Transcutaneous Electrical Nerve Stimulation (TENS) (2022)

Introduction
Machine parameters
Mechanism of Action
Electrode placement
Contraindications
Precautions
References

Introduction

TENS is a method of electrical stimulation which primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system. The different methods of applying TENS relate to these different physiological mechanisms. The effectiveness of TENS varies with the clinical pain being treated, but research would suggest that when used ‘well’ it provides significantly greater pain relief than a placebo intervention. There is an extensive research base for TENS in both the clinical and laboratory settings and whilst this summary does not provide a full review of the literature, the key papers are referenced. It is worth noting that the term TENS could represent the use of ANY electrical stimulation using skin surface electrodes which has the intention of stimulating nerves. In the clinical context, it is most commonly assumed to refer to the use of electrical stimulation with the specific intention of providing symptomatic pain relief. If you do a literature search on the term TENS, do not be surprised if you come across a whole lot of ‘other’ types of stimulation which technically fall into this grouping.

TENS is most commonly delivered from small, hand held, battery powered devices. They can be purchased 'over the counter' in many (but not all) countries. In some locations, they need to be 'prescribed' by a therapist, doctor or other healthcare practitioner. Most multi-modal clinic based stimulators include TENS as an option, though its use in the clinic is less well supported than its use as a home based, patient delivered therapy. Examples of typical TENS units are illustrated below.

It is interesting that in therapy practice, the majority of practitioners consider TENS as a treatment options in circumstances when a patient is experiencing CHRONIC pain. This is not a problem as there is a significant evidence base to support this mode of application. There is however, a significant and growing body of evidence that supports the use of TENS as a valid and effective intervention in a ACUTE pain conditions. Examples would include : Desantana et al (2009); Sbruzzi et al (2012); Silva et al (2012); Solak et al (2007) and Unterrainer et al (2010).

TENS as a treatment technique is non invasive and has few side effects when compared with drug therapy. The most common complaint is an allergic type skin reaction (about 2-3% of patients) and this is almost always due to the material of the electrodes, the conductive gel or the tape employed to hold the electrodes in place. Most TENS applications are now made using self adhesive, pre gelled electrodes which have several advantages including reduced cross infection risk, ease of application, lower allergy incidence rates and lower overall cost. Digital TENS machines are becoming more widely available and extra features (like automated frequency sweeps and more complex stimulation patterns) are emerging, though there remains little clinical evidence for enhanced efficacy at the present time. Some of these devices do offer pre-programmed and/or automated treatment settings.

Machine parameters

Before attempting to describe how TENS can be employed to achieve pain relief, the main treatment variables which are available on modern machines will be outlined. The location of these controls on a typical (analogue) TENS machine is illustrated in the diagram below.

The current intensity (A) (strength) will typically be in the range of 0 - 80 mA, though some machines may provide outputs up to 100mA. Although this is a small current, it is sufficient because the primary target for the therapy is the sensory nerves, and so long as sufficient current is passed through the tissues to depolarise these nerves, the modality can be effective.

Transcutaneous Electrical Nerve Stimulation (TENS) (2)

The machine will deliver discrete ‘pulses’ of electrical energy, and the rate of delivery of these pulses (the pulse rate or frequency (B) will normally be variable from about 1 or 2 pulses per second (pps) up to 200 or 250 pps (sometimes the term Hertz or Hz is used here). To be clinically effective, it is suggested that the TENS machine should cover a range from about 2 – 150 pps (or Hz).

In addition to the stimulation rate, the duration (or width) of each pulse (C) may be varied from about 40 to 250 micro seconds (ms). (a micro second is a millionth of a second). Recent evidence would suggest that this is possibly a less important control that the intensity or the frequency and the most effective setting in the clinical environment is probably around 200ms.

The reason that such short duration pulses can be used to achieve these effects is that the targets are the sensory nerves which tend to have relatively low thresholds ( i.e. they are quite easy to excite) and that they will respond to a rapid change of electrical state. There is generally no need to apply a prolonged pulse in order to force a sensory nerve to depolarise, therefore stimulation for less than a millisecond is sufficient.

In addition, most modern machines will offer a BURST mode (D) in which the pulses will be allowed out in bursts or ‘trains’, usually at a rate of 2 - 3 bursts per second. Finally, a MODULATION mode (E) may be available which employs a method of making the pulse output less regular and therefore minimising the accommodation effects which are often encountered with this type of stimulation. Both the burst and modulation modes will be discussed in more detail in the following sections.

Most machines offer a dual channel output - i.e. two pairs of electrodes can be used simultaneously. In some circumstances this can be a distinct advantage, though it is interesting that most patients and therapists tend to use just a single channel application. Widespread and diffuse pain presentations can be usefully treated with a 4 electrode (2 channel) system, as can a combined treatment for local and referred pain (see later).

The pulses delivered by TENS stimulators vary between manufacturers, but tend to be asymmetrical biphasic modified square wave pulses. The biphasic nature of the pulse means that there is usually no net DC component (often described in the manufacturers blurb as ‘zero net DC’), thus minimising any skin reactions due to the build up of electrolytes under the electrodes.

Transcutaneous Electrical Nerve Stimulation (TENS) (3)

Mechanism of Action

The type of stimulation delivered by the TENS unit aims to excite (stimulate) the sensory nerves, and by so doing, activate specific natural pain relief mechanisms. For convenience, if one considers that there are two primary pain relief mechanisms which can be activated : the Pain Gate Mechanism and the Endogenous Opioid System, the variation in stimulation parameters used to activate these two systems will be briefly considered.

Pain relief by means of the pain gate mechanism involves activation (excitation) of the A beta (Aβ) sensory fibres, and by doing so, reduces the transmission of the noxious stimulus from the ‘c’ fibres, through the spinal cord and hence on to the higher centres. The Aβ fibres appear to appreciate being stimulated at a relatively high rate (in the order of 80 - 130 Hz or pps). It is difficult to find support for the concept that there is a single frequency that works best for every patient, but this range appears to cover the majority of individuals. Clinically it is important to enable the patient to find their optimal treatment frequency – which will almost certainly vary between individuals. Setting the machine and telling the patient that this is the ‘right’ setting is almost certainly not going to be the maximally effective treatment, though of course, some pain relief may well be achieved.

An alternative approach is to stimulate the A delta (Aδ) fibres which respond preferentially to a much lower rate of stimulation (in the order of 2 - 5 Hz, though some authors consider a wider range of 2 - 10Hz), which will activate the opioid mechanisms, and provide pain relief by causing the release of an endogenous opiate (encephalin) in the spinal cord which will reduce the activation of the noxious sensory pathways. In a similar way to the pain gate physiology, it is unlikely that there is a single (magic) frequency in this range that works best for everybody – patients should be encouraged to explore the options where possible.

A third possibility is to stimulate both nerve types at the same time by employing a burst mode stimulation. In this instance, the higher frequency stimulation output (typically at about 100Hz) is interrupted (or burst) at the rate of about 2 - 3 bursts per second. When the machine is ‘on’, it will deliver pulses at the 100Hz rate, thereby activating the Aβ fibres and the pain gate mechanism, but by virtue of the rate of the burst, each burst will produce excitation in the Aδ fibres, therefore stimulating the opioid mechanisms. For some patients this is by far the most effective approach to pain relief, though as a sensation, numerous patients find it less acceptable than some other forms of TENS as there is more of a ‘grabbing’, ‘clawing’ type sensation and usually more by way of muscle twitching than with the high or low frequency modes.

(Video) Transcutaneous Electrical Nerve Stimulation (TENS) for Rheumatoid Arthritis (Practical Session)

Traditional TENS (Hi TENS, Normal TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) (6)

Usually uses stimulation at a relatively high frequency (80 - 130Hz) and employ a relatively narrow (short duration) pulses though as mentioned above, there is less support for manipulation of the pulse width in the current research literature. Most patients seem to find best effect at around 200ms. The stimulation is delivered at ‘normal’ intensity - definitely there but not uncomfortable. 30 minutes is probably the minimal effective time, but it can be delivered for as long as needed. The main pain relief is achieved during the stimulation, with a limited ‘carry over’ effect – i.e. pain relief after the machine has been switched off.

Acupuncture TENS (Lo TENS, AcuTENS)

Transcutaneous Electrical Nerve Stimulation (TENS) (7)

Use a lower frequency stimulation (2-5Hz) with wider (longer) pulses (200-250ms). The intensity employed will usually need to be greater than with the traditional TENS - still not at the patients threshold, but quite a definite, strong sensation. As previously, something like 30 minutes will need to be delivered as a minimally effective dose. It takes some time for the opioid levels to build up with this type of TENS and hence the onset of pain relief may be slower than with the traditional mode. Once sufficient opioid has been released however, it will keep on working after cessation of the stimulation. Many patients find that stimulation at this low frequency at intervals throughout the day is an effective strategy. The ‘carry over’ effect may last for several hours, though the duration of this carry over will vary between patients.

Brief Intense TENS

This is a TENS mode that can be employed to achieve a rapid pain relief, but some patients may find the strength of the stimulation too intense and will not tolerate it for sufficient duration to make the treatment worthwhile. The pulse frequency applied is high (in the 80-130Hz band) and the pulse duration (width) is also high (200ms plus). The current is delivered at, or close to the tolerance level for the patient - such that they would not want the machine turned up any higher. In this way, the energy delivery to the patients is relatively high when compared with the other approaches. It is suggested that 15 - 30 minutes at this stimulation level is the most that would normally be used.

Burst Mode TENS

As described above, the machine is set to deliver traditional TENS, but the Burst mode is switched in, therefore interrupting the stimulation outflow at rate of 2 - 3 bursts / second. The stimulation intensity will need to be relatively high, though not as high as the brief intense TENS – more like the Lo TENS. It is proposed that the application of BURST mode TENS can effectively stimulate both the PAIN GATE and the OPIOID mechanisms simultaneously.

The diagram below shows stimulation (at around 100Hz) delivered in BURST mode (at 2-3Hz) such that both the A Beta (due to 100Hz) and the A delta (due to 2-3Hz) are stimulated

Transcutaneous Electrical Nerve Stimulation (TENS) (9)

Modulation mode TENS

Transcutaneous Electrical Nerve Stimulation (TENS) (10)

In modulation mode, the machine delivers a less regular pattern of TENS stimulation in an attempt to reduce or minimise the accommodation effects of regular, patterned stimulation. Machines offer different methods of varying the stimulation pattern – some vary the frequency, some vary the intensity and some vary the pulse duration, and some machines offer a choice between these methods, though the research evidence to date does not favour one variation method over another. This potentially most useful for patients who use TENS for hours a day, if for no other reason than accommodation occurs at a slower rate and therefore less intensity adjustment may be required.

Frequency Selection : with all of the above mode guides, it is probably inappropriate to identify very specific frequencies that need to be applied to achieve a particular effect. If there was a single frequency that worked for everybody, it would be much easier, but the research does not support this concept. Patients (or the therapist) need to identify the most effective frequency for their pain, and manipulation of the stimulation frequency dial or button is the best way to achieve this. Patients who are told to leave the dials alone are less likely to achieve optimal effects.

Stimulation Intensity : As identified above, it is not possible to describe treatment current strength in terms of how many microamps. The most effective intensity management appears to be related to what the patient feels during the stimulation, and this may vary from session to session. As a general guide, it appears to be effective to go for a ‘definitely there but not painful’ level for the normal (high) TENS, and a ‘strong but not painful’ level for the acupuncture (lo) mode. There is a growing body of evidence that suggests that a ‘strong’ sensation, whichever mode is being used, might achieve better clinical effects.

Transcutaneous Electrical Nerve Stimulation (TENS) (11)

Electrode placement

In order to get the maximal benefit from the modality, target the stimulus at the appropriate spinal cord level (appropriate to the pain). Placing the electrodes either side of the lesion – or pain areas, is the most common mechanism employed to achieve this. There are many alternatives that have been researched and found to be effective – most of which are based on the appropriate nerve root level :

  • Stimulation of appropriate nerve root(s)
  • ​Stimulate the peripheral nerve (best if proximal to the pain area)
  • Stimulate motor point (innervated by the same root level)
  • Stimulate trigger point(s) or acupuncture point(s)
  • Stimulate the appropriate dermatome, myotome or sclerotome

If the pain source is vague, diffuse or particularly extensive, one can employ both channels simultaneously. A 2 channel application can also be effective for the management of a local + a referred pain combination – one channel used for each component. The low frequency (Acupuncture like) TENS can be effectively applied to the contralateral side of the body.

CONTRAINDICATIONS

Patients who do not comprehend the physiotherapist’s instructions or who are unable to co-operate
It has been widely cited that application of the electrodes over the trunk, abdomen or pelvis during pregnancy is contraindicated BUT a recent review suggests that although not an ideal (first line) treatment option, application of TENS around the trunk during pregnancy can be safely applied, and no detrimental effects have been reported in the literature (see www.electrotherapy,org for publication details)
TENS during labour for pain relief is both safe and effective
Patients with a Pacemaker should not be routinely treated with TENS though under carefully controlled conditions it can be safely applied. It is suggested that routine application of TENS for a patient with a pacemaker or any other implanted electronic device should be considered a contraindication.
Patients who have an allergic response to the electrodes, gel or tape
Electrode placement over dermatological lesions e.g. dermatitis, eczema
Application over the anterior aspect of the neck or carotid sinus

PRECAUTIONS

If there is abnormal skin sensation, the electrodes should preferably be positioned elsewhere to ensure effective stimulation
Electrodes should not be placed over the eyes
Patients who have epilepsy should be treated at the discretion of the therapist in consultation with the appropriate medical practitioner as there have been anecdotal reports of adverse outcomes, most especially (but not exclusively) associated with treatments to the neck and upper thoracic areas
Avoid active epiphyseal regions in children (though there is no direct evidence of adverse effect)
The use of abdominal electrodes during labour may interfere with foetal monitoring equipment and is therefore best avoided

(Video) What is TENS (Transcutaneous Electric Nerve Stimulation)? How Does It Work?

REFERENCES – KEY TEXTS

Johnson, M. (2008). TENS In : Electrotherapy: Evidence Based Practice. Ed. Watson. T. Elsevier

Robertson, V. et al (2007). Electrotherapy Explained. Elsevier.

Walsh, D. (1997). TENS: Clinical Applications and Related Theory. Edinburgh, Churchill Livingstone.

REFERENCES – JOURNAL ARTICLES AND PAPERS

Adedoyin, R. A., et al. (2005). "Transcutaneous electrical nerve stimulation and interferential current combined with exercise for the treatment of knee osteoarthritis: a randomised controlled trial." Hong Kong Physiotherapy Journal 23: 13-9.

Ainsworth, L., et al. (2006). "Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation." Pain 120(1-2): 182-7.

Alves-Guerreiro, J., et al. (2001). "The effect of three electrotherapeutic modalities upon peripheral nerve conduction and mechanical pain threshold." Clin Physiol 21(6): 704-11.

Bjordal, J. M., et al. (2007). "Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials." BMC Musculoskelet Disord 8(1): 51.

Bodofsky, E. (2002). "Treating carpal tunnel syndrome with lasers and TENS." Arch Phys Med Rehabil 83(12): 1806; author reply 1806-7.

Brosseau, L., et al. (2003). "Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand." Cochrane Database Syst Rev(3): CD004377.

Brosseau, L., et al. (2002). "Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain." Spine 27(6): 596-603.

Brosseau, L., et al. (2004). "Efficacy of transcutaneous electrical nerve stimulation for osteoarthritis of the lower extremities: a meta-analysis." Physical Therapy Reviews 9: 213-233.

Brosseau, L., et al. (2003). "Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand." Cochrane Database Syst Rev(3): CD004287.

Carroll, D., et al. (2006). "Transcutaneous electrical nerve stimulation (TENS) for chronic pain." The Cochrane Library 4(CD003222).

Chandran, P. and K. A. Sluka (2003). "Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration." Pain 102: 195-201.

Chen, C., et al. (2008). "Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia? A systematic review of studies using experimental pain and healthy human participants." Physiotherapy 94(1): 11-20.

Chesterton, L. S., et al. (2002). "Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects." Pain 99: 253-262.

Chesterton, L. S., et al. (2003). "Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects." Pain 106: 73-80.

Chiu, T. T., et al. (2005). "A randomized clinical trial of TENS and exercise for patients with chronic neck pain." Clin Rehabil 19(8): 850-60.

Claydon, L. S., et al. (2008). "Effects of simultaneous dual-site TENS stimulation on experimental pain." Eur J Pain 12(6): 696-704.

Cosmo, P., et al. (2000). "Effects of transcutaneous nerve stimulation on the microcirculation in chronic leg ulcers." Scand J Plast Reconstr Surg Hand Surg 34(1): 61-4.

(Video) Transcutaneous Electrical Nerve Stimulation (TENS)

Cowan, S., et al. (2009). "An investigation of the hypoalgesic effects of TENS delivered by a glove electrode." J Pain 10(7): 694-701.

de Ferrer, G. (2006). "TENS: non-invasive pain relief for the early stages of labour." British Journal of Midwifery 14(8).

Desantana, J. M. et al. (2009). "High and low frequency TENS reduce postoperative pain intensity after laparoscopic tubal ligation: a randomized controlled trial." Clin J Pain 25(1): 12-19.

Dickstein, R., et al. (2006). "TENS to the posterior aspect of the legs decreases postural sway during stance." Neurosci Lett 393(1): 51-5

Ellis, B. (1995). "Transcutaneous electrical nerve stimulators: outpatient response to a temporary home-loan programme." Br J Therapy & Rehabilitation 2(8): 419-422.

Gadsby, J. G. and M. W. Flowerdew (2000). "Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain." Cochrane Database Syst Rev(2): CD000210.

Garrison, D. W. and R. D. Foreman (1994). "Decreased activity of spontaneous and noxiously evoked dorsal horn cells during transcutaneous electrical nerve stimulation (TENS)." Pain 58(3): 309-15.

Han, J. S., et al. (1991). "Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF." Pain 47(3): 295-8.

Hingne, P. M. and K. A. Sluka (2007). "Differences in waveform characteristics have no effect on the anti-hyperalgesia produced by transcutaneous electrical nerve stimulation (TENS) in rats with joint inflammation." J Pain 8(3): 251-5.

Jarzem, P. F., et al. (2005). "Transcutaneous electrical nerve stimulation [TENS] for chronic low back pain." Journal of Musculoskeletal Pain 13(2): 3-9.

Johnson, M. and M. Martinson (2007). "Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials." Pain 130(1-2): 157-65.

Johnson, M. I. (2000). "The clinical effectiveness of TENS in pain management." Critical Reviews in Physical and Rehabilitation Medicine 12(2): 131-49.

Johnson, M. I. (2001). "A critical review of the analgesic effects of TENS-like devices." Physical Therapy Reviews 6(3): 153-73.

Khadilkar, A., et al. (2006). "Transcutaneous electrical nerve stimulation (TENS) for chronic low-back." The Cochrane Library 4(CD003008).

Khadilkar, A., et al. (2005). "Transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a systematic review." Spine 30(23): 2657-66.

Lang, T., et al. (2007). "TENS relieves acute posttraumatic hip pain during emergency transport." J Trauma 62(1): 184-8; discussion 188.

Lone, A. R., et al. (2003). "Analgesic efficacy of transcutaneous electrical nerve stimulation compared with diclofenac sodium in osteo-arthritis of the knee." Physiotherapy 89(8): 478-85.

Miller, L., et al. (2005). "The effects of transcutaneous electrical nerve stimulation on spasticity." Physical Therapy Reviews 10(4): 201-208.

Palmer, S. T., et al. (2004). "Effects of electric stimulation on C and A delta fiber-mediated thermal perception thresholds." Arch Phys Med Rehabil 85(1): 119-28.

Robb, K. A., et al. (2007). "Transcutaneous electrical nerve stimulation vs. transcutaneous spinal electroanalgesia for chronic pain associated with breast cancer treatments." J Pain Symptom Manage 33(4): 410-9

(Video) Transcutaneous Electrical Nerve Stimulation (TENS) therapy

Robb, K., et al. (2009). "A cochrane systematic review of transcutaneous electrical nerve stimulation for cancer pain." J Pain Symptom Manage 37(4): 746-53.

Roche, P. A. and A. Wright (1990). "An investigation into the value of transcutaneous electrical nerve stimulation (TENS) for arthritic pain." Physiotherapy Theory & Practice 6: 25-33.

Rodriguez, M. A. (2005). "Transcutaneous electrical nerve stimulation during birth." British Journal of Midwifery 13(8): 522-4.

Rutjes, A. W., et al. (2009). "Transcutaneous electrostimulation for osteoarthritis of the knee." Cochrane Database Syst Rev(4): CD002823.

Sbruzzi, G. et al. (2012). "Transcutaneous electrical nerve stimulation after thoracic surgery: systematic review and meta-analysis of 11 randomized trials." Rev Bras Cir Cardiovasc 27(1): 75-87.

Searle, R. D., et al. (2009). "Transcutaneous electrical nerve stimulation (TENS) for cancer bone pain." J Pain Symptom Manage 37(3): 424-8.

Shanahan, C., et al. (2006). "Comparison of the analgesic efficacy of interferential therapy and transcutaneous electrical nerve stimulation." Physiotherapy. 92(4): 247-53.

Silva, M. et al. (2012). "Analgesic effect of transcutaneous electrical nerve stimulation after laparoscopic cholecystectomy." Am J Phys Med Rehabil 91(8): 652-657.

Sluka, K. A., et al. (2006). "Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation." Arch Phys Med Rehabil 87(8): 1137-40.

Sluka, K. A. and D. Walsh (2003). "Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness." J Pain 4(3): 109-21.

Solak, O., et al. (2007). "Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study." Thorac Cardiovasc Surg 55(3): 182-5.

Somers, D. L. and F. R. Clemente (2006). "Transcutaneous Electrical Nerve Stimulation for the Management of Neuropathic Pain: The Effects of Frequency and Electrode Position on Prevention of Allodynia in a Rat Model of Complex Regional Pain Syndrome Type II." Phys Ther 86(5): 698-709.

Unterrainer, A. et al. (2010). "Postoperative and preincisional electrical nerve stimulation TENS reduce postoperative opioid requirement after major spinal surgery." J Neurosurg Anesthesiol 22(1): 1-5.

Vance, C. G., et al. (2007). "Transcutaneous electrical nerve stimulation at both high and low frequencies reduces primary hyperalgesia in rats with joint inflammation in a time-dependent manner." Phys Ther 87(1): 44-51.

Wang, K., et al. (2007). "Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial." Clin J Pain 23(4): 316-22.

Walsh, D. M. (1996). "Transcutaneous electrical nerve stimulation and acupuncture points." Complement-Ther-Med 4: 133-137

Walsh, D. M. and D. Baxter (1996). "Transcutaneous electrical nerve stimulation (TENS) : A review of experimental studies." Eur J Phys Med Rehabil 6(2): 42-50.

Walsh, D. M., et al. (2009). "Transcutaneous electrical nerve stimulation for acute pain." Cochrane Database Syst Rev(2): CD006142.

Ward, A. R., et al. (2009). "A comparison of the analgesic efficacy of medium-frequency alternating current and TENS." Physiotherapy 95(4): 280-8

Yan, T. and C. W. Hui-Chan (2009). "Transcutaneous electrical stimulation on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial." J Rehabil Med 41(5): 312-6.

(Video) Transcutaneous Electrical Nerve Stimulation (TENS) - How to set up the electrodes

FAQs

How do you use transcutaneous electrical nerve stimulation TENS? ›

A TENS machine is a small, battery-operated device that has leads connected to sticky pads called electrodes. You attach the pads directly to your skin. When the machine is switched on, small electrical impulses are delivered to the affected area of your body, which you feel as a tingling sensation.

What is TENS therapy good for? ›

What Is a TENS Unit Anyways? Transcutaneous electrical nerve stimulation is a nonpharmacologic treatment for pain relief. Using a low voltage electrical current, it safely and effectively can reduce pain, allowing you to live a better quality of life.

What is difference between TENS and EMS? ›

The main difference

Transcutaneous Electrical Nerve Stimulation (TENS) machines stimulate the nerves exclusively for the purpose of relieving pain, whereas Electrical Muscle Stimulation (EMS) machines are designed to stimulate the muscles for the purposes of strengthening and rehabilitating them.

Is a TENS machine good for nerve damage? ›

Studies show that TENS can help relieve pain from diabetic nerve damage, most commonly in the hands and feet. Spinal cord injury pain. At least three studies on TENS and spinal cord injury pain have shown improvements in this kind of pain, which is hard to treat.

Where should I not use a TENS unit? ›

Do not apply TENS therapy to the abdomen; pelvic area; lower back; or to acupuncture points at the knee, hand or ankle. (However, TENS can be used for labor pain.) Cancer. Do not apply electrodes to areas of the body where there is known or suspected cancer.

How long should you use a TENS unit at a time? ›

You can safely use a TENS machine as often as you like. Usually for 30-60 minutes up to 4 times daily. TENS can provide relief for up to four hours.

What are the disadvantages of TENS therapy? ›

The disadvantages are that: it doesn't work for everybody. TENS machines can't be used in the bath or shower.

How long does TENS pain relief last? ›

The post-stimulation analgesic effects of TENS can therefore last anywhere from five minutes to 18 hours (Woolf, 1991). Some patients' pain levels do not return to pre-stimulation levels even after 24 hours (Cheing et al, 2003).

Does TENS therapy reduce inflammation? ›

Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation.

Do chiropractors use TENS or EMS? ›

There are two types of electrical stimulation therapies used in chiropractic care to treat pain conditions affecting your nerves or your muscles – transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS).

What is better than a TENS unit? ›

EMS uses a slightly stronger current than TENS to get muscles to contract. The unit's electrodes (also placed on the skin near the affected muscles) cause rhythmic contractions. This can improve muscle strength if the user attempts to contract the muscle simultaneously.

Can electrical stimulation cause nerve damage? ›

Generally, greater intensity, higher frequency, and longer pulse width stimulation lead to more severe damage in nerve cells (McCreery et al., 2004). In addition, although short-term electrical stimulation is not damaging to nervous tissue, chronic electrical stimulation can damage nerve structure.

Does a TENS unit promote nerve healing? ›

Conclusions: Although there is some heterogeneous evidence in animal research, TENS seems to be a promising treatment for nerve injury that should be better explored.

Where do you place TENS electrodes for neuropathy? ›

Peripheral Neuropathy (upper extremities)

Electrode Placement Channel 1: Place one electrode anterior and inferior to the acromion. Place the other electrode near the lateral epicondyle. Channel 2: Place one electrode over the anterior wrist. Place the other electrode over the carpal area.

Can a TENS unit be used for sciatic nerve pain? ›

The answer is yes. TENS can relieve sciatica pain—even the radiating, and sometimes debilitating shooting pains that patients often experience. It's a safe, non-addictive painkiller alternative that might help you reduce discomfort and gain some mobility from sciatica.

Can I overuse a TENS unit? ›

TENS is safe, so you can use it as much as you like, although it's good practice to take regular 10-minute breaks every hour or so. Some people use TENS for more than five hours a day. It may be worth buying a TENS machine for home use.

Is TENS machine good for lower back pain? ›

You might have been recommended a TENS (transcutaneous electrical nerve stimulation) mechine as part of your treatment for back pain. This helpful medical device won't 'cure' your symptoms but it can provide short-term pain relief and it's a useful alternative or addition to pain medication.

Can you put TENS on your neck? ›

Transcutaneous Electrical Nerve Stimulation (TENS) is the most common among electrotherapy devices, and it can be used to manage neck pain.

Can I sleep with TENS machine on? ›

Do not use a TENS unit with heating pads or cold packs. Do not use TENS while sleeping.

What is the main contraindication for the use of a TENS machine? ›

Pregnancy, epilepsy, and pacemaker are all contraindications for TENS.

How much does a TENS unit cost? ›

How Much Does a TENS Unit Cost? A TENS device is available online and can be used at home. It's not typically covered by insurance, but you also don't need a prescription for one. A TENS unit is a $30 to $100 expense.

Can TENS make nerve pain worse? ›

Can TENS unit placement make the pain worse? Overstimulation can make pain worse. In using TENS therapy, tiny electrical shocks from the TENS machine can block some pain perceived by the brain. For those who are new to using TENS therapy, take things slowly at first.

What are the three types of TENS? ›

Table 1.
  • Conventional TENS (low-intensity, high-frequency)
  • Acupuncture-like TENS (high-intensity, low-frequency)
  • Intense TENS (high-intensity, high-frequency)

Does TENS help arthritis pain? ›

TENS units, or transcutaneous electrical nerve stimulation therapy, can help to control arthritis pain without the use of additional drugs as well as reduce the amount of medication and related side-effects. If your arthritic pain is confined to a single region, a TENS unit may help reduce your pain.

How does a TENS unit stop pain? ›

A transcutaneous electrical nerve stimulator (TENS) sends electrical pulses through the skin to start your body's own pain killers. The electrical pulses can release endorphins and other substances to stop pain signals in the brain.

Does electrical stimulation reduce inflammation? ›

Electrical stimulation helps to prevent atrophy and build or maintain muscular strength, reduces inflammation, and improves range of motion. Different types of electrical stimulation are used in treating sprains, arthritis, chronic pain, and sciatica.

Can TENS help with weight loss? ›

It also gives the muscle more resistance, helps it burn fat, and convert it into muscle fibers, toning the muscle. For all these reasons, electrostimulation is the best way to tone muscles and lose weight. While the muscles are toned, at the same time, you lose fat.

Can a TENS unit help with muscle spasms? ›

The TENS can reduce the sensation of muscle tension and spasm that can be a problem for many patients with back and neck pain.

Where do you put a TENS unit for neck pain? ›

To relieve neck pain, place two electrodes either side of your spine high on your neck, just underneath your skull. Follow this by placing the other two electrodes about 5cm underneath them. Remember not to place the electrodes directly over your spine, as this will diminish the effect of the TENS.

How long should you use electrical muscle stimulation? ›

You should feel your muscles twitching or contract during treatment. Finally, the average muscular stimulation therapy sessions last about 10 minutes. However, your treatment may range between 5 and 15 minutes, depending on the area and condition of your muscles.

Is EMS painful? ›

EMS treatment usually feels like a mild tingling or pulsing sensation. Some people may feel a slight discomfort, but this is typically not painful. EMS treatments are usually brief, lasting anywhere from 5 to 20 minutes.

What should EMS feel like? ›

What Does EMS Feel Like? The sensation is hard to describe. It's sort of like a spasm or cramping, but not at all painful. It's a little bit like pins and needles – only it doesn't hinder your movement in the same way.

Do TENS machines strengthen muscles? ›

Since it does not cause a full muscle contraction, TENS can't be used to build muscle. However, the therapy is useful in treating pain, relieving muscle knots and in a therapeutic capacity can help improve athletic training sessions.

Does TENS unit increase blood flow? ›

The analgesic effect was possibly the result of reduced sympathetic activity, which induces vasodilation and relieves pain (43). Therefore, it is suggested that TENS increases blood flow, thereby stimulating the healing of various types of wounds.

Is electrical muscle stimulation safe? ›

A. Yes. FDA has received reports of shocks, burns, bruising, skin irritation, and pain associated with the use of some of these devices. There have been a few recent reports of interference with implanted devices such as pacemakers and defibrillators.

Does a TENS machine affect your heart? ›

The same TENS stimulation had no effect on coronary blood flow of patients with heart transplants.

What are signs of nerve regeneration? ›

How do I know the nerve is recovering? As your nerve recovers, the area the nerve supplies may feel quite unpleasant and tingly. This may be accompanied by an electric shock sensation at the level of the growing nerve fibres; the location of this sensation should move as the nerve heals and grows.

What does electrical stimulation do to nerves? ›

Electrical nerve stimulation uses a low-level electrical signal to stimulate nerves and block pain signals from reaching the brain. These therapies can bring relief to pain sufferers, and can often be used at home.

How do you use a nerve stimulator? ›

Connect the nerve stimulation needle to the nerve stimulator (which should be turned on) and set the current amplitude and duration to the desired levels. For superficial blocks, select 1.0 mA as a starting current intensity. For deep blocks, select 1.5 mA as a starting current intensity.

Where do you put TENS pads for peripheral neuropathy? ›

Peripheral Neuropathy (upper extremities)

Electrode Placement Channel 1: Place one electrode anterior and inferior to the acromion. Place the other electrode near the lateral epicondyle. Channel 2: Place one electrode over the anterior wrist. Place the other electrode over the carpal area.

How long should you use electrical muscle stimulation? ›

You should feel your muscles twitching or contract during treatment. Finally, the average muscular stimulation therapy sessions last about 10 minutes. However, your treatment may range between 5 and 15 minutes, depending on the area and condition of your muscles.

How many times a day can you use electrotherapy? ›

You can begin with one 15-minute therapy session. Repeat for another 15 minutes if needed. Use up to three times per day at a maximum. During each therapy, rate your pain before and after the session, 1 (low) to 10 (high) in order to gauge the true reduction of pain.

Does electrical stimulation help nerve damage? ›

Findings: Electrical stimulation applied to injured peripheral nerves during surgical repair can greatly enhance nerve recovery—both sensory and motor functions.

What does TENS therapy feel like? ›

What does TENS feel like? You may feel tingling, tapping, buzzing, or muscle twitching. You may also notice the TENS feels stronger or weaker at times. You may become used to the feeling and can turn up the intensity as you wear it longer.

Does a TENS unit work? ›

One study found that TENS treatment provided temporary pain relief for people with fibromyalgia while the machine was in use. While there is a lack of strong clinical evidence for its effectiveness, TENS is a low-risk pain relief option for many people.

Can a TENS unit help with foot neuropathy? ›

TENS therapy was associated with significantly subjective improvement in overall neuropathic symptoms in 12 weeks follow-up [WMD-0.18, 95% CI (-0.32, -0.051)]. No TENS-related adverse events were registered in TENS group. Conclusions: TENS therapy may be an effective and safe strategy in treatment of symptomatic DPN.

Does a TENS machine help peripheral neuropathy? ›

Researchers generally agree that TENS can provide sufficient relief of DPN pain, especially during initial use, although its long-term effectiveness is unclear. While some patients may experience enduring benefits, for others the analgesia may occur only during actual stimulation.

How can I stop neuropathy getting worse? ›

These changes can include:
  1. Losing weight.
  2. Exercising.
  3. Monitoring blood sugar levels.
  4. Not smoking.
  5. Limiting alcohol.
  6. Making sure injuries and infections don't go unnoticed or untreated (this is particularly true for people who have neuropathies of diabetes).
  7. Improving vitamin deficiencies.
17 Jan 2020

Who should not use EMS? ›

WB-EMS is contraindicated in patients with implanted electronic devices such as pacemakers, implanted defibrillators, neuro-stimulators or pain pumps because of potential electrical interference. There are various diseases or conditions mentioned as exclusion criteria, as listed in table 4.

Can you overdo EMS? ›

The EMS unit should not used excessively. Each athlete has their own limitations for how long a contraction can occur. When using the device, be sure to consult with a professional trainer and use the device within reason to achieve your specific goals.

Why do chiropractors use electrical stimulation? ›

Electrical stimulation works by providing electrical impulses to nerve endings in an area of injury. The stimulation soothes the nerve endings, provides pain relief, and may also increase blood flow to speed up healing in injured tissues.

Can I overuse a TENS unit? ›

TENS is safe, so you can use it as much as you like, although it's good practice to take regular 10-minute breaks every hour or so. Some people use TENS for more than five hours a day. It may be worth buying a TENS machine for home use.

Can you put TENS on your neck? ›

Transcutaneous Electrical Nerve Stimulation (TENS) is the most common among electrotherapy devices, and it can be used to manage neck pain.

Is TENS machine good for sciatica? ›

The answer is yes. TENS can relieve sciatica pain—even the radiating, and sometimes debilitating shooting pains that patients often experience. It's a safe, non-addictive painkiller alternative that might help you reduce discomfort and gain some mobility from sciatica.

Videos

1. How Does TENS Work to Relieve Pain?
(OMRON Healthcare US)
2. Transcutaneous Electrical Nerve Stimulation #TENS ( Electrotherapy lecture Part 1)
(Tony's Tutorial)
3. How to Use a TENS Unit for Pain Relief - Ask Doctor Jo
(AskDoctorJo)
4. What Exactly Does a TENS unit do for Pain? (Transcutaneous Electrical Nerve Stimulation)? +Giveaway!
(Bob & Brad)
5. Transcutaneous Electrical Nerve Stimulation (TENS) for Rheumatoid Arthritis (Lecture)
(Arthritis Society Canada)
6. TENS || TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION | TYPES OF TENS | INDICATIONS | CONTRAINDICATION
(MEDICAL ONESHOT)

Top Articles

Latest Posts

Article information

Author: Patricia Veum II

Last Updated: 09/10/2022

Views: 5833

Rating: 4.3 / 5 (64 voted)

Reviews: 95% of readers found this page helpful

Author information

Name: Patricia Veum II

Birthday: 1994-12-16

Address: 2064 Little Summit, Goldieton, MS 97651-0862

Phone: +6873952696715

Job: Principal Officer

Hobby: Rafting, Cabaret, Candle making, Jigsaw puzzles, Inline skating, Magic, Graffiti

Introduction: My name is Patricia Veum II, I am a vast, combative, smiling, famous, inexpensive, zealous, sparkling person who loves writing and wants to share my knowledge and understanding with you.