressive manner and continued beyond the termination of treatment. During the study period, true auricular TENS produced a maximal score reduction of 45.95% in VAS-rest, 43.90% in VAS-huff and 32.65% in VAS-cough whereas the sham auricular TENS produced a maximal score reduction of 14.05% in VAS-rest, 4.72% in VAS-huff and 5.10% in VAS-cough respectively. In both treatment groups, maximal reduction of resting pain occurred at 15 minutes after intervention and the level of movement-evoked pain appeared to drop beyond 30 minutes after intervention. In contrast, the VAS scores of the control group demonstrated a rising trend in VAS-rest and VAS-huff and it remained stable in VAS-cough during the study period. Between-group comparison revealed that the VAS scores of the "True TENS" group were significantly lower than the control group at 15 and 30 minutes after intervention in all the three VAS measurements (all p<0.02). Patients in both the "True TENS" group and the "Sham TENS" group showed no significant improvement in PEFR but there was a significant drop in PEFR (p=0.000) for patients in the control group. No between-group difference was observed at any time point. To conclude, a single session of auricular TENS applied to specific therapeutic points significantly reduced the resting pain (VAS-rest) and movement-evoked pain (VAS-huff, VAS-cough) as compared to the control group. The pain reduction outlasted the treatment for at least 30 minutes. The analgesic effects of auricular TENS appeared to be point specific and cannot be totally attributed to placebo alone. However, auricular TENS did not demonstrate significant improvement in the performance of PEFR.
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