TENS treatment – pain relief without medication

Is your shoulder stabbing, does your back hurt? Won't the wrist or knee pain go away?

Most doctors usually recommend the same thing for these problems: "take a painkiller!" Advertisements and patient information sites also push this message. But you should know that pills affect not only the pain but every part of your body! Long-term use leads to unwanted consequences. Analgesic medications eventually cause side effects in almost everyone – gastrointestinal complaints, excess stomach acid, stomach ulcer, in severe cases stomach bleeding, and by damaging white blood cells they can impair the body's defenses against disease.

Data show that regular use of analgesics quadruples the risk of death from heart disease and of stroke.

If you suffer from persistent pain, it is in your own interest to look for a solution that reduces your need for medication and at the same time provides effective pain relief. TENS treatment is such a method, and it has been proven to have no side effects.

TENS treatment and pain relief – which complaints does it help?

Primarily use it for the following

• pain caused by acute musculoskeletal conditions
  • muscle strain,
  • muscle pain, myalgia,
  • contusion,
  • sprain,
  • joint inflammation,
  • joint bleeding,
  • tenosynovitis,
  • periartritis,
  • lumbago (low back pain)
  • sciatica,
  • neuralgias: sciatica, brachialgia, intercostal neuralgia, trigeminal neuralgia, post-herpetic neuralgia (pain after shingles), scar pain,
  • pain caused by phantom limb pain, etc.
• pain caused by chronic (weeks or months) musculoskeletal conditions
  • herniated disc,
  • tendon-muscle stiffness (contracture),
  • arthritis,
  • arthrosis,
  • rheumatism,
  • epicondylitis (tennis elbow and golfer's elbow),
  • neck, lower back and thoracic,
  • wrist, elbow, hand joint
  • hip, knee, ankle and foot joint pain, etc.
• other pains
  • For headache and migraine the "standard" TENS is not applicable. For these you can use special electrotherapy devices (e.g. Cefaly).
  • myalgia,
  • postoperative pain,
  • gynecological and menstrual pain,
  • for cancer pain as a complement to pharmacological therapy. Although it usually cannot completely eliminate cancer pain, it may reduce the need for analgesic drugs.

The small, lightweight TENS devices can be used at home anytime. Exactly when you want, as often as necessary.

Product recommendation: TENS devices

In our webstore you can find a wide selection of electrotherapy devices that also provide TENS treatment, i.e. they can be used to reduce pain caused by musculoskeletal conditions without drugs or side effects.

Click and choose the one that suits you! →

What is TENS and what is TENS treatment?

TENS is an acronym from the English 'Transcutaneous Electric Nerve Stimulation'.

TENS is a form of electrotherapy in which the TENS device delivers a series of mild electrical impulses to the area affected by pain. The impulses interact with nerve endings in the skin and as a result

• the transmission of pain impulses towards the brain is stopped,
• the production of endorphins (the body's own pain-relieving substances) increases,
• and the sensation of pain disappears or is reduced.

In the majority of cases TENS treatment alone is sufficient to achieve a pain-free state. When used together with analgesic medication, the effects add up, so you may need less medicine. This is especially important if you need long-term and large amounts of medication for a chronic disease. It matters how much chemical substance you put into your body.

A short TENS session – 20–30 minutes – can free you from unpleasant pain for many hours. The main advantage of the treatment is pain relief without drugs and without side effects.

Important information before TENS treatment

• Never treat an acute, newly appearing pain with a transcutaneous electric nerve stimulation (TENS) device first; see a doctor so the cause of the pain can be found.
• In general, only treat pain whose cause you know.
• If a doctor recommended analgesia, you may choose TENS treatment instead of the analgesic medication.
• Only a mentally competent patient should use a TENS device independently.
• If you have a pacemaker, TENS is generally not recommended. It is not absolutely forbidden, but it requires careful and thorough evaluation. Obviously you must not apply it near the pacemaker, on the chest, back, shoulders or neck; however its use on your leg, hip or wrist might be considered.
• During pregnancy, placing electrodes over the trunk, abdomen or pelvis is contraindicated. A recent study suggests that although TENS is not ideal (not first-line) during pregnancy, with proper precautions it can be used.
• TENS pain relief performed while working (for example while sitting in your office chair) is safe and effective. However, never use it while driving, operating heavy machinery, or working at heights!
• If you are allergic to electrode gel or adhesive, do not use self-adhesive electrodes. In that case use rubber (silicone) electrodes.
• Do not attach electrodes to skin areas with skin lesions (e.g. inflamed skin, shingles-affected area, eczema).
• Do not apply treatment on the front of the neck or over the carotid (neck) arteries.
• Electrodes must not be placed over the eyes.
• Patients with epilepsy are generally not treated with stimulation – consult the attending physician.

TENS application points

The TENS device is easy to use on almost any part of the body!

The main rule regarding TENS application points is that electrodes must be placed depending on the pain! You should "surround" the painful area, i.e. do not place the electrode directly on the painful spot!

Consequently, placement must always be tailored to your specific complaint. The diagrams in the device manual are only guidelines.

Electrodes must always be used in pairs. A single electrode is not enough! The two electrodes of a pair should be connected to the two ends of the same cable. The pain-relieving impulses will "travel" between them.

Electrodes should never touch each other; always keep at least 2–3 cm between them. The farther apart the pair members are, the higher current intensity is needed, and beyond about 20 cm the effectiveness starts to decrease.

Manufacturers usually include some diagrams with the devices, but if you follow my suggestions you can treat almost anywhere on your body—even areas for which you may not find a diagram.

If you want to be "scientifically" thorough, place the positive electrode farther from your trunk and the negative closer. For example, for the wrist put the positive on the (more distant) palm and the negative above the wrist (closer). Some physicians believe this polarity matters somewhat, others consider polarity unimportant in TENS treatment.

In this video I demonstrate where to stick the electrodes.

TENS modes

After placing the electrodes and connecting the cable, turn on your device and select the treatment program.

One type of TENS device shows only program numbers and you have to look up what each number means in the manual. For example, you may find that the conventional TENS program is number “3”. Then set your device to program 3 and start the treatment with the Start or OK button.

The other type of TENS device has a menu, so you select the appropriate program from a list on the display.

TENS programs differ in the electrical impulse settings and therefore act differently. It matters when and which one you use.

Conventional (high-frequency) TENS program

It blocks the transmission of pain signals to the brain. Its effect develops quickly but lasts only 30–120 minutes. After 3–4 treatments its effect diminishes or disappears because the brain becomes accustomed. After 1–2 weeks' break it is effective again for a few sessions.

Endorphin (low-frequency) TENS program

It triggers the production of pain-relieving substances (endorphins) in your body. Its effect develops more slowly but can last 2–8 hours. After a few treatments its effect diminishes or disappears because of habituation. After 1–2 weeks' break it becomes effective again for a few sessions.

Burst (or pulsed-frequency) TENS program

The program delivers high frequency for a few seconds, then switches to low, repeatedly. Therefore it combines the advantages of both the Conventional and Endorphin programs. It was originally developed to avoid habituation, but even with this treatment the effect may decrease after 1–2 weeks. After a short treatment break it becomes effective again.

Modulated (continuously varying impulse) TENS program

The program continuously varies the impulse frequency, duration and intensity, so there is little or no habituation. It combines the benefits of the Conventional and Endorphin programs. You can apply this pain-relieving treatment anywhere on your body (except the skull, across the heart, over the thyroid, or over the neck arteries). Simply place the electrodes around the pain, choose one of the above programs and enjoy the effect. Try them all and see which works best for you.

Using the TENS device

After placing the TENS pads and selecting the program there is one more task: you must set the current intensity (i.e. the treatment strength).

Because each person's skin nerve endings have different sensitivity, everyone must find their own appropriate intensity. Too low an intensity (you feel nothing) is ineffective; too high can be painful. Aim for the golden mean. You should clearly feel a "tingling" sensation, but it must not cause pain. Excessive intensity may trigger muscle twitching, which is not necessary.

My suggestion: with the electrodes on your skin, start increasing the intensity. At first you feel only a light tingling, then a pricking sensation which can turn into pain. The pain threshold location is individual! Everyone feels it at a different setting. When you feel you've reached the maximum you can tolerate, you have "determined your pain threshold." If this is, for example, 30 mA, then perform the TENS treatment at 20–24 mA. If the pain threshold is 60, then around 40 mA (i.e. about two-thirds of the pain threshold) is a good value.

When using a 5×5 cm electrode, the maximum current should not exceed 50–60 mA!

If you feel nothing even at 50 mA, it means your skin is extremely dry, keratinized and has high resistance. This makes the treatment less effective. If you experience this, perform the treatment after bathing, when your skin is softened by water. Proper hydration also helps, so drink a large glass of water before the session!!! Read this article of mine.

Once you have done that, the device will treat you. Each program has a recommended duration based on medical guidelines. When this time elapses the device stops. You may extend the treatment time, but generally do not shorten it. For the TENS effect to develop, most devices and programs require 20–30 minutes or longer. A 5-minute "emergency" session usually achieves nothing.

The duration of pain relief mainly depends on the program settings

• Short treatment at high frequency provides immediate but not very long-lasting pain relief.
• Using low frequencies the analgesic effect develops more slowly (after a 30–40 minute session) but can last longer, even up to 24 hours.

How does the nerve stimulation (TENS) impulse work?

TENS impulses intervene at several points in the processing of pain signals.

Gate theory

The pain gate mechanism is associated with the "Aβ" sensory nerve fibers. Repeated stimulation of these fibers reduces or abolishes the transmission of pain signals through the spinal cord to the brain's pain center. If the pain signal is not transmitted, the sensation of pain does not arise.

Aβ fibers are most effectively stimulated at 90–120 Hz, i.e. relatively high frequency. It is impossible to give a single frequency that works universally and identically for everyone! It can be said that impulses in this range will be most effective, but within that range you must "find" the frequency that suits you best. For effective pain relief I recommend purchasing a device that allows you to change the treatment frequency so you can find the optimal one.

Endorphin release

Endorphin is a pain-relieving substance produced in your body; it is one of the most powerful natural analgesics.
As the pain signal travels toward the brain it "jumps" from neuron to neuron. Endorphins act at the synapses, the transfer points between cells, and prevent the pain signal from continuing. The low-frequency "endorphin TENS" impulses of TENS devices effectively increase your body's endorphin production and thereby reduce or completely stop the pain.

If we use low frequencies of 2–10 Hz, these can stimulate the "Aδ" (A delta) fibers. Their activation increases the production of endogenous opioids (encephalins) in the spinal cord. Encephalins are strong analgesics and also reduce the activity of pain-conducting nerve pathways. As with the gate mechanism, there is no single magical frequency that is equally effective for everyone. Each person must find the frequency that works best for them.

How to find the most effective frequency?

The best is to buy a device that offers a modulated TENS program. In this program the impulse frequency continuously varies within a given range. For example, between 90–120 Hz, so it will certainly include the frequency that works best for you.

If you don't have such a device, try frequencies of 90, then 95, 100… Hz, etc. Use the one at which you experienced the strongest effect.

The importance of frequency

The duration of pain relief depends on the frequency you apply. High-frequency short treatments give quick but short-lived pain relief. Low frequencies take effect more slowly (after a 20–40 minute session), but the effect can be long, even up to 24 hours.

Attention! Some manufacturers advertise TENS as effective only at 143 Hz. As mentioned earlier, the nerve fibers transmitting pain are most effectively stimulated in the 2–10 and 90–120 Hz ranges. Advertisements claiming exclusivity for 143 Hz are misleading!

How often can TENS treatment be used per day?

Important: if you do not know the cause of the pain, do not start treatment! Eliminating an unknown pain can be dangerous. For example, your abdomen starts to hurt and you start treating it. The pain may briefly subside, but a few hours later it returns stronger. Then you are taken to the emergency room by ambulance, where it may turn out that appendicitis caused the problem, it perforated and you put your life at risk.

Otherwise TENS is generally completely safe and risk-free. If necessary, you can use it multiple times. But don't overdo it! Usually 2–3 sessions a day help.

If the cause of the pain is long known, recurring regularly, and doctors have advised analgesics, you can use TENS instead of or alongside medication. For pain that returns repeatedly at the same place, you don't have to visit the doctor every time. TENS reduces pain already on the first application. You must know, however, that TENS only relieves pain—it does not cure the underlying disease. Nevertheless, effectively eliminating pain frees you from suffering and improves your quality of life.

In the first days TENS reduced my pain, but then the effect disappeared — what happened?

This is a common phenomenon! I've seen many comments from disappointed TENS owners about this. I must state, however, that the fault is not in the TENS method but in incorrect application!

Most people want to "test" the method first and try a cheap, low-cost TENS device. They do not consider what disease causes their pain, how large an area is affected, or how often they need to use it. Differences between devices become apparent at this point.

Just as a frying pan is cookware but is not suitable to cook soup.

All cheap TENS devices provide only constant-frequency programs. Regularly repeating impulses are recognized by the brain and after a few days the brain "gets used" to them. The excellent effect of the first treatments begins to decrease after a few days and then disappears. This is why buyers of cheap devices often find their device ineffective after a while.

If the description of your device does not mention "modulated TENS", expect only a few days of pain relief from that device. Don't be surprised if its effect starts to fade on the 3rd–4th day. The loss of effect is not permanent. If you take a 1–2 week break, it will be effective again for a few sessions. Use such a device for acute neck strain, toothache, sprain, contusion, bruise, etc. In these conditions the triggering cause of the initially severe pain resolves in 2–3 days and the device remains effective for that time.

Modern TENS devices offer a MODULATED TENS program to prevent habituation. Modulation means the device continuously modifies impulse parameters (frequency, pulse duration, intensity), so the brain cannot filter it out and habituation does not develop. Therefore modulated TENS programs do not lose their effectiveness. They are excellent for pains that have persisted for a long time and require ongoing treatment.

If your device provides a modulated TENS program, you own a modern and versatile device. You can use it for all pains, including chronic pains (e.g. caused by arthrosis, arthritis, rheumatism, etc.), and expect sustained effects.

Why might the expected effect be absent?

TENS is one method of pain relief. It is most often used instead of analgesic drugs or to reduce their dosage, because unlike drugs TENS definitely has no harmful side effects. However, it does not work in every case and is not guaranteed. Let's review why TENS treatment might be ineffective.

TENS is not a miracle cure!

For any procedure or method (whether TENS, a pill, injection, surgery, etc.) it is true that it does not work for some people, causes strong adverse reactions in others, and produces the expected effect in others. The effect of TENS varies by person. For some it completely eliminates pain, for others it only reduces it to some degree. Even reduction is beneficial because it reduces the need for medication, which is important to avoid side effects.

A medical method makes sense if it benefits a substantially larger proportion of patients than it harms or fails. Assessing TENS effectiveness is complicated by the fact that pain cannot be objectively measured. The result is evaluated only by the patient's report. Studies on TENS have shown that the majority report favorable effects.

The fact that TENS doesn't work for YOU does not mean the method is entirely wrong; it only means you need to try another method to find the right one. Just like in the household: if a nail clipper can't cut fabric, you take out the shears.

Poorly chosen application

TENS is not suitable for everything! I often heard of people trying TENS for headache, cancer pain, abdominal pain, biliary colic, urinary infection pain, kidney stone colic, etc. — but these are not among the recommended uses and only limited or no effect should be expected.

There are types of pain for which TENS is expected to have a good analgesic effect, while in other conditions it is not effective.

The "trial" trap

Many people buy a cheap device out of caution, even from a supermarket for just a few currency units. Unfortunately, many traders sell poor-quality Chinese junk devices to unsuspecting people. And it's unwise to buy a medical device at a grocery store… If you buy milk, cheese or flour there I understand… but a medical device? Ask the store clerk how to use it! I doubt they could even tell you whether TENS is better for soup or stew! 🙂

Poor quality device

The "soul" of TENS and every other electrotherapy treatment is the impulse. Numerous medical studies confirm that one of the most important elements of effective TENS treatment is the most perfect square pulse possible. The impulse waveform produced by cheap devices does not even approach a square wave (see the right-hand impulse on the diagram).

The more imperfect the waveform, the more painful the stimulation feels. Treatment with a poor-quality device stings, causes a nettle-like sensation or burning, which prevents you from raising the intensity to an effective level. But if the intensity is not strong enough, the treatment effect will be weak or absent. In short, cheap devices often have more hype than substance.

Far Eastern manufacturers churn out millions of these junk devices (pardon the expression, there is no better one). I show what they can cause.

In summary

TENS treatment is not effective for every kind of pain. Before using it, check whether it is suitable for the type of pain you want to treat.

Use a good quality device and a modulated TENS program to avoid habituation!

Make sure the electrodes adhere well or, for permanent electrodes, use enough contact gel.

Even so, it may happen that TENS does not work for you! That does not mean the TENS method is ineffective, only that you are not among those who benefit from it.

TENS provides a favorable effect for the majority of those treated, i.e. it reduces pain to some extent!

Product recommendation: TENS devices

In our webstore you can find a wide selection of electrotherapy devices that also provide TENS treatment, i.e. they can be used to reduce pain caused by musculoskeletal conditions without drugs or side effects.

Click and choose the one that suits you! →