Vibration: Transcutaneous Electrical Nerve Stimulation (TENS)

  • Transcutaneous Electrical Nerve Stimulation (TENS) transmits low-voltage electric current of different frequencies through the skin to affect peripheral nerves for therapeutic purposes, such as relieving pain.
  • A TENS unit consists of a battery-powered device that delivers electrical impulses through electrodes placed on the surface of the skin at or near nerves where the pain is located or at trigger points.

Mechanism of Action:

  • TENS may modulate or suppress pain signals in the brain.  Pain reduction or pain relief is achieved by:  
    • High frequency pulses: Suppressing the transmission of pain in nerves (the electrical pulses prevent communication between peripheral nerves and the brain)
    • Low frequency pulses: Stimulate the release of beta endorphins
Clinical Use: 
  • Indications:
    • To modulate or suppress pain signals in the brain
  • Contraindications: 
    • Patients who do not comprehend instructions or who are unable to co-operate
    • Presence of a pacemaker 
    • Patients who have an allergic response to the electrodes, gel or tape
    • Pregnancy
    • Patients with a history of seizure 
    • Avoid face and head, front of the neck, front of the chest, anywhere internally, over tumor or malignancy, directly on the spinal column.
  • Best uses:
    • Clinicians consider TENS as an adjuvant therapy to decrease patients’ pain or treat other symptoms 
  • Applications: 
    • TENS is most commonly delivered from small, hand held, battery powered devices. They can be purchased 'over the counter' in many (but not all) countries.
Special Considerations: 
  • The use of abdominal electrodes during labor may interfere with fetal monitoring equipment and is therefore best avoided
  • If there is abnormal skin sensation, the electrodes should preferably be positioned elsewhere to ensure effective stimulation
  • Clean TENS unit with appropriate wipes between patient rooms for infection control purposes

Ainsworth, L., et al. (2006). "Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation." Pain 120(1-2): 182-7.

Carroll, D., et al. (2006). "Transcutaneous electrical nerve stimulation (TENS) for chronic pain." The Cochrane Library 4(CD003222).

Johnson MI. Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in perioperative settings: a critical review. Expert Rev Neurother 2017;17:1013–27. 10.1080/14737175.2017.1364158 10.1080/14737175.2017.1364158

Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD011890. Transcutaneous electrical nerve stimulation (TENS) for chronic pain ‐ an overview of Cochrane Reviews.

US National Library of Medicine. . Accessed 1/4/2020.Effectiveness of Transcutaneous Electrical Nerve Stimulation for Treatment of Hyperalgesia and Pain (