TENS Therapy for Back Pain

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Back pain, according to the American Chiropractic Association, is the leading worldwide cause of disability. 80% of the human population experiences back pain.

Back pain can be highly debilitating because the back is large and central to our everyday movements. We use our back to do almost everything, including sitting, standing, walking, laying down, running, and even more minor things such as writing and watching movies.

If you’re experiencing back pain, you might have heard of TENS therapy. This holistic method of pain management offers a safe and effective way of relieving pain so you can go about everyday activities. This guide provides an insight into what TENS electrotherapy for back pain is, how it works, how to use it to relieve back pain properly, and the best TENS pad placement for back pain.

What is a TENS Unit for Back Pain?

Transcutaneous electrical nerve stimulation, known as TENS, therapy uses a battery-operated device called a TENS unit that delivers mild electric shocks to pain areas.

Electrodes, also called TENS pads, are placed around the area of pain and attached to lead wires connected to the device. The device administers electrical shocks to the pads through lead wires which blocks the pain from being felt.

How Does a TENS Unit Help Back Pain?

TENS units block back pain in two ways:

• Endorphin Release: The electrical shocks from the TENS device stimulate nerves to activate and release your body's endorphins. When endorphins are released, they reduce the sensation of pain, make you happier, and improve your immune system’s response. TENS units achieve the same endorphin release as pain medications but without the risk of addiction.
• Pain Gating: Acts to block the small nerve fibers responsible for sending pain signals to the pain when an injury occurs. TENS units send an electrical pulse to the large fiber, which blocks the small fiber from sending pain signals to the brain. This helps temporarily reduce the perception of pain.

Most TENS units have various intensity levels and modes that vary the electrical shock’s pulse and width. Some devices give you complete control to fully customize the settings.

Do TENS Units Work for Back Pain?

Professional physical therapists and chiropractors have used TENS units for years to enhance treatments for back pain.

However, there isn’t enough evidence for the NHS to recommend it (more thorough research is needed). For example, one 2014 study found positive trends for chronic back pain, whereas another found it to act as a placebo.

Meanwhile, thousands of positive reviews showcase its effectiveness in blocking pain. Medical experts and researchers aren’t quite 100% sure how TENS therapy works. Still, many users have reported this treatment method as an excellent method of short-term pain relief and much safer than pain medications.

Types of Back Pain TENS Units Treat

Back pain is a generalized type of pain used to reference an area rather than a kind of pain. This section breaks down the various types of back pain TENS therapy is used to treat.

Muscle Pain

One of the most common uses of TENS units is for muscle pain. The NHS has recommended these devices, and studies have linked them as an effective treatment for blocking pain related to:

• Sore muscles: A study conducted with 50 participants with delayed onset muscle soreness (DOMS) administered TENS therapy and cryotherapy three times a week for eight weeks. After eight weeks, the combined treatments were found to reduce pain from DOMS significantly.
• Muscle spasms: A study was conducted with 30 patients using TENS and a control group of 30 participating in passive exercises. At the end of the research, the study found that the group using TENS significantly decreased muscle spasms and improved range of motion. The study also found that muscle spasms are better reduced if more extended stimulation periods are applied.
• Muscle knots: A study involving 60 participants with myofascial trigger point pain in their upper back found TENS therapy to be an effective treatment for immediate pain relief.
• Muscle atrophy: A study used TENS during physical therapy treatment for patients with muscle atrophy and found the treatment to be an excellent addition to rehabilitation in strengthening and growing muscles.

Because TENS therapy provides a calming effect, they’re effective in allowing users to rehabilitate muscles more comfortably when stretching. 

Nerve Pain

TENS therapy is an excellent option for nerve pain relief because it targets nerves to prevent them from sending pain signals to the brain. It’s recommended by the Brain and Spine Foundation and the Foundation of Peripheral Neuropathy as a treatment for neuropathic pain.

Fibromyalgia

Fibromyalgia is a condition that is well under-researched and understood by medical professionals. It’s often characterized by widespread pain in the muscles and bones. TENS therapy is commonly used to treat pain from fibromyalgia.

A 2020 study found that 50% of participants experienced less pain and other symptoms using TENS. Another 2019 study found decreased pain levels as the alpha power in the frontal lobe increased with TENS therapy. And a study in 2018 saw 44% of participants experience a 30% or more significant reduction in pain after using TENS therapy for fibromyalgia.

Arthritis

When it comes to arthritis in the back (most commonly spinal arthritis), the results have been 50/50. A 2015 Cochrane review found evidence that TENS therapy minimizes the intensity of the pain, whereas the other 50% experience it as a placebo. More research is needed.

Post-Surgery Recovery

TENS units have been proven and recommended to those recovering from surgery. They’ve found this treatment to help ease post-surgery pain and pain related to injuries such as fractures and sprains. If you’ve had back surgery and want to be less dependent on prescription medications, TENS therapy can help.

Spinal Cord Injuries

A result of spinal cord injuries is a struggle with movements due to pain and damaged nerves. While TENS therapy does not help with movement during physical therapy, it can help with reducing the perceived pain to make movements less painful.

Best Practices: How to Use a TENS Machine for Back Pain

There are a few general best practices for effective treatment when using your TENS unit to relieve back pain. Below, you’ll find our best tips for starting TENS therapy.

• Start with a low-intensity setting: You might get a zapping sensation that can be painful (but not harmful) if you start with a higher setting. Start at the lowest setting and go up until the pain is no longer felt.
• Don’t use your device while driving: A side effect of TENS therapy is that it will make your muscles twitch. Because of this, it’s essential never to use it while operating heavy machinery. Doing so can cause an accident.
• Don’t use your device in or around water: TENS units are relatively safe. However, because they deliver mild electrical shocks, it’s best not to use them around liquids.
• Don’t use your device while sleeping: If you can’t sleep because of pain, use your device before bed. Using it while asleep can cause the electrodes to lose their stick and zap you.
• Don’t use your TENS with hot & cold packs: While we recommend using other forms of pain relief to aid in healing, it’s best to use only one at a time. Using a hot & cold pack simultaneously can cause moisture to get into the pads.
• Try various settings until pain relief is achieved: Keep testing your device's settings until the pain is no longer felts. If you’re new to TENS therapy, start with the preset modes and see if they work. Some devices give you the option to customize your settings fully.
• Incorporate other pain relief methods: TENS therapy does not heal injuries. Add other pain relief methods such as hot & cold therapy, stretching, or physical exercise. Try to use your device within an hour before exercise. You’ll notice movements to be easier as the effects of the endorphin release from the device continue.

Best TENS Settings for Back Pain

The common question is, “which TENS unit setting is best?” The true answer is that there is no best setting as no pain is the same. Some people’s nerves are more responsive to TENS therapy, whereas others may need a higher setting for relief. Below, you’ll find some general tips about selecting a TENS unit setting.

Pulse Rate (Frequency) Settings

The pulse rate is the number of electrical pulses delivered in one second. Pulse rate is measured in hertz (Hz). A lower pulse rate is ideal for chronic pain, whereas a larger pulse rate treats acute pain. Below, we identify which range of Hz is best for acute pain, chronic pain, and muscle stimulation.

• 2-10Hz: Best for chronic pain and endorphin release
• 35-50Hz: Best for muscle stimulation 
• 80-120Hz: Best for acute pain

Pulse Width (Duration) Settings

The pulse width refers to the length of the pulse being administered. This is the amount of time an electric shock is delivered. Pulse width is measured in microseconds. A more extended pulse width equates to stronger stimulation.

Intensity Level

The device's intensity level is how strong the electrical pulse is. Most machines offer an intensity range of 0 to 80mA. However, stronger over-the-counter units can go up to 100 mA. Generally, the stronger the pain level, the higher the intensity needed. Start at the lowest setting and increase it as required when starting any TENS session.

Time Duration

The great thing about TENS therapy is it can be used as often as needed without any side effects. The following settings are recommended based on the pain type:

• Acute pain: 20-60 minutes, up to four times per day
• Chronic pain: 20-30 minutes, up to five times weekly

Best Practices: TENS Unit Placement for Back Pain

At the center of TENS therapy success is the placement of electrodes. To achieve pain relief, the pads need to conduct the electrical current through the area in pain. This effectively blocks the area's nerves to minimize pain. Follow the best practices below when using electrode treatment for back pain.

• Identify the pain’s location and the most tender area: Softly touch the area in pain to locate where most of it stems from. This is going to be your target area.
• Always use at least two pads: TENS therapy relies on an electrical current of two electrodes to pass through the pain area. You’ll need to use a minimum of two electrodes to achieve that current. Your pad usage should also be in even numbers (i.e., 2, 4, 6, 8) to conduct the current(s).
• Make sure each channel cross aligns: Each channel should cross align if you’re using four or more electrodes. For example, each pad on channel one should be diagonal to the other and not directly next. The same applies to the other channels.
• For a larger surface area, increase the number of pads: Some TENS units offer the capability of up to four channels (eight pads) at once. This gives you the ability to simultaneously target a larger surface area (or multiple areas). If you experience a broader back pain area, this might be helpful.
• The closer the pads, the stronger the electrical sensation: If you want to increase or decrease the electrical sensation, you can place the pads closer or further apart. The closer the pads, the stronger the sensation. Just be sure not to put them too far apart as this can reduce effectiveness.
• Place your pads at least 1” apart: Pads should be a minimum of 1” apart and should never touch.
• Try not to place your pads over joints: Movement can interfere with the adherence of the pads. If parts of the pads unstick, it can zap you.
• Always place pads on clean and dry skin: This removes any dirt or debris on your skin that can reduce the lifetime of the pads.
• Don’t place pads over broken skin: It’s important to let any broken skin heal before placing electrodes on it.
• Test your placement until pain relief is achieved: Sometimes, you’ll need to test the placement of your pads until the pain is blocked. There is no right or wrong placement of TENS pads as no pain is the same. Additionally, try placing your pads at various angles.
• Remove any hair before placing: Body hair tends to diminish the life of the pads. Try to shave any hair over the target area before treating it.

How to Use a TENS Unit for Upper Back Pain

TENS Placement for Upper Back Pain

Much upper back pain is caused by poor posture or soft tissue injuries such as sprains or strains from looking downward for long periods. When using a TENS for upper back pain, use this placement guide to effectively direct your device's electrical pulses to the area in pain.

Selecting a Mode

Most TENS units have preset “modes” that set the device's pulse rate and width for you. These are helpful if you’re new to TENS therapy or want to start quickly. Below, we identify the three standard modes for most TENS devices.

• Normal: Provides constant stimulation at the frequency and width setting. This setting is most commonly used for acute pain through a pain gating effect.
• Burst: This mode is used for chronic pain relief. This setting sends quick bursts of electrical stimulation.
• Modulation: In this mode, the device variates its settings and uses a cyclical to prevent nerve adaptation. It’s an excellent mode for both acute and chronic pain.

How to Use a TENS Unit for Middle Back Pain

TENS Pad Placement for Middle Back Pain

A few common middle back pain injuries include spinal arthritis, spinal stenosis, and degenerated, ruptured, or herniated discs. Use this placement guide to block any pain in the middle back area effectively.

How to Use a TENS Unit for Lower Back Pain

TENS Pad Placement for Lower Back Pain

Strains and sprains can cause lower back pain from lifting heavy objects or unsafe methods. When using your TENS for lower back pain, this placement guide can help. Remember that your TENS placement for lower back pain may prevent you from bending over while in use. Because of the location, the pads can come undone from bending over.

Conclusion

If you’re looking for a machine to help back pain that’s safe, effective, and customizable, you can’t go wrong with TENS therapy. However, the device you choose is also essential. You’ll need a reputable TENS unit that delivers true TENS rather than a massage-like sensation. For this reason, we recommend reading our TENS unit buyer’s guide, which covers the essentials of choosing a device.

It’s also vital to note that TENS does not treat the condition. It only blocks the sensation of pain. It’s best to incorporate other treatment types to rehabilitate your back injury. Our back pain relief guide highlights the best methods of back pain relief.

From your experience, what’s your number one TENS therapy piece of advice for back pain? Let us know in the comments!

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About the Author

Brandon Landgraf is the Digital Marketing Manager for Carex Health Brands. He finds passion and fulfillment in creating content that enhances, improves, and enlivens others' quality of life. All of his written work is formulated to not only offer essential advice and tips but back it with proven studies and experts. His mission is to connect with readers and provide steps to make their lives better.

You can connect with him on LinkedIn here.

About Carex Health Brands

Carex is your one-stop shop for home medical equipment and for products that assist caregivers with providing the best possible support and care for their loved ones. Carex Health Brands has been the branded leader in in-home, self-care medical products for over 35 years. Our goal is to improve the lives of our customers by bring them quality products that bring dignity back to their lives. With our three nationally distributed brands, Carex Health Brands serves national, regional and independent food, drug and mass retailers along with wholesalers, distributors and medical dealers.