Background & Aims
People with knee osteoarthritis (KOA) often have co-morbid pain in the lower back and lower extremities. Transcutaneous electrical nerve stimulation (TENS) has been shown to provide analgesia for movement-evoked pain (MEP) when stimulated in the affected area, but it is complicated to apply TENS to both knees and lower back. TENS mechanisms underlying gate control theory provide analgesia in the stimulated innervational area and stimulation of the same dermatome segment as the affected area provides analgesia. Applying TENS to the lumbar region, the same dermatome as for the knee is possibly effective for pain in both knees, but it has not been well established. The study aims to preliminarily investigate whether lower back wearable TENS have simultaneous analgesic effects on the MEP of the bilateral knee.
Methods
The study design was a participant-blinded, randomized controlled trial with three groups. Inclusion criteria were 45 – 75 years of age with KOA, and who have pain when walking for one week. A customized TENS, HV-F710 (Omron Healthcare) was used. The pulse frequency of high-frequency (H-TENS) and modulated frequency (MF-TENS) were set to 100Hz and from 10 to 100Hz respectively. Placebo (P-TENS) was no stimulation. The electrodes were placed on the lower back at the L3 and L4 dermatomes. The ground walking, stair climbing, and the 30-second chair stand test (CS-30) as MEP tests were conducted at pre and during the TENS. The intensity of knee pain for each MEP test was assessed using a visual analogue scale (VAS). Data were analyzed using the Wilcoxon signed?rank test for participants with bilateral knee pain to assess differences between pre and during TENS within each group and analyzed using the Kruskal-Wallis test for differences between the groups.
Results
57 participants allocated randomly to three groups (H-TENS, MF-TENS, and P-TENS) completed the study. Of those who completed the study, 27 participants with bilateral knee pain were preliminarily analyzed. The VAS scores of the HF-TENS and MF-TENS groups on the ground walking test, stair ascending and descending test, and CS-30 were significantly reduced during stimulation compared to pre-stimulation. On the other hand, the VAS scores of the P-TENS group on all MEP tests were not significantly reduced. There were no significant VAS scores on all MEP test differences between the three groups. The significance level was set at ? = 0.05.
Conclusions
Preliminary results appeared to demonstrate that H-TENS and MF-TENS applied to the lumbar region at the L3, and L4 dermatomes were potentially effective for bilateral knee MEP in participants with KOA. For low back pain, previous studies have shown that applying TENS to the lower back is effective. These results suggest the possibility of simultaneous analgesia for the lower back and bilateral knees by applying TENS to the lumbar region in people with co-morbid lower back and knee pain.
References
[1] Al-Smadi J, Warke K, Wilson I, Cramp AF, Noble G, Walsh DM, Lowe-Strong AS. A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Clin Rehabil 2003;17(7):742-749.
[2] Amarasinghe P, Wadugodapitiya S, Weerasekara I. Biomechanical and clinical relationships between lower back pain and knee osteoarthritis: a systematic review. Syst Rev 2023;12(1):28.
[3] Johnson MI. Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in perioperative settings: a critical review. Expert Rev Neurother 2017;17(10):1013-1027.
[4] Kawamura H, Tsujishita M. Comparison of the effective intensity of transcutaneous electrical nerve stimulation contralateral to a pain site for analgesia. J Phys Ther Sci 2022;34(10):704-709.
[5] Lawson D, Degani AM, Lee K, Beer EI, Gohlke KE, Hamidi KN, Coler MA, Tews NM. Use of transcutaneous electrical nerve stimulation along with functional tasks for immediate pain relief in individuals with knee osteoarthritis. Eur J Pain 2022;26(3):754-765.
[6] Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150(3699):971-979.
[7] Metcalfe AJ, Andersson ML, Goodfellow R, Thorstensson CA. Is knee osteoarthritis a symmetrical disease? Analysis of a 12 year prospective cohort study. BMC Musculoskelet Disord 2012;13:153.
[8] Shimoura K, Iijima H, Suzuki Y, Aoyama T. Immediate Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Physical Performance in Individuals With Preradiographic Knee Osteoarthritis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019;100(2):300-306 e301.
[9] Topuz O, Özfidan E, Ozgen M, Ardic F. Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain. J Back Musculoskelet Rehabil 2004;17(3-4):127-133.
[10] Vance CGT, Zimmerman MB, Dailey DL, Rakel BA, Geasland KM, Chimenti RL, Williams JM, Golchha M, Crofford LJ, Sluka KA. Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia. Pain 2021;162(5):1545-1555.
[11] Wolfe F, Hawley DJ, Peloso PM, Wilson K, Anderson J. Back pain in osteoarthritis of the knee. Arthritis Care Res 1996;9(5):376-383.
[12] Yoshimura N, Akune T, Fujiwara S, Shimizu Y, Yoshida H, Omori G, Sudo A, Nishiwaki Y, Yoshida M, Shimokata H, Suzuki T, Muraki S, Oka H, Nakamura K. Prevalence of knee pain, lumbar pain and its coexistence in Japanese men and women: The Longitudinal Cohorts of Motor System Organ (LOCOMO) study. J Bone Miner Metab 2014;32(5):524-532.
Presenting Author
Shozo Takamatsu
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other