Rakel Barbara, Frantz Rita
Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
J Pain. 2003 Oct;4(8):455-64. doi: 10.1067/s1526-5900(03)00780-6.
This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in significantly less pain than the control during both walking (P <.5) and vital capacity activities (P <.1) and significantly less pain than placebo TENS during vital capacity (P <.01). TENS also produced significantly better gait speeds than the control (P <.05) and greater gait distances (P <.01) than the control and placebo TENS. Vital capacity and pain intensity at rest were not significantly different among the 3 treatments. These results suggest TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia. The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia.
本研究测试了间歇性经皮电神经刺激（TENS）作为腹部手术后运动及静息时疼痛的药物镇痛补充手段的有效性，并评估了在步行和肺活量动作期间使用TENS是否能提高这些活动的表现。采用交叉设计，将频率调制、强度调至受试者可耐受的最高水平且电极置于切口两侧并与切口平行的TENS，与安慰剂TENS及单纯药物镇痛（对照）进行比较。对33名受试者的疼痛强度、步行功能和肺活量进行自我报告评估。在步行（P<.05）和肺活量活动（P<.01）期间，TENS导致的疼痛均显著少于对照，在肺活量活动期间，TENS导致的疼痛也显著少于安慰剂TENS（P<.01）。TENS还产生了显著优于对照的步态速度（P<.05），以及优于对照和安慰剂TENS的更大步幅（P<.01）。三种治疗方法在静息时的肺活量和疼痛强度无显著差异。这些结果表明，当作为药物镇痛的补充手段使用时，TENS可减轻步行和深呼吸时的疼痛强度，并提高术后的步行功能。对静息时疼痛无影响支持了TENS通过减轻痛觉过敏起作用的假说。
