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TENS for pain relief

Peo­ple liv­ing with long-term pain may be offered treat­ment with a TENS machine to help ease their symp­toms, but what is it? How does it work? And what can it bring to your pain man­age­ment toolk­it? Phys­io­ther­a­pist Dr Pete Glad­well draws upon his clin­i­cal expe­ri­ence and research to answer these ques­tions and explain the effects and ben­e­fits of TENS

How does TENS work?

TENS stands for tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tion. TENS devices have been around since the 1960s and help in pain man­age­ment by deliv­er­ing elec­tri­cal impuls­es across the skin.

TENS machines are usu­al­ly a small box with wires lead­ing to self-adhe­sive pads, although wear­able belts suit­able for back pain are also avail­able. The pads are placed on either side of, on top of or close to the painful area. When switched on you get a tin­gling sen­sa­tion under the pads. My usu­al advice is to aim for a strong, but com­fort­able, sen­sa­tion. The right sen­sa­tion for you can be found using the con­trols on the TENS machine.

The TENS machine works through dif­fer­ent mech­a­nisms. Some research shows that the TENS machine oper­ates through the pain-gate, a spe­cial sys­tem that helps to block pain mes­sages going up through the spinal cord. Oth­er evi­dence sug­gest that the TENS machine also stim­u­lates some of the opi­oid sys­tems, or nat­ur­al pain-killing sys­tems, with­in the body. The third mech­a­nism, which my research sug­gests as well, is the dis­trac­tion mech­a­nism; it may actu­al­ly just take your mind off the pain.

Can TENS be use­ful to everyone?

For some peo­ple, using a TENS machine leads to pain relief. For oth­ers, the sen­sa­tion just takes their mind off the pain for a while.

Unfor­tu­nate­ly, for some peo­ple it is not help­ful or they find the sen­sa­tion too unpleas­ant. In our clin­ics we encour­age peo­ple to change the sen­sa­tion to suit them, but it may not work as peo­ple’s expe­ri­ence of pain is diverse.

Peo­ple should NOT use TENS if they have epilep­sy, a heart rhythm dis­or­der, a pace­mak­er fit­ted or if they are preg­nant (except for pain relief dur­ing labour). If you are unsure, speak to your health­care professional.

As far as we can tell, the TENS machine can be used for all pain con­di­tions, pro­vid­ing there is no health rea­son pre­vent­ing its use. How­ev­er, it can be dif­fi­cult if you have many pain sites espe­cial­ly if the pain can move and vary through­out the day, so you end up chas­ing after the pain with the TENS machine.

Peo­ple with wide­spread pain such as fibromyal­gia syn­drome may feel that it is dif­fi­cult to choose a spe­cif­ic area to treat, but it may be pos­si­ble to select one treat­ment area such as the low­er back, to see if the TENS machine can offer an over­all ben­e­fit. There is a ran­dom­ized con­trolled tri­al explor­ing exact­ly this approach which is due to report its find­ings soon. How­ev­er, peo­ple with wide­spread pain often have a localised pain prob­lem which can be helped through using a TENS machine, even if it doesn’t help their more wide­spread pain. It is down to each indi­vid­ual to try out dif­fer­ent approach­es to see what may help them.

Dif­fer­ent Strategies

We asked peo­ple who had expe­ri­ence of using TENS about the ways that they used their TENS machine, the ben­e­fits they got and how they over­came their prob­lems. From this research, there seemed to be five main strate­gies that peo­ple had worked out to gain the most from their TENS machine:

  1. Use the TENS machine only on a bad day or dur­ing a flare-up to help cope and get through the pain
  2. Use TENS inter­mit­tent­ly dur­ing the day dur­ing a rest break, per­haps in com­bi­na­tion with relax­ation techniques
  3. Use TENS for par­tic­u­lar activ­i­ties (such as walk­ing or sit­ting, e.g. in the cin­e­ma) which would oth­er­wise have been dif­fi­cult because of pain
  4. Use TENS on and off all day to help with most dai­ly activities
  5. Use TENS in the morn­ing, to help with the extra pain and stiff­ness that some peo­ple expe­ri­ence first thing.

These dif­fer­ent meth­ods show how a range of peo­ple can find using a TENS machine ben­e­fi­cial by using dif­fer­ent strategies.

When it comes to the ben­e­fits, some peo­ple talk about direct pain relief. How­ev­er, some peo­ple also find the dis­trac­tion from their pain real­ly quite help­ful. This is known as counter-stim­u­la­tion, where a more pleas­ant sen­sa­tion helps you to man­age your pain. These peo­ple assert­ed that the dis­trac­tion was a sep­a­rate ben­e­fit from pain relief, as it can just pro­vide a break. Some peo­ple said that using TENS could help them to do more despite not nec­es­sar­i­ly reduc­ing the amount of pain. Oth­ers found that TENS use could help them to fall asleep more eas­i­ly. These aspects are cur­rent­ly the focus of research on the ben­e­fits of TENS machines.

Hints and Tips

  • One strat­e­gy some peo­ple find help­ful is to use the machine when at rest in a com­fort­able posi­tion, per­haps while you are hav­ing a break or before sleep. Anoth­er strat­e­gy is to use TENS dur­ing par­tic­u­lar activ­i­ties that would oth­er­wise be dif­fi­cult to manage
  • The pre­ferred type of sen­sa­tion is per­son­al. There are some peo­ple who feel that the stronger the sen­sa­tion, the more effec­tive the TENS machine will be. The set­tings on most machines can be adjust­ed to suit indi­vid­ual pref­er­ences and can be tweaked dur­ing a treat­ment session
  • Despite being hypoal­ler­genic, the pads can aggra­vate the skin. Rub­ber pads with gel are an alter­na­tive that can be less of an irri­tant. How­ev­er, some peo­ple do con­tin­ue to react to the pads. In this case it is impor­tant to lim­it use to short peri­ods where pain relief is cru­cial and also to change the posi­tion of the pads reg­u­lar­ly to avoid the problem
  • Be per­sis­tent! Some­times patients have to plug away at a prob­lem for two or three months before they feel sure that they are get­ting the ben­e­fits. Chang­ing the set­tings and chang­ing tack can help you work out whether TENS can work for you.

More infor­ma­tion

Dr Pete Glad­well is Clin­i­cal Spe­cial­ist Phys­io­ther­a­pist in the pain man­age­ment ser­vice at North Bris­tol NHS Trust in Bristol.

If you would like to know more about the sources of evi­dence con­sult­ed for this pub­li­ca­tion please click here.

TENS for pain relief © Peter Glad­well. All rights reserved. Revised June 2019. To be reviewed April 2022. First pub­lished April 2015.


im need­ing a tens machine as mine broke i have suf­fered chron­ic pain since hav­ing my gaul blad­der out 4 n half years ago.its changed my life I am in pain MORE ooften than not and don’t seem to be get­ting any help just medication.

Hi ker­ry
I had my Gall­blad­der out 7 months ago and have been in chron­ic pain since was tak­ing mor­phine and also oth­er tablets , also chair bound with the pain , ive been put on a tens machine 3 days ago from the pain clin­ic at hos­pi­tal to use 4 times a day and with in 12 hours im pain free but was told to keep using it till next appoint­ment in 10wks , im up and about and feel­ing great ive also bought a tens £20 ( same one ) from amazon .
Hope you get relief soon
Pam bird

I have been suf­fer­ing with long term back pain until i got my TENS around 3 months ago. Get the big­ger pads for your back and legs. I noticed in my first month that you might also have to play around with the place­ment to hit the sweet spot. But once you do its blisss

My sav­iour lol

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