***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Transcutaneous electrical nerve stimulation ( TENS ) has been used to treat chronic pain syndromes and has been reported to be of some utility in the treatment of postsurgical pain . A r and omized , blinded , placebo-controlled trial was design ed to evaluate the utility of TENS  after total knee arthroplasty . Patients were r and omly enrolled into patient-controlled anesthesia ( PCA ) alone , PCA plus TENS , or PCA plus sham TENS .  The cumulative dose of morphine by PCA for each group was used as the end-point of the study . There was no significant reduction in the requirement for patient-controlled analgesia with or without TENS . We conclude that there is no utility for TENS in the postoperative management of pain after knee arthroplasty Abstract The influence of transcutaneous electrical stimulation ( TES ) and psychological factors in determining the intensity of  acute postoperative pain was examined in a prospect i ve , double‐blind controlled trial completed by 30 patients having elective surgery . Psychometric tests were administered prior to surgery . Postoperative pain was assessed by cumulative morphine requirement ( M48 ) administered intramuscularly , and the mean score of a visual analogue scale of pain ( VAS ) , in the first 48 h following surgery . M48 was significantly correlated with the VAS score ( r = 0.62 , P < 0.001 ) , and with the psychometric test scores for trait‐anxiety ( r = 0.70 , P < 0.001 ) and neuroticism ( r = 0.67 , P < 0.001 ) . Though patients treated with TES required 25 % less morphine than those treated with placebo , the difference was not significant using monovariate analysis and applying unpaired two‐tailed Student 's t‐test ( P > 0.2 ) . When the contribution of neuroticism to the variance of M48 was adjusted using multiple regression analysis , the effect of TES became significant at the 0.05 level . Covariance analysis showed that TES contributed some 19 % to the explained variance of M48 while neuroticism contributed about 80 % , and there was no interaction between these two factors . These findings allow a degree of prediction of the individual patient 's postoperative pain and narcotic requirement , and point to a strong correlation between postoperative pain perception and personality Background Transcutaneous electrical nerve stimulation ( TENS ) is an effective adjunctive therapy for postoperative pain ; however , effects of different frequencies of stimulation have not been systematic ally investigated . Laparoscopic sterilization ( LS ) causes significant pain in the early postoperative period and requires substantial postoperative medication . Therefore , we studied the effects of TENS on postoperative pain after LS through placement of Yoon fallopian rings in a prospect i ve , r and omized , double-blinded , and placebo-controlled study . Methods Sixty-four patients undergoing LS for uterine tube ligation were r and omly allocated to receive either active TENS or placebo TENS .  Postoperative pain was evaluated using a st and ard 11-point numeric rating scale and the McGill Pain Question naire (MPQ)-pain rating index and number of words chosen . Both high frequency ( 100 Hz ) and low frequency ( 4 Hz ) TENS , at strong , but comfortable sensory intensity , were applied for 20 minutes through 4 electrodes placed around the surgical incision immediately after surgery . Pain was assessed before and after application of TENS when patients were at postanesthesia care unit ( PACU ) . Results Both high and low frequency TENS significantly decreased postoperative pain intensity when compared with before administration of TENS using the numeric rating scale ( P=0.001 ) , pain rating index ( P=0.001 ) , and number of words chosen ( P=0.001 ) compared with placebo TENS ( P=0.001 ) . TENS in combination with st and ard pharmacologic analgesic treatment was efficacious for postoperative pain relief after LS . Conclusions We recommend regular use of multimodal therapy with TENS and analgesic drugs after LS with placement of Yoon rings Background and Objectives Continuous-infusion femoral nerve block ( FNB ) improves analgesia and rehabilitation after total knee replacement . In this study , we investigated the efficacy of single-injection FNB to achieve similar results . Methods A total of 30 patients were prospect ively and r and omly assigned to receive 40-mL injections of either 0.25 % bupivacaine ( group B ) or saline ( group S ) after total knee replacement . Blinded observers evaluated the patients for postoperative pain , morphine consumption , ambulating distances , and maximal knee flexion ; pain was scored on the visual analog scale ( VAS ) . Results Compared with group S patients , group B patients had significantly lower VAS pain scores ( P < .01 in the postoperative anesthesia care unit , P < .05 on the day after surgery ) ; group B patients also showed significantly lower total morphine use ( P < .05 ) and a lower incidence of morphine-related side effects . Significantly more group B than group S patients could ambulate on the day after surgery ( 93 % v 46 % , P < .05 ) , and mean ambulatory distance was significantly better for group B than group S patients at discharge ( 166 ± 37 v 117 ± 24 feet , P < .01 ) . Knee flexion was significantly better for group B than group S patients on the second day after surgery ( 70 ° v 60 ° , P < .01 ) , but the between-group difference was no longer statistically significant at discharge . Mean length of acute hospitalization was significantly shorter for group B ( 3 days ; range , 3 to 5 days ) than group S patients ( 4 days ; range , 3 to 6 days , P < .05 ) . Conclusions Single-injection FNB provided effective analgesia , facilitated early ambulation , and reduced the length of acute hospitalization in patients undergoing total knee replacement OBJECTIVE To investigate the possible effect of electric muscle stimulation ( EMS ) of the vastus medialis on the walking speed , Hospital for Special Surgery ( HSS ) knee score , and Physiological Cost Index ( PCI ) of patients during rehabilitation after total knee arthroplasty ( TKA ) . DESIGN Prospect i ve , r and omized controlled trial . SETTING Various departments at a district general hospital in the United Kingdom . PARTICIPANTS Thirty patients with unilateral osteoarthritis of the knee admitted for elective TKA were r and omly assigned to 1 of 2 groups ( 15 per group ) : control and treatment . Both groups received st and ard physical therapy . The treatment group also received EMS of the vastus medialis . INTERVENTION EMS ( 40Hz , 300micros ) of the vastus medialis muscle for 4 hours a day , starting on postoperative day 2 , over the first 6 postoperative weeks . MAIN OUTCOME MEASURES Changes in walking speed , HSS knee score , and effort of walking as measured by the PCI . RESULTS A statistically significant increase in walking speed was observed in the treatment group in relation to the control group at both 6 weeks ( P=.0002 ) and 12 weeks ( P<.0001 ) postoperatively . No statistically significant difference was observed in relation to the PCI or the HSS knee score variables . CONCLUSIONS Application of EMS after TKA result ed in a statistically significant improvement in patients ' walking speed . There was also a carry-over effect after the discontinuation of treatment BACKGROUND Transcutaneous electrical nerve stimulation ( TENS ) is regarded as an effective treatment for various types of pain . However , no r and omized controlled trial has investigated TENS on acupoints for postoperative analgesia in elderly patients . This study aim to investigate whether TENS on acupoints has any favorable effect on complementary analgesia after total hip arthroplasty ( THA ) for elderly patients compared with a sham control treatment . METHODS Sixty-eight elderly patients requiring THA surgery were enrolled and r and omly allocated to one of two groups . Group Acu received true TENS on acupoints ( bilateral P6 , L14 ; ST36 , GB31 ipsilateral to the surgery site ) and Group Sham received sham treatment . All patients received patient-controlled analgesia for two days postoperatively . Analgesia was assessed by postoperative fentanyl requirement and pain intensity using a visual analogue scale ( VAS-10 cm ) . The incidence of analgesia-related side effects , optional medication use and effects of patients ' blinding were recorded . RESULTS Fentanyl consumption in Group Acu was lower than that in Group Sham at 24 h ( mean ± SD ; 360±117 vs. 572±132 μg ; P<0.001 ) and 48 h ( 712±184 vs. 1022±197 μg ; P<0.001 ) after surgery . Postoperative pain intensity measured by VAS was similar in both groups . The incidence of opioid-related side effects and rescue medication for postoperative analgesia was significantly higher in Group Sham than in Group Acu . Differences between the groups regarding the effects of patients ' blinding were not significant . CONCLUSION TENS on specific acupoints is an effective and complementary approach to reduce postoperative analgesic requirement in elderly patients after THA OBJECTIVE To study the effects of transcutaneous electrical nerve stimulation on multimodal analgesia after total knee arthroplasty . METHODS Sixty patients diagnosed as knee osteoarthritis and suffered unilateral total knee arthroplasty in the department of orthopedics , Zhejiang Traditional Chinese Medicine Hospital from March 2009 to May 2012 were r and omly divided into control group and test group , 30 cases in each group . All the patients received celecoxib preoperatively , knee periarticular injection with the drug mixture intraoperatively , and celecoxib and morphine sulfate controlled-release tablets postoperatively . The patients in the test group were also treated with transcutaneous electrical nerve stimulation each day after operation . All the patients started doing functional exercises at 24 h after operation . Postoperative visual analogue scales(VAS ) , passive and active range of motion of knee joint , and complications were recorded . RESULTS The VAS scores of test group during postoperative 24 h to 1 week were 3.39 + /- 0.69 , 2.79 + /- 0.51 , 2.16 + /- 0.52 , and 1.07 + /- 0.57 separately , which were lower than 3.80 + /- 0.86 , 3.22 + /- 0.58 , 2.53 + /- 0.54 and 1.38 + /- 0.52 in the control group . The passive and active range of knee joint motion in the test group during postoperative 24 h to 2 weeks were ( 30.67 + /- 3.65 ) degrees , ( 39.17 + /- 3.96 ) degrees , ( 47.83 + /- 4.86 ) degrees , ( 93.67 + /- 7.30 ) degrees , ( 107.67 + /- 7.51 ) degrees and ( 29.83 + /- 5.33 ) degrees , ( 78.33 + /- 8.24 ) degrees , ( 95.17 + /- 5.94 ) degrees respectively , which were higher than ( 28.67 + /- 3.92 ) degrees , ( 36.83 + /- 4.25 ) degrees , ( 45.17 + /- 5.17 ) degrees , ( 89.83 + /- 7.25 ) degrees , ( 103.17 + /- 7.37 ) degrees and ( 24.17 + /- 10.26 ) degrees , ( 73.83 + /- 9.07 ) degrees , ( 91.33 + /- 7.42 ) degrees in the control group . In the test group , 19 patients had ring-shaped haemostasis impression to some extent in the skin of knee joint to different degree , and 5 patients had blister formation . CONCLUSION It is meaningful to apply transcutaneous electrical nerve stimulation for treating multimodal analgesia after total knee arthroplasty , which can not only relieve patients ' postoperative pain , and also promote the rehabilitation of knee function as far as possible OBJECTIVE Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia  in women with deep endometriosis . STUDY DESIGN This r and omized controlled trial was performed in a tertiary health care center , including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and /or deep dyspareunia . This study was registered in the Brazilian Record of Clinical Trials ( ReBEC ) , under n RBR-3rndh6 . TENS application for 8 weeks followed a r and omized allocation into two groups : Group 1 - acupuncture-like TENS ( Frequency : 8Hz , pulse duration : 250μs ) - VIF ( n=11 ) and Group 2 - self-applied TENS ( Frequency : 85Hz , pulse duration : 75μs ) ( n=11 ) . The intensity applied was " strong , but comfortable " . We evaluated patients before and after treatment by the use of the Visual Analogue Scale , Deep Dyspareunia Scale and Endometriosis Quality of Life Question naire . We used 
    Output:
    
Compared with control intervention , transcutaneous electrical nerve stimulation supplementation intervention was found to significantly reduce pain and morphine requirement over a period of 24 h and to promote functional recovery in patients who have undergone total knee arthroplasty