The Role of Electrotherapy in Postoperative Pain Management

Postoperative pain is part of the body’s response to tissue injury resulting from the surgical procedure, and is associated with various physiological changes. Any tissue damage, including those caused by surgical procedures, elicits a physiological response involving the release of a variety of substances, which include cytokines, substance P, serotonin, bradykinin, prostaglandins and histamine. These substances cause inflammation of the local tissues, resulting in the activation of the body’s repair mechanism, however, they also lower the activation threshold and stimulate the nociceptors, leading to algesia. Pain is a multidimensional experience, and if left unchecked it can significantly impair an individual's quality of life. Despite the advances in modern surgical and medical practice, pain management still remains a clinical challenge and a significant burden to individuals and society.

Each year more than 230 million people undergo surgery worldwide and the number is increasing annually. The complexity of the procedures and patient comorbidity are also increasing. Moreover, inadequate postoperative pain relief is a major cause of prolonged stays and readmission after outpatient surgery. Controlling and managing postoperative pain effectively are of primary concern to the patient and also of importance to the surgeon. This because of the unpleasant sensory and emotional experience, and the potential adverse effects resulting from the physiological response to pain after surgery. There is evidence suggesting that postoperative pain management is far from being successful, and many patients suffer from severe pain after an operation, which contributes to the development of chronic pain. Thus, it is important to identify and implement appropriate strategies to control postoperative pain.

Electrotherapy involves the delivery of electrical impulses, generated by specifically designed devices and delivered to the target area of the body. This technique comprises various modalities, with different applications. Transcutaneous electrical nerve stimulation (TENS) and peripheral nerve stimulation (PNS) are electrotherapy modalities used to induce electroanalgesia. Numerous studies have demonstrated both in clinical and laboratory settings that electrotherapy represents an efficacious and safe method to relieve postoperative pain and improve function. In addition, research has revealed that the application of this technique following surgery, reduces the consumption of pharmacological analgesics and thus their side effects. Therefore, the inclusion of electrotherapy within the analgesic treatment repertoire can help improve postoperative pain management.

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