Barbara Rakel, Ph.D., assistant professor of nursing, was recently awarded a $2.1 million grant from the National Institute of Nursing Research to study the use of balanced nonpharmacologic and pharmacologic strategies to improve movement-evoked pain and enhance function in TKR patients.

Rakel's study will evaluate a new approach to transcutaneous electrical nerve stimulation (TENS), a decades-old pain control therapy which involves application of electric impulses to nerve endings through electrodes placed on the skin.

This project distinguishes pain with movement -- the type of pain largely uncontrolled with current pain treatments -- from pain at rest. It uses a new TENS approach to target movement-evoked pain after surgery. Rakel will test the effectiveness of intense (high amplitude) TENS, applied intermittently as a supplement to current drug therapy during recovery activities.

The aim is to decrease pain, improve function and prevent the development of new chronic pain syndromes in older adults after TKR.

The study will compare the effectiveness of active TENS to placebo TENS and standard care in 321 patients. TENS will be used during exercise sessions for six weeks after TKR. Various methods will be used to measure pain sensitivity, pain intensity, function and chronic pain syndrome. This study translates bench (animal model) science to human subjects by testing the effect of TENS on severe pain sensitivity.

Rakel teaches in the Systems and Practice Area of Study in the UI College of Nursing.

The UI College of Nursing educates nurses at the undergraduate, graduate and doctoral levels, providing both clinical experience and research opportunities. Ranked No. 1 in nursing administration education and adult and gerontologic nursing among the nation's public universities, the college also excels in child and family health, informatics and genetics. Known for the development of evidence-based protocols for care that are used throughout the nursing community, UI College of Nursing scientists seek to improve clinical outcomes and enhance nursing practice worldwide.

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Professor North's latest research has focused on how the absence of the protein influences muscle function. The authors have also looked at why the genetic variation has occurred.

In answering the first question, researchers developed a strain of mice which was completely deficient in alpha-actinin-3. They found the muscle metabolism of the mice without the actinin protein was more efficient: the mice were able to run, on average, 33 per cent further before reaching exhaustion than mice with the normal ACTN3 gene.

To answer the question as to why the variation occurred they looked at DNA samples from 96 individuals from around the world.

"Most Africans have alpha-actinin-3, it's the normal ancestral state. But as you move into European and Asian populations there is a marked increase in the number of people without the protein. In some Asian populations that number reaches 40 per cent, or even higher in some isolated populations," she said.

She believes the switch to more efficient metabolism is likely to have occurred due to natural selection during the last Ice Age, when humans began moving out of the food-rich areas of Africa into colder, harsher environments.

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