The 2025 Ultimate Guide to TENS Units

What is TENS?
TENS, transcutaneous electrical nerve stimulation, is a low frequency electrical current stimulating a sensory nerve (signal going to the brain) that blocks the pain signal.

What causes pain?
Pain is an unpleasant sensory or emotional experience. Pain is intended to alert the brain when the body is in danger. However, sometimes this “alarm” signal becomes so “loud” that it sends up a “danger” signal when there is no actual threat.

Why does pain persist?
Once the brain starts to perceive these experiences as harmful, one might have a tendency to avoid situations, movements, and/or positions that cause the unpleasant experience. Lack of movement and/or lack of exposure to the experience can make the experience more intense.

How can TENS reduce pain?
TENS can be used to temporarily block a pain signal while gradually re-exposing someone to the uncomfortable experience with the end goal of turning down the volume knob on the brain’s perception of the unpleasant experience.

Who should use TENS?
- Anyone who has pain with movement
- Anyone who avoids movement due to pain

Can TENS cure chronic pain?
No. In and of itself, TENS is not a “cure” for chronic pain. TENS works best when it is used in conjunction with gradual exposure to the unpleasant experience. Over time with gradual exposure to an unpleasant experience, the brain can become less “alarmed”. This type of training is referred to as desensitization strategies.

"Tens machines can be hit or miss depending on the person. If your pain is on the surface level and something that does not affect you everyday, a tens machine could be the right thing for you, instead of taking medication such as paracetamol or ibuprofen. If your pain is chronic however, I would suggest that you think about other treatment and not a tens machine. They may not be able to help the deep levels of pain, or if it is frequent. I think that as a medical professional, it is up to your discretion whether you recommend a unit or not."

"TENS units provide short-term pain relief for low back pain. The sensation experienced while using TENS essentially replaces the perception of pain. Think of TENS as a fancy method of rubbing your elbow after hitting it on the corner of the table. The effect experienced by TENS is individual as expectations influence the magnitude of pain relief. TENS, along with other modalities such as ultrasound and hot packs, rely heavily on a placebo effect. The pain reduction is real, but it is not the result of a fancy mechanism exclusive to TENS. TENS does not facilitate healing, any healing that occurs would have taken place without the TENS. I rarely recommend TENS. If the options are TENS or medication, TENS will win out every time, but there is no reason for the options to be limited. TENS will not cause direct harm, but it can create dependence and failure to implement long term strategies for pain (exercise, diet, sleep, stress, understanding of pain mechanisms, etc.)"

"I use TENS on a regular basis with patients to help decrease bladder pain and improve bladder frequency and urgency complaints. It can also be effective in helping decrease nighttime trips to the bathroom.

Over my 30 year career as a PT I have also used TENS for back pain, with varying degrees of success.

Why I recommend TENS units to patients:
1. Simple to use
2. Portable, so does not interfere with daily activities
3. Can provide effective pain relief with minimal side effects, such as may occur with medications. Occasional irritation at electrode sites may occur.
4. Available over the counter
5. Affordable for many

What type of ailments I typically use TENS for:
I have found TENS to be particularly effective in addressing bladder symptoms, such as bladder pain, frequency, and/or urgency. Electrodes can be placed on the lower abdomen, or on the low back, to help alleviate bladder pain that can be associated with conditions such as painful bladder syndrome and interstitial cystitis. Electrodes placed on the low back, at the level of the sacral nerves which supply the bladder, can be helpful in decreasing urinary frequency and even leakage such as with overactive bladder syndrome or urge incontinence."

"TENS machines are used by hundreds of thousands of pain sufferers all over the world for the relief of many types of physical pain from back to knee to neck pain. It is trusted global and this is why I recommend it for my patient with any major or minor pain such as acute and chronic pain, post-op incisions and post-surgical pain, labor, and delivery, migraine and tension headaches, acute pain from sports, and other injuries, arthritis, chronic pain from tendentious and bursitis, cancer pain, and wound healing."

"IMO, the best use of a TENS machine is during childbirth. TENS is deemed safe in the UK and Europe for this purpose and used in early and active labor to help manage contractions.

Most women rent a TENS machine at their local pharmacy for a six week period. Use of TENS for labor and childbirth is not (yet) common in the USA however there are FDA approved TENS machines for menstrual cramps that could be used for labor as well.

I used a TENS device myself in labor and found it a great experience. The only downside is that the device cannot be used when immersed in water."

"I often recommend TENs units for patient in chronic pain or experiencing high levels of pain post surgery. Neck, low back, knee and shoulder pain are the most common locations. TENs is also great on the low back region during labor for mother's that want to go the natural route.

It is a great tool to have around the house due to its small size and relatively low cost. You can find one for $20-30 dollars on Amazon and most insurance will cover costs with a MD or PT referral.

What is TENS used for?
People use TENS to relieve pain for several different types of illnesses and conditions. They use it most often to treat muscle, joint, or bone problems that occur with illnesses such as osteoarthritis or fibromyalgia, or for conditions such as low back pain, neck pain, tendinitis, or bursitis. People have also used TENS to treat sudden (acute) pain, such as labor pain, and long-lasting (chronic) pain, such as cancer pain.

Although TENS may help relieve pain for some people, its effectiveness has not been proved.

Is TENS safe?
Experts generally consider TENS to be safe, although the machine could cause harm if misused. Have your physical therapist or doctor show you the proper way to use the machine, and follow these instructions carefully.
Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy."

I have used TENS units regularly throughout my practice. As I have gone further into my career though I have used them less in my practice. I still recommend them, especially for home use and when a patient is in acute pain but during my actual, individual time with a patient I would prefer to use something that is more effective at treating the root cause of my patient's ailment.

TENS units do what they say they do...They help with pain relief. However, just like any medication you take or any injection you get, it is temporary. At a maximum it will provide about 20 minutes of relief after the machine is turned off.

The way a TENS machine works is it basically distracts your brain. As signals from out peripheral tissues (low back, leg, hands, etc.), along our nerves, and up to our brains in order to be interpreted as pain, they need to travel along pathways that are connected with other nerves. Nerve fibers that are responsible for pain travel a lot slower than your tactile or touch sensation.. Therefore, the TENS machine, itself works to stimulate your touch sensation to travel and "cut off" the message of pain to your brain. Basically, the TENS machine acts as a distraction for your brain from pain (fascinating right???).

It's the same principle that happens when you bump your head. What do you do? You rub your head. Who told you to rub your head to make it feel better?? I still don't remember who told me the first time but it follows the same principle. Stimulation of your touch sensation, prevents the pain signal from reaching the brain and in turn, you don't feel pain.

When I recommend them to my patients for use, I teach them to use it as a tool. Not as a crutch or something they need to rely on. They can use it for acute pain to help get through the initial inflammatory stages of healing or can use it when they have an acute flare up. However, they need to make sure that they are still seeking care to take care of the ORIGIN and direct CAUSE of the pain. TENS machines again are not something to become reliant on."

"As a doctor of physical therapy, I use and recommend TENS to my patients often. Using TENS can be helpful for temporary pain relief. It is a great alternative to help with pain when a patient needs immediate relief, wants relief while continuing with their daily routine and when they prefer not to use medication. It is a great way to calm down pain prior to getting my patients to start moving.

I usually recommend using TENS when my patients have acute pain (pain that began in the last 2-4 days) in a large area. I mostly use TENS on the shoulder, upper and lower back. However, it can be placed anywhere on the body that is not over the heart, implanted devices, or active tumors.

With acute pain, people often feel that they are unable to move or have difficulty moving. TENS can be easily put on while at rest (sitting or laying down) to help with pain. It can also help for those who need to continue to move, but feel limited because of pain. Many of the at-home units are portable, so it can be easily clipped onto clothing to provide relief while doing work (housework, or a laborious job)."

"At our office, we prescribe TENS units regularly for our patients. They are good for musculoskeletal pain. You can use them almost anywhere. Using them for 20 minutes at a time is a great way to reduce pain. It helps by interrupting the pain signals and can even snap a muscle out of a spasm. They are a great adjunct therapy for pain. There are also only a few restrictions so most people will benefit from the use of them.

All of our products and practices in our office are evidence based. We also have tested them on ourselves as well, so we can speak from personal experience for any service we offer for our patients."

"I’ve used TENS units with patients who have pain. Typically, I would use on patients after a treatment session paired with heat or ice, depending on patient’s preference, level of pain, and goal of treatment. A TENS unit stimulates the touch sensation of the nervous system, which can busy the brain, to decrease its ability to perceive pain.

I recommend TENS units for three reasons:

- TENS units can reduce pain.
- TENS units are used locally on the affected body part, rather than systemically, like medication
- TENS units allow the patient to be in control of pain, which improves autonomy and ownership of recovery from an injury or surgery.

Typical ailments that patients use for a TENS unit for include: chronic pain (back and neck pain are common), acute pain related to injuries, and post op surgical pain (shoulder, knee, and ankle are common)."

"I have recommended TENS units to several family members with neck and shoulder pain. Everyone so far agrees that as long as you use the correct setting and pad size, they work very well. If they are placed in the wrong location or the wrong settings are used, TENS units can cause a tingling sensation or even a mild shock. Reading the directions or watching a video usually ensures proper use."

"I was educated on TENS in my DPT program as well as self-learning after graduation. I see it as a good non-pharmacological/surgical way to help manage acute and chronic pain that is safe for most. With the rise in ability to get TENS units online or in the store, I typically recommend the one that is most convenient for the person I am actively treating to help them get back to their activities or be able to manage more chronic conditions."

"As a physical therapist the use of TENS devices is part of our routine practice.

TENS for pain relief: TENS units work to reduce pain through dorsal horn inhibition. This essentially means that the sensation created by the TENS device overrides, or inhibits, the painful sensation that the person is experiencing. This process occurs both in the peripheral and central nervous system.

We all use dorsal horn inhibition on a regular basis without even knowing it. Have you ever hit your funny bone or stubbed your toe? I bet you found yourself rubbing the injured area for some pain relief, right? If you did, you are actively performing dorsal horn inhibition, the same exact thing that a TENS machine would do.

General experience with TENS: TENS can be helpful at reducing the intensity of someone's pain. TENS however won't fix the cause of the pain only mask the symptoms so to speak. This can still be beneficial as it may allow for other treatments that can directly affect healing.

Another benefit is that by reducing the intensity of pain the patient may experience less fear avoidance behaviors, something critical to long term prognosis.

When TENS works best: TENS can be used when someone is experiencing both a new onset of pain (acute) and persistent pain. TENS typically works best when the pain is moderate. If the pain is too severe it likely won't help or may make things worse. Likewise if the pain is fairly minimal it won't have as great of affect.

Conclusion: In general TENS can be helpful as a "distraction" for moderate pain. It certainly won't fix the cause of the pain but may allow for other treatments or for the person to become more active again."

"I have used TENS units with my patients for many years to assist with pain relief. I recommend them for a variety of medical conditions and injuries such as: chronic cervical, thoracic, and/or lumbar pain, tendonitis, ankle sprains, and sports injuries. I also often recommend them after surgical procedures such as rotator cuff repairs, total knee arthroplasty, ACL repairs, and total hip arthroplasty to help decrease pain.

My experience working with TENS units is primarily in an outpatient Physical therapy clinic setting. I use them to assist with decreasing patient's symptoms of pain and sometimes issue them a home TENS unit for symptom management of pain at home. They are conveniently small and patients can wear the unit in their pocket and still be able to walk around their house."