Cecilia Ögren: TENS – a good alternative to opioids after surgery

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CECILIA ÖGREN
Dissertation defense: 12 December 2025 (click for details)
Doctoral thesis: High-frequency, high-intensity transcutaneous electrical nerve stimulation for postoperative pain – evaluating a new treatment regime and a clinical bedside prediction test in outpatient surgery
Research area: Anesthesiology and Intensive Care
Sahlgrenska Academy, The Institute of Clinical Sciences

Experiencing pain after surgery, known as postoperative pain, is common. Regardless of whether the procedure is minor or major, 20–40 percent of patients report moderate to severe pain afterward. If not properly managed, postoperative pain can lead to long-term pain problems, delayed rehabilitation, and reduced quality of life.

– Opioid medications, such as morphine, have long been a cornerstone of postoperative pain management because of their strong analgesic effect. However, opioids can cause side effects such as respiratory depression, nausea, and drowsiness, which can negatively affect recovery, says Cecilia Ögren, nurse anesthetist and intensive care nurse at the Pain Center, Sahlgrenska University Hospital Östra, and a doctoral student at the Institute of Clinical Sciences.

Reduce opioid consumption

Opioids are addictive, and studies show that about 6–7 percent of all surgical patients develop long-term use, posing serious health risks. Healthcare is therefore seeking effective methods that can reduce opioid use during and after surgery while providing equally good pain relief.

– If we could predict an individual patient’s risk of experiencing severe postoperative pain, that would be highly beneficial. Healthcare professionals could then tailor pain management during and after surgery to meet the patient’s specific needs.

Predicting the level of postoperative pain

This thesis is based on five sub-studies. It investigated whether a simple clinical test could predict postoperative pain. The test asked patients to rate the pain they experienced when a peripheral intravenous (IV) catheter was inserted into their arm or hand – a standard procedure before surgery.

– After surgery, patients were asked to rate their pain again, and the results showed that the test could indeed predict postoperative pain. We also found that patients with higher pain intensity at the time of IV insertion needed to stay an average of 30 minutes longer in the recovery unit, which has important implications for patient flow in surgical departments. 

She also examined the effect of specific high-frequency and high-intensity settings on a standard TENS device* to determine whether it could replace or reduce the need for opioids after surgery.

– The results showed that the specific settings at the TENS provides good and rapid pain relief and reduces opioid consumption in the recovery unit. Patients were also very satisfied with the treatment, reporting increased comfort, confidence, and a greater sense of independence.

What has been most rewarding and most challenging about the PhD project?
– It’s exciting to present results from both quantitative and qualitative studies. The main challenge has been that research is a completely different kind of work – fundamentally different from my usual clinical practice.

Text: Susanne Lj Westergren