What Is TENS Therapy? Uses, Benefits, How It Works

TENS (transcutaneous electrical nerve stimulation) is a type of pain relief therapy. A TENS unit is a device that delivers gentle electrical impulses through the skin, which helps to quiet the body’s pain response. TENS machines are often used to manage or reduce back and neck pain, nerve pain, and pain from arthritis, sports injuries, and chronic conditions like fibromyalgia.

A traditional TENS unit is a battery-operated device with leads (wires) that connect to sticky pads with electrodes, which are placed on your skin. The device sends electrical pulses through these pads.

Here, learn more about how TENS therapy works to relieve pain — and learn about Enso, a wearable pain relief device from Hinge Health.

What conditions are TENS devices used for?

Research shows that different TENS devices have been shown to help improve symptoms related to a variety of acute and chronic pain conditions. 

• Back pain. A 2016 review of thirteen studies published in Surgical Technology International concluded that treatment with a TENS device significantly helped improve chronic lower back pain. But benefits wore off after about five weeks.

• Knee arthritis. TENS therapy is often used for knee osteoarthritis. A 2021 review of twenty-nine studies found that it significantly reduced pain and improved walking ability in people with knee osteoarthritis.

• Fibromyalgia. A review found that TENS treatment helped reduce pain in people with fibromyalgia. The effect was even greater when combined with exercise.

• Tendonitis. TENS may relieve pain from tendonitis (inflammation of the tendons that attach muscle to bone). 

• Diabetic neuropathy. This is a type of nerve damage that can occur with diabetes. Almost half of adults with diabetes will develop it at some point. TENS has been shown to improve symptoms associated with this condition.

How does TENS therapy work?

A traditional TENS (transcutaneous electrical nerve stimulation) device is similar in size to a smartphone. You can use one at home (you can buy them over the counter, or your doctor can write you a prescription), or during physical therapy in a clinic. 

The device generates pulses and sends them through wires to electrodes within pads, which are placed on the skin in the affected area. The pulses are intended to stimulate certain nerves, which can reduce your body’s pain response.

You may feel some relief from symptoms during the session. It may or may not persist after you stop using the TENS device.

How often should you use TENS? 

There is no single recommended session length for using a TENS device — duration can vary based on your individual needs and the specific device you’re using. Many people use TENS for anywhere from 10 to 60 minutes per session, and some find it helpful to use a TENS unit multiple times a day for pain relief. If you’re receiving TENS therapy during in-person physical therapy, the therapist may use it for 10 to 15 minutes during the session, notes Joey Loeb, PT, DPT, a physical therapist at Hinge Health.

Always follow the instructions provided by your TENS unit’s manufacturer, including any guidance on how long and how often to use the device. Be sure to give your skin periodic breaks from the electrode pads to minimize irritation. If you’re unsure about what’s right for you, consult your healthcare provider or physical therapist for personalized recommendations.

Benefits of TENS therapy

According to Hinge Health’s 2024 State of MSK report, which surveyed 10,000 people in pain, most respondents (77%) say they want non-invasive options to manage their pain. More than one-third (35%) worry about side effects and complications from pain treatment. TENS therapy combined with exercise therapy is a good option for people who want drug-free, non-invasive options for pain treatment. 

Drug-free option for pain relief. It’s common to take pain medications to manage pain, which can have side effects or be addictive. A TENS device offers relief without medication side effects.

Help people get active. “If you have less pain, you can get through the day easier, and engage in exercise therapy, which also helps relieve pain,” says Dr. Loeb.

“Movement and lifestyle changes are key to improving pain and managing your overall health,” says Amitabh Gulati, MD, a board-certified anesthesiologist and pain medicine physician, president of the World Academy of Pain Medicine United, and member of the Hinge Health Clinical Advisory Board. “But some people are in so much pain that they simply cannot get started with their exercises. For these patients, a TENS device can be very helpful and appropriate in their treatment.” 

In other words, consider TENS as an adjunct to exercise or physical therapy.

Precautions with TENS therapy

While TENS therapy is considered very safe, it’s best to avoid it under certain conditions. Make sure to read the instruction manual for any TENS device and review the contraindications, warnings, and precautions.

For instance, TENS devices may be contraindicated for those who are pregnant or who have implanted electronic devices, such as a cardiac pacemaker or implanted defibrillator. TENS may not be recommended for people with heart disease or who have epilepsy or another seizure disorder. TENS may cause skin reactions, such as a rash or irritation where electrodes are placed on the body. This isn’t a complete list, so be sure to read the instruction manual for your device.

What is hybrid-form impulse therapy (HFIT)?

Hybrid-form impulse therapy (HFIT) is an advanced form of nerve stimulation that is different from traditional TENS (transcutaneous electrical nerve stimulation). HFIT uses unique waveforms — patterns of electrical pulses that change in speed and strength — that can deliver more tailored pain relief. 

Hinge Health offers a wearable pain relief device called Enso as part of its programs. Enso uses HFIT waveforms and lets users control the strength (intensity) of the pulses. This makes it easy for people to adjust the treatment to fit their needs.

Enso has key differences from other TENS:

• Small, lightweight, and wireless, making it convenient to wear throughout the day.

• Patented waveforms that can provide personalized pain relief.

• Proven effectiveness: A clinical study of 325 participants with chronic pain showed that those who paired Hinge Health’s exercise therapy programs with consistent Enso use were 2.3x more likely to experience reduced pain after four weeks compared to users of another TENS device.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. An Enso device can be an important component of your comprehensive Hinge Health program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. You may also receive an Enso pain relief device as part of your program. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Zhou, L., Xu, Y., Song, F., Li, W., Gao, F., Zhu, Q., & Qian, Z. (2023). The effect of TENS on sleep: A pilot study. Sleep Medicine, 107, 126–136. doi:10.1016/j.sleep.2023.04.029

2. Al-Zamil, M., Minenko, I. A., Kulikova, N. G., Alade, M., Petrova, M. M., Pronina, E. A., Romanova, I. V., Narodova, E. A., Nasyrova, R. F., & Shnayder, N. A. (2022). Clinical Experience of High Frequency and Low Frequency TENS in Treatment of Diabetic Neuropathic Pain in Russia. Healthcare, 10(2), 250. doi:10.3390/healthcare10020250

3. Machado, A. F. P., Santana, E. F., Tacani, P. M., & Liebano, R. E. (2012). The effects of transcutaneous electrical nerve stimulation on tissue repair: A literature review. The Canadian Journal of Plastic Surgery, 20(4), 237–240.

4. Jamison, R. N., Curran, S., Wan, L., Ross, E. L., Gilligan, C. J., & Edwards, R. R. (2022). Higher Pain Sensitivity Predicts Efficacy of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Persons With Fibromyalgia: A Randomized Double-Blind Sham-Controlled Trial. Neuromodulation: Technology at the Neural Interface, 8, 1410-1420. 

5. Wu, Y., Zhu, F., Chen, W., & Zhang, M. (2021). Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: A systematic review and meta-analysis. Clinical Rehabilitation, 36(4), 472–485. doi:10.1177/02692155211065636

6. Jj, J., Jj, C., Cu, G., M, C., Jb, M., Rk, E., Sf, H., A, B., & Ma, M. (2016, April 1). A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surgical Technology International, 28, 296-302.

7. Vance, C. G. T., Dailey, D. L., Chimenti, R. L., Van Gorp, B. J., Crofford, L. J., & Sluka, K. A. (2022). Using TENS for Pain Control: Update on the State of the Evidence. Medicina (Kaunas), 58(10), 1332. doi:10.3390/medicina58101332

8. Megía García, Á., Serrano-Muñoz, D., Bravo-Esteban, E., Ando Lafuente, S., Avendaño-Coy, J., & Gómez-Soriano, J. (2019). Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review. Atención Primaria, 51(7), 406–415. doi:10.1016/j.aprim.2018.03.010