Cliff Harvey PhD
Transcutaneous electrical nerve stimulation (TENS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes. It is popularly used by athletes and practitioners for rehabilitation and therapy for a range of injuries, and health conditions.
Several Cochrane database reviews have been conducted for various outcomes resulting from TENS
- 2002: High frequency (but not low-frequency) TENS is more effective for pain relief than placebo in primary dysmenorrhoea.1
- 2008: Unclear results reported for reduction of chronic low-back pain.2
- 2008: There is a trend towards pain reduction in chronic pain treatment but results are unclear.3
- 2009: The data is inconclusive for the use of TENS for the treatment of osteoarthritic knee pain, however, there is an (unclear) trend towards small improvements.4
- 2015: Evidence suggests that TENS is more effective than placebo for reducing acute pain.5
These results are somewhat equivocal but suggest that TENS might be of benefit for reducing both chronic and acute pain. Several other reviews and meta-analyses have also examined TENS for pain and other outcomes.
- TENS, when administered with a strong (but not painful) dose at the wound area, can significantly reduce the use of pain medication post-surgery.6
- TENS could also reduce symptoms of diabetic neuropathy.7
- In a recent 2016 review for the effect of TENS on chronic, low back pain, a significant reduction of pain also resulted in less pain medication used.8 A 2017 review reported unclear results for most outcomes, but significant improvement in pain from TENS used during therapy.9 Another review compared TENS to sham, placebo or medication, finding little benefit for pain reduction (which is unsurprising if active treatment medications were used as comparators), but still found an improvement over these treatments for function (i.e. reduced disability).10
- TENS has also shown benefits for use in a ‘pre-hospital setting’. A 2014 meta-analysis indicated that TENS produced a clinically significant reduction in the severity of pain in patients with moderate-to-severe acute pain and significantly lower post-treatment pain scores than a ‘sham’ TENS treatment. TENS was also effective in reducing acute anxiety secondary to pain.11
- Consistent application, ‘bursts’, or acupuncture-like TENS are all thought to also be effective for improving outcomes and reducing pain in osteoarthritis of the hips and knees.12 High-frequency TENS has demonstrated a greater effect for reduction of pain in knee osteoarthritis than electroacupuncture.13
- This meta-analysis suggests that TENS may serve as an effective and well-tolerated alternative for migraineurs.14
- TENS can improve static balance, muscle spasticity, and walking speed in post-stroke patients.15-18
- TENS can also significantly reduce pain and pain medication use following knee surgery.19, 20
- TENS reduces reported symptoms of tinnitus and might be an effective adjunct treatment for this condition.21
- TENS promotes reductions in blood pressure and heart rate in healthy individuals.22
Additional factors to consider:
A 2011 trial examined differences in intensity of electrical stimulation finding that only the strong, non-painful TENS (active TENS for 30 min at ~80 Hz) reduced pressure pain compared to below sensory threshold, and placebo TENS. The authors write “This study shows a dose-response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief.”23 A thesis review found similarly that sufficiently strong TENS at the strongest, non-painful dose are effective for reducing pain.24
However, in a 2018 meta-analysis, the following points were noted for the efficacy of interferential current vs TENS25
- Both TENS and IFC have been indicated to reduce pain intensity.
- TENS and IFC have similar effects on pain intensity.
- Physical therapists could choose either TENS or IFC and expect similar treatment effects.
An overall reading of the evidence suggests that TENS can reduce pain and pain-medication use across a range of injuries and health conditions and can also improve some aspects of functional ability (such as walking speed and static balance) in post-stroke patients.
Sub-perceptual and evident applications of TENS are likely to be effective but the most effective strategy is likely to be used for relatively long times (i.e. >20 min) at the strongest, non-painful dose.
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- Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. 2002(1).
- Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low‐back pain. Cochrane Database of Systematic Reviews. 2008(4).
- Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database of Systematic Reviews. 2008(3).
- Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2009(4).
- Johnson MI, Paley CA, Howe TE, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database of Systematic Reviews. 2015(6).
- Bjordal JM, Johnson MI, Ljunggreen AE. Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain. European Journal of Pain. 2003;7(2):181-8.
- Jin D-m, Xu Y, Geng D-f, Yan T-b. Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: A meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice. 2010;89(1):10-5.
- Jauregui JJ, Cherian JJ, Gwam CU, Chughtai M, Mistry JB, Elmallah RK, et al. A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surgical technology international. 2016;28:296-302.
- Resende L, Merriwether E, Rampazo ÉP, Dailey D, Embree J, Deberg J, et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. European Journal of Pain. 2018;22(4):663-78.
- Wu L-C, Weng P-W, Chen C-H, Huang Y-Y, Tsuang Y-H, Chiang C-J. Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain. Regional Anesthesia &amp; Pain Medicine. 2018;43(4):425.
- Simpson PM, Fouche PF, Thomas RE, Bendall JC. Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting: a systematic review and meta-analysis of randomized-controlled trials. European Journal of Emergency Medicine. 2014;21(1).
- Brosseau L, Yonge K, Marchand S, Robinson V, Osiri M, Wells G, et al. Efficacy of Transcutaneous Electrical Nerve Stimulation for Osteoarthritis of the Lower Extremities: a Meta-analysis. Physical Therapy Reviews. 2004;9(4):213-33.
- Shi X, Yu W, Zhang W, Wang T, Battulga O, Wang L, et al. A comparison of the effects of electroacupuncture versus transcutaneous electrical nerve stimulation for pain control in knee osteoarthritis: a Bayesian network meta-analysis of randomized controlled trials. Acupuncture in medicine : journal of the British Medical Acupuncture Society. 2020:964528420921193.
- Tao H, Wang T, Dong X, Guo Q, Xu H, Wan Q. Effectiveness of transcutaneous electrical nerve stimulation for the treatment of migraine: a meta-analysis of randomized controlled trials. The Journal of Headache and Pain. 2018;19(1):42.
- Lin S, Sun Q, Wang H, Xie G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: A systematic review and meta-analysis. Journal of Rehabilitation Medicine. 2018;50(1):3-7.
- Kwong PW, Ng GY, Chung RC, Ng SS. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. Clinical rehabilitation. 2018;32(9):1203-19.
- Mahmood A, Veluswamy SK, Hombali A, Mullick A, Manikandan N, Solomon JM. Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2019;100(4):751-68.
- Marcolino MAZ, Hauck M, Stein C, Schardong J, Pagnussat AdS, Plentz RDM. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disability and Rehabilitation. 2020;42(5):623-35.
- Zhu Y, Feng Y, Peng L. Effect of transcutaneous electrical nerve stimulation for pain control after total knee arthroplasty: A systematic review and meta-analysis. Journal of rehabilitation medicine. 2017;49(9):700-4.
- Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine. 2017;96(37).
- Byun YJ, Lee JA, Nguyen SA, Rizk HG, Meyer TA, Lambert PR. Transcutaneous Electrical Nerve Stimulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis. Otol Neurotol. 2020.
- Campos FV, Neves LM, Da Silva VZ, Cipriano GF, Chiappa GR, Cahalin L, et al. Hemodynamic effects induced by transcutaneous electrical nerve stimulation in apparently healthy individuals: a systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation. 2016;97(5):826-35.
- Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, et al. Hypoalgesia in Response to Transcutaneous Electrical Nerve Stimulation (TENS) Depends on Stimulation Intensity. The Journal of Pain. 2011;12(8):929-35.
- Johnson M. Transcutaneous electrical nerve stimulation: review of effectiveness. Nursing Standard. 2014;28(40):44-53.
- Almeida CCd, Silva VZMd, Júnior GC, Liebano RE, Durigan JLQ. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Brazilian Journal of Physical Therapy. 2018;22(5):347-54.  ‐0.07 (95% CI ‐0.46 to 0.32