transcutaneous electric nerve stimulation


Summary: The use of specifically placed small electrodes to deliver electrical impulses across the SKIN to relieve PAIN. It is used less frequently to produce ANESTHESIA.

Top Publications

  1. Chesterton L, Foster N, Wright C, Baxter G, Barlas P. Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain. 2003;106:73-80 pubmed
    ..The role of TENS frequency, intensity and site are pivotal to achieving optimal hypoalgesic effects, during and after stimulation. Clinical applications of these parameter combinations require further investigations. ..
  2. Venancio R, Pelegrini S, Gomes D, Nakano E, Liebano R. Effects of carrier frequency of interferential current on pressure pain threshold and sensory comfort in humans. Arch Phys Med Rehabil. 2013;94:95-102 pubmed publisher
    ..Carrier frequencies of 1kHz and 2kHz are perceived as more uncomfortable than carrier frequencies of 4kHz, 8kHz, and 10kHz. ..
  3. Facci L, Nowotny J, Tormem F, Trevisani V. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Med J. 2011;129:206-16 pubmed
    ..05); a difference was only found between these groups and the controls (P < 0.0001). There was no difference between TENS and interferential current for chronic low back pain treatment. NCT01017913. ..
  4. Claydon L, Chesterton L, Barlas P, Sim J. Alternating-frequency TENS effects on experimental pain in healthy human participants: a randomized placebo-controlled trial. Clin J Pain. 2013;29:533-9 pubmed publisher
    ..Transcutaneous electrical nerve stimulation (TENS) is a modality commonly used in pain management...
  5. Stanton Hicks M, Panourias I, Sakas D, Slavin K. The future of peripheral nerve stimulation. Prog Neurol Surg. 2011;24:210-7 pubmed publisher
  6. Wilson R, Bennett M, Lechman T, Stager K, Chae J. Single-lead percutaneous peripheral nerve stimulation for the treatment of hemiplegic shoulder pain: a case report. Arch Phys Med Rehabil. 2011;92:837-40 pubmed publisher
    ..Additional studies are needed to further demonstrate safety and efficacy, determine optimal dose, define optimal prescriptive parameters, expand clinical indications, and demonstrate long-term effect...
  7. Claydon L, Chesterton L, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. Clin J Pain. 2011;27:635-47 pubmed publisher
    ..Future clinical RCTs may consider these TENS dose responses. ..
  8. Gobbo M, Gaffurini P, Bissolotti L, Esposito F, Orizio C. Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response. Eur J Appl Physiol. 2011;111:2451-9 pubmed publisher
    ..e., comfortable and effective, stimulation to promote the aforementioned muscle adaptive modifications. ..
  9. Dounavi M, Chesterton L, Sim J. Effects of interferential therapy parameter combinations upon experimentally induced pain in pain-free participants: a randomized controlled trial. Phys Ther. 2012;92:911-23 pubmed publisher
    ..Further research is warranted to investigate the hypoalgesic effect of different IFT parameter combinations and to explain its possible mechanism of action. ..

More Information


  1. Burgher A, Huntoon M, Turley T, Doust M, Stearns L. Subcutaneous peripheral nerve stimulation with inter-lead stimulation for axial neck and low back pain: case series and review of the literature. Neuromodulation. 2012;15:100-6; discussion 106-7 pubmed publisher
    ..Future investigations should include a randomized, controlled study design, as well as defined implantation technique and neurostimulator programming algorithms. ..
  2. Johnson M, Bjordal J. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Rev Neurother. 2011;11:735-53 pubmed publisher
    ..The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future. ..
  3. Moran F, Leonard T, Hawthorne S, Hughes C, McCrum Gardner E, Johnson M, et al. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain. 2011;12:929-35 pubmed publisher
  4. Hawker G, Mian S, Bednis K, Stanaitis I. Osteoarthritis year 2010 in review: non-pharmacologic therapy. Osteoarthritis Cartilage. 2011;19:366-74 pubmed publisher
    ..High quality studies suggest modest, if any, benefit of many non-pharmacologic therapies over attention control or placebo, but a significant impact of both over no intervention at all. ..
  5. Pantaleão M, Laurino M, Gallego N, Cabral C, Rakel B, Vance C, et al. Adjusting pulse amplitude during transcutaneous electrical nerve stimulation (TENS) application produces greater hypoalgesia. J Pain. 2011;12:581-90 pubmed publisher
    ..We propose that the fading of current sensation allows the use of higher pulse amplitudes, which would activate a greater number of and deeper tissue afferents to produce greater analgesia. ..
  6. Liebano R, Rakel B, Vance C, Walsh D, Sluka K. An investigation of the development of analgesic tolerance to TENS in humans. Pain. 2011;152:335-42 pubmed publisher
    ..Repeated high-frequency and low-frequency transcutaneous electrical nerve stimulation produce analgesic tolerance in humans by the fourth and fifth day of treatment, respectively. ..
  7. Buchmuller A, Navez M, Milletre Bernardin M, Pouplin S, Presles E, Lanteri Minet M, et al. Value of TENS for relief of chronic low back pain with or without radicular pain. Eur J Pain. 2012;16:656-65 pubmed publisher
    ..Other outcome measures did not differ significantly between the two groups. There was no functional benefit of TENS in the treatment of patients with chronic LBP. ..
  8. Hughes N, Bennett M, Johnson M. An investigation into the magnitude of the current window and perception of transcutaneous electrical nerve stimulation (TENS) sensation at various frequencies and body sites in healthy human participants. Clin J Pain. 2013;29:146-53 pubmed publisher
    ..001) and least comfortable at the tibia and forearm (P<0.001). TENS is most comfortable and easiest to titrate to a strong nonpainful intensity when applied over areas of muscle and soft tissue. ..
  9. Lazarou L, Kitsios A, Lazarou I, Sikaras E, Trampas A. Effects of intensity of Transcutaneous Electrical Nerve Stimulation (TENS) on pressure pain threshold and blood pressure in healthy humans: A randomized, double-blind, placebo-controlled trial. Clin J Pain. 2009;25:773-80 pubmed publisher
    ..These results affirm that high levels of intensity are of fundamental importance in effective TENS dosage. This also applies for low frequency, segmental stimulation. Resting BP seems not to be dependent on intensity. ..
  10. Koldas Dogan S, Sonel Tur B, Kurtais Y, Atay M. Comparison of three different approaches in the treatment of chronic low back pain. Clin Rheumatol. 2008;27:873-81 pubmed publisher
    ..On the other hand, physical therapy + home exercise was found to be more effective regarding disability and psychological disturbance. ..
  11. Moharić M, Burger H. Effect of transcutaneous electrical nerve stimulation on sensation thresholds in patients with painful diabetic neuropathy: an observational study. Int J Rehabil Res. 2010;33:211-7 pubmed publisher
    ..TENS did not alter C, A? nor A? fibre-mediated perception thresholds. The observed changes at thenar are probably because of central mechanisms. In general, analgesic mechanisms of TENS are likely to be complex. ..
  12. Van Rey F, Heesakkers J. Applications of neurostimulation for urinary storage and voiding dysfunction in neurological patients. Urol Int. 2008;81:373-8 pubmed publisher
    ..We review the utilization and the results of electrical stimulation by means of pudendal nerve stimulation, stimulation of the sacral nerve roots and lower limb stimulation in patients with neurogenic detrusor overactivity. ..
  13. Peters K, Carey J, Konstandt D. Sacral neuromodulation for the treatment of refractory interstitial cystitis: outcomes based on technique. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:223-8; discussion 228 pubmed
    ..We concluded that sacral nerve modulation can treat refractory IC symptoms. The response to therapy and the reoperation rate are dependent on the technique used to test and implant the device. ..
  14. Sabino G, Santos C, Francischi J, de Resende M. Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain. J Pain. 2008;9:157-63 pubmed
    b>Transcutaneous electric nerve stimulation (TENS) is a noninvasive treatment used in physiotherapy practice to promote analgesia in acute and chronic inflammatory conditions...
  15. Oosterhof J, Samwel H, de Boo T, Wilder Smith O, Oostendorp R, Crul B. Predicting outcome of TENS in chronic pain: a prospective, randomized, placebo controlled trial. Pain. 2008;136:11-20 pubmed
    ..Predicting pain intensity reflects mechanisms of pain behavior and perceived control of pain, independent of treatment modality. Pain catastrophizing did not predict TENS treatment outcome. ..
  16. de Vries J, Anthonio R, Dejongste M, Jessurun G, Tan E, de Smet B, et al. The effect of electrical neurostimulation on collateral perfusion during acute coronary occlusion. BMC Cardiovasc Disord. 2007;7:18 pubmed
    ..22 +/- 0.09 to 0.24 +/- 0.10 (p = 0.001) when electrical neurostimulation was activated. Electrical neurostimulation induces a significant improvement in the Pw/Pa ratio during acute coronary occlusion. ..
  17. Ng M, Leung M, Poon D. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J Altern Complement Med. 2003;9:641-9 pubmed
    ..Both EA and TENS treatments were effective in reducing OA-induced knee pain. EA had the additional advantage of enhancing the TUGT results as opposed to TENS treatment or no treatment, which did not produce such corollary effect. ..
  18. Renzenbrink G, IJzerman M. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil. 2004;18:359-65 pubmed
    ..This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed. ..
  19. Turna A, Pekcolaklar A, Metin M, Sayar A, Solak O, Gurses A. Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg. 2007;55:182-5 pubmed
    ..We aimed to assess the efficacy of transcutaneous electric nerve stimulation (TENS) in patients with postthoracotomy pain...
  20. Law P, Cheing G. Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis. J Rehabil Med. 2004;36:220-5 pubmed
    ..Our findings suggested that 2 weeks of repeated applications of transcutaneous electrical nerve stimulation at 2 Hz, 100 Hz or 2/100 Hz produced similar treatment effects for people suffering from osteoarthritic knee. ..
  21. Bjordal J, Johnson M, Lopes Martins R, Bogen B, Chow R, Ljunggren A. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8:51 pubmed
    ..TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK. ..
  22. Sluka K, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109-21 pubmed
    ..However, the clinical efficacy of TENS will remain equivocal until the publication of sufficient numbers of high quality, randomized, controlled clinical trials. ..
  23. Somers D, Clemente F. The relationship between dorsal horn neurotransmitter content and allodynia in neuropathic rats treated with high-frequency transcutaneous electric nerve stimulation. Arch Phys Med Rehabil. 2003;84:1575-83 pubmed
    ..content in the dorsal horn and allodynia in neuropathic rats treated with high-frequency transcutaneous electric nerve stimulation (TENS). A completely randomized experimental design...
  24. van Balken M, Vergunst H, Bemelmans B. The use of electrical devices for the treatment of bladder dysfunction: a review of methods. J Urol. 2004;172:846-51 pubmed
    ..The introduction of new stimulation methods may provide treatment alternatives as well as help answer more basic questions on electrical neurostimulation and neuromodulation. ..
  25. Koppert W, Ihmsen H, Körber N, Wehrfritz A, Sittl R, Schmelz M, et al. Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model. Pain. 2005;118:15-22 pubmed
    ..It will be of major clinical interest whether this difference will translate into improved treatment of pain states dominated by central sensitization. ..
  26. Chesterton L, van der Windt D, Sim J, Lewis M, Mallen C, Mason E, et al. Transcutaneous electrical nerve stimulation for the management of tennis elbow: a pragmatic randomized controlled trial: the TATE trial (ISRCTN 87141084). BMC Musculoskelet Disord. 2009;10:156 pubmed publisher
    ..It also benefits from being patient controlled, thereby promoting self-management. This study aims to assess the effectiveness, in terms of pain relief, and cost-effectiveness of a self-management package of treatment that includes TENS...
  27. Solak O, Emmiler M, Ela Y, Dundar U, Koçoiullari C, Eren N, et al. Comparison of continuous and intermittent transcutaneous electrical nerve stimulation in postoperative pain management after coronary artery bypass grafting: a randomized, placebo-controlled prospective study. Heart Surg Forum. 2009;12:E266-71 pubmed publisher
    ..We compared the effectiveness of continuous transcutaneous electrical nerve stimulation (TENS) and intermittent TENS in the management of pain after coronary artery bypass grafting (CABG)...
  28. DeSantana J, Da Silva L, de Resende M, Sluka K. Transcutaneous electrical nerve stimulation at both high and low frequencies activates ventrolateral periaqueductal grey to decrease mechanical hyperalgesia in arthritic rats. Neuroscience. 2009;163:1233-41 pubmed publisher
    b>Transcutaneous electric nerve stimulation (TENS) is widely used for the treatment of pain. TENS produces an opioid-mediated antinociception that utilizes the rostroventromedial medulla (RVM)...
  29. Tong K, Lo S, Cheing G. Alternating frequencies of transcutaneous electric nerve stimulation: does it produce greater analgesic effects on mechanical and thermal pain thresholds?. Arch Phys Med Rehabil. 2007;88:1344-9 pubmed
    To determine whether alternating frequency transcutaneous electric nerve stimulation (TENS) at 2 and 100Hz (2/100Hz) has a more potent hypoalgesic effect than a fixed frequency at 2 or 100Hz in healthy participants...
  30. Aarskog R, Johnson M, Demmink J, Lofthus A, Iversen V, Lopes Martins R, et al. Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects. Physiother Res Int. 2007;12:251-63 pubmed
    ..Further clinical trials are needed to clarify if these findings may also be generalized to populations of chronic pain sufferers. ..
  31. Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain. 2007;130:157-65 pubmed
    ..0005). These results indicate that ENS is an effective treatment modality for chronic musculoskeletal pain and that previous, equivocal results may have been due to underpowered studies. ..
  32. Kuhn A, Keller T, Lawrence M, Morari M. A model for transcutaneous current stimulation: simulations and experiments. Med Biol Eng Comput. 2009;47:279-89 pubmed publisher
    ..The presented TES model provides a first step to more extensive model implementations for TES in which e.g., multi-array electrode configurations can be tested. ..
  33. Vanderthommen M, Duchateau J. Electrical stimulation as a modality to improve performance of the neuromuscular system. Exerc Sport Sci Rev. 2007;35:180-5 pubmed
    ..The adaptations evoked by NMES are not confined to the activated muscle but also involve neural adaptations through reflex inputs to the spinal cord and supraspinal centers. ..
  34. North R, Kidd D, Olin J, Sieracki J, Farrokhi F, Petrucci L, et al. Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes. Spine (Phila Pa 1976). 2005;30:1412-8 pubmed
    ..While we observed disadvantages for dual electrodes in treating axial low back pain, we achieved technical success with single or dual electrodes in most patients and maintained this success clinically with dual electrodes in 53%. ..
  35. Koke A, Schouten J, Lamerichs Geelen M, Lipsch J, Waltje E, van Kleef M, et al. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: a randomized crossover trial. Pain. 2004;108:36-42 pubmed
    ..Because no placebo group was included, no definite conclusions on effectiveness of TENS in general in the treatment of chronic pain could be made. ..
  36. Cipriano G, de Camargo Carvalho A, Bernardelli G, Tayar Peres P. Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity. Interact Cardiovasc Thorac Surg. 2008;7:539-43 pubmed publisher
    ..05). TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles. ..
  37. Mesin L, Merlo E, Merletti R, Orizio C. Investigation of motor unit recruitment during stimulated contractions of tibialis anterior muscle. J Electromyogr Kinesiol. 2010;20:580-9 pubmed publisher
    ..Marginal effect of MU excitation thresholds was observed, suggesting that MUs closer to the stimulation electrode are recruited first during TES regardless of their excitability. ..
  38. Khadilkar A, Milne S, Brosseau L, Wells G, Tugwell P, Robinson V, et al. Transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a systematic review. Spine (Phila Pa 1976). 2005;30:2657-66 pubmed
    ..Increased attention should be given to the risks and benefits of long-term use, which more appropriately addresses the realities of managing chronic low back pain. ..
  39. Mangold S, Keller T, Curt A, Dietz V. Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury. Spinal Cord. 2005;43:1-13 pubmed
    ..Case series...
  40. Rodrigues D, Siriani A, Berzin F. Effect of conventional TENS on pain and electromyographic activity of masticatory muscles in TMD patients. Braz Oral Res. 2004;18:290-5 pubmed
    ..It is possible to conclude that a single TENS application is effective in pain reduction. However, it does not act homogeneously on the features of the electric activity of the muscles evaluated...
  41. Defrin R, Ariel E, Peretz C. Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain. 2005;115:152-60 pubmed
    ..Possible mechanisms explaining the findings are discussed. ..
  42. Resende M, Sabino G, Cândido C, Pereira L, Francischi J. Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain. Eur J Pharmacol. 2004;504:217-22 pubmed
    ..Thus, our data demonstrated absence of an antiinflammatory effect associated to TENS use and confirmed the participation of endogenous opioids on low TENS-induced analgesia. ..
  43. Erdogan M, Erdogan A, Erbil N, Karakaya H, Demircan A. Prospective, Randomized, Placebo-controlled Study of the Effect of TENS on postthoracotomy pain and pulmonary function. World J Surg. 2005;29:1563-70 pubmed
    ..TENS is thus beneficial for pain relief following thoracotomy and has no side effects. Consequently, the routine use of TENS following thoracic surgery is recommended. ..
  44. Rakel B, Cooper N, Adams H, Messer B, Frey Law L, Dannen D, et al. A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. J Pain. 2010;11:230-8 pubmed publisher
    ..This device facilitates blinding of subjects and investigators to eliminate expectation bias and determine the true efficacy of TENS for use in clinical populations. ..
  45. Poitras S, Brosseau L. Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. Spine J. 2008;8:226-33 pubmed publisher
    ..It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP. ..
  46. Sluka K, Lisi T, Westlund K. 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. 2006;87:1137-40 pubmed
    To determine the release pattern of serotonin and noradrenaline in the spinal cord in response to transcutaneous electric nerve stimulation (TENS) delivered at low or high frequency. Prospective randomized allocation of 3 treatments...
  47. Desantana J, Walsh D, Vance C, Rakel B, Sluka K. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep. 2008;10:492-9 pubmed
    ..Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness. ..
  48. van Kerrebroeck P, Van Voskuilen A, Heesakkers J, Lycklama á Nijholt A, Siegel S, Jonas U, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029-34 pubmed
    ..This long-term study demonstrates that InterStim therapy is safe and effective for restoring voiding in appropriately selected cases refractory to other forms of treatment. ..
  49. Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain. 2003;4:455-64 pubmed
    ..The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia. ..
  50. Desantana J, Sluka K, Lauretti G. High and low frequency TENS reduce postoperative pain intensity after laparoscopic tubal ligation: a randomized controlled trial. Clin J Pain. 2009;25:12-9 pubmed publisher
    ..We recommend regular use of multimodal therapy with TENS and analgesic drugs after LS with placement of Yoon rings. ..
  51. Buonocore M, Camuzzini N. Increase of the heat pain threshold during and after high-frequency transcutaneous peripheral nerve stimulation in a group of normal subjects. Eura Medicophys. 2007;43:155-60 pubmed
    ..Further studies are needed to test the hypothesis that intermittent HF-TPNS is able to maintain its hypoalgesic effectiveness over time. ..
  52. Desantana J, Santana Filho V, Sluka K. Modulation between high- and low-frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats. Arch Phys Med Rehabil. 2008;89:754-60 pubmed publisher
    To investigate whether repeated administration of modulating frequency transcutaneous electric nerve stimulation (TENS) prevents development of analgesic tolerance. Knee joint inflammation (3% carrageenan and kaolin) was induced in rats...
  53. Walter M, Sammer U, Kessler T. [Chronic pelvic pain syndrome: neurostimulation, neuromodulation and acupuncture]. Urologe A. 2012;51:1683-91 pubmed publisher
    ..Thus, these promising therapeutic alternatives should be considered more often in daily clinical practice. ..