{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T19:41:49Z","timestamp":1785526909001,"version":"3.56.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":68,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Total Knee Arthroplasty (TKA) is a widely used procedure to relieve disability associated with advanced knee osteoarthritis. The management of postoperative TKA is crucial for the success of surgery and patient satisfaction. This study aims to determine the effects of integrating transcutaneous electrical nerve stimulation into standard postoperative TKA care on acute resting pain scores and intravenous analgesic requirements during the first three postoperative days. This randomised controlled trial was conducted from July to December 2022 at two hospitals in Lahore, Punjab, Pakistan. A total of 60 participants with TKA, aged 41 to 85 years, were recruited through purposive sampling. The control group received standard intravenous analgesics and postoperative rehabilitation, and the experimental group received transcutaneous electrical nerve stimulation (TENS) additionally. TENS was applied at a frequency of 85\u00a0Hz, pulse width of 120 \u00b5s, and at low intensity as tolerated. Pain was measured through the numeric pain rating scale, and analgesic requirements were monitored through the prescription chart. The results showed significant between-group differences in pain reduction (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), whereas no statistically significant difference was observed in drug dose (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.06) and frequency (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.032\/ corrected\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0167). TENS was a useful integrated modality to conservative pharmacological management of pain after total knee arthroplasty.\n                  <\/jats:p>\n                  <jats:p>Trial registration: This trial was prospectively registered at ClinicalTrials.gov (Trial ID NCT05470244) on 13th July, 2022. https\/\/clinicaltrials.gov\/study\/NCT05470244.<\/jats:p>","DOI":"10.1038\/s41598-026-54205-9","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T05:43:56Z","timestamp":1779515036000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of transcutaneous electrical nerve stimulation in postoperative total knee arthroplasty pain and intravenous analgesic requirement"],"prefix":"10.1038","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05470244","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2180-8001","authenticated-orcid":false,"given":"Ayesha","family":"Jamil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahsan","family":"Javed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Adeel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Akram","family":"Naseem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"54205_CR1","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.3899\/jrheum.170990","volume":"46","author":"JA Singh","year":"2019","unstructured":"Singh, J. A., Yu, S., Chen, L. & Cleveland, J. D. Rates of total joint replacement in the United States: Future projections to 2020\u20132040 using the National Inpatient Sample. J. Rheumatol. 46, 1134\u20131140 (2019).","journal-title":"J. Rheumatol."},{"issue":"5","key":"54205_CR2","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1097\/ACO.0000000000001285","volume":"36","author":"DJ Dembek","year":"2023","unstructured":"Dembek, D. J. & Bicket, M. C. Advances in the management of persistent pain after total knee arthroplasty. Curr. Opin. Anesthesiol. 36 (5), 560\u2013564 (2023).","journal-title":"Curr. Opin. Anesthesiol"},{"key":"54205_CR3","doi-asserted-by":"publisher","first-page":"17660","DOI":"10.1038\/s41598-020-74986-x","volume":"10","author":"F Leiss","year":"2020","unstructured":"Leiss, F. et al. Pain management of unicompartmental (UKA) vs. total knee arthroplasty (TKA) based on a matched pair analysis of 4144 cases. Sci. Rep. 10, 17660 (2020).","journal-title":"Sci. Rep."},{"key":"54205_CR4","doi-asserted-by":"publisher","first-page":"2466","DOI":"10.1016\/j.arth.2021.02.044","volume":"36","author":"LWT Lo","year":"2021","unstructured":"Lo, L. W. T. et al. Early postoperative pain after total knee arthroplasty is associated with subsequent poorer functional outcomes and lower satisfaction. J. Arthroplasty. 36, 2466\u20132472. https:\/\/doi.org\/10.1016\/j.arth.2021.02.044 (2021).","journal-title":"J. Arthroplasty"},{"key":"54205_CR5","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.bpa.2019.02.004","volume":"33","author":"BS Kandarian","year":"2019","unstructured":"Kandarian, B. S., Elkassabany, N. M., Tamboli, M. & Mariano, E. R. Updates on multimodal analgesia and regional anaesthesia for total knee arthroplasty patients. Best Pract. Res. Clin. Anaesthesiol. 33, 111\u2013123. https:\/\/doi.org\/10.1016\/j.bpa.2019.02.004 (2019).","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"54205_CR6","doi-asserted-by":"publisher","first-page":"333","DOI":"10.3390\/healthcare9030333","volume":"9","author":"SJ Hyland","year":"2021","unstructured":"Hyland, S. J. et al. Perioperative pain management and opioid stewardship: A practical guide. Healthcare 9, 333. https:\/\/doi.org\/10.3390\/healthcare9030333 (2021).","journal-title":"Healthcare"},{"key":"54205_CR7","doi-asserted-by":"publisher","unstructured":"Cusma, W. H., Davis, B. J., Mak, R. A. & Brown, N. M. Decreasing post-operative narcotic usage following total knee arthroplasty requires more than simple education: a blinded randomized controlled trial. Orthop. Clin. 54 (4). https:\/\/doi.org\/10.1016\/j.ocl.2023.06.001 (2023).","DOI":"10.1016\/j.ocl.2023.06.001"},{"key":"54205_CR8","first-page":"6828","volume":"14","author":"M Li","year":"2022","unstructured":"Li, M. et al. Non-pharmaceutical treatments to relieve pain or reduce opioid analgesic intake and improve quality of life after total hip replacement: A meta-analysis. Am. J. Transl Res. 14, 6828\u20136845 (2022).","journal-title":"Am. J. Transl Res."},{"key":"54205_CR9","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.3390\/medicina58101332","volume":"58","author":"CGT Vance","year":"2022","unstructured":"Vance, C. G. T. et al. Using TENS for pain control: Update on the state of the evidence. Medicina 58, 1332. https:\/\/doi.org\/10.3390\/medicina58101332 (2022).","journal-title":"Medicina"},{"key":"54205_CR10","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s11916-020-0846-1","volume":"24","author":"T Mokhtari","year":"2020","unstructured":"Mokhtari, T. et al. Transcutaneous electrical nerve stimulation in relieving neuropathic pain: basic mechanisms and clinical applications. Curr. Pain Headache Rep. 24, 14. https:\/\/doi.org\/10.1007\/s11916-020-0846-1 (2020).","journal-title":"Curr. Pain Headache Rep."},{"key":"54205_CR11","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.3233\/BMR-210146","volume":"35","author":"CI Ezema","year":"2022","unstructured":"Ezema, C. I. et al. Transcutaneous electrical nerve stimulation effects on pain-intensity and endogenous opioids levels among chronic low-back pain patients: A randomized controlled trial. J. Back Musculoskelet. Rehabil. 35, 1053\u20131064. https:\/\/doi.org\/10.3233\/BMR-210146 (2022).","journal-title":"J. Back Musculoskelet. Rehabil"},{"key":"54205_CR12","doi-asserted-by":"publisher","unstructured":"Johnson, M. I. Post-surgical pain: The status of evidence for the use of transcutaneous electrical nerve stimulation (TENS). Analg. Resusc. Curr. Res. https:\/\/doi.org\/10.4172\/2324-903X.1000e109 (2017).","DOI":"10.4172\/2324-903X.1000e109"},{"key":"54205_CR13","unstructured":"Barsoum, W. Prospective evaluation of transcutaneous electrical nerve stimulation (TENS) for pain relief following total knee arthroplasty (TKA). ClinicalTrials.gov. https:\/\/clinicaltrials.gov\/study\/NCT01641471. Accessed 15 Mar 2026 (2018)."},{"key":"54205_CR14","doi-asserted-by":"publisher","first-page":"2599","DOI":"10.1016\/j.pain.2014.09.025","volume":"155","author":"BA Rakel","year":"2014","unstructured":"Rakel, B. A. et al. Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial. Pain 155, 2599\u20132611. https:\/\/doi.org\/10.1016\/j.pain.2014.09.025 (2014).","journal-title":"Pain"},{"issue":"2","key":"54205_CR15","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1055\/s-0037-1602134","volume":"31","author":"D Beckw\u00e9e","year":"2018","unstructured":"Beckw\u00e9e, D. et al. 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Zhongguo Gu Shang. 27, 283\u2013286 (2014).","journal-title":"Zhongguo Gu Shang"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54205-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54205-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54205-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:05:47Z","timestamp":1785521147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54205-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,23]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["54205"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-54205-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,23]]},"assertion":[{"value":"31 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The ethical approval of the study was obtained from the Research Ethics Committee (REC) of The University of Lahore on 19th June, 2022, before the enrollment of participants in the study; Ref Id: REC-UOL-115-06-2022.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was taken from all the participants.","order":3,"name":"Ethics","label":"Consent to participate\/consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23573"}}