TENS Machine – revised advice

TENS is an acronym for transcutaneous electrical nerve stimulation. TENS is a non-invasive device purported to be useful in both acute and chronic pain and in both pathophysiological and neuropathic pain. It is recommended for use with musculoskeletal pain, peripheral nerve disorders, phantom limb pain, spinal cord and spinal nerve root lesions.


The TENS is a small device that is attached to the skin by 2 or 4 self-adhesive electrodes, placed around the area of pain. TENS is believed to alternatively stimulate nerve fibres, which may diminish the perception of pain in the brain. The TENS does not address the underlying pain generator but is often used as an alternative to medication. One benefit of TENS is that unlike pain medication, it does not cause nausea, drowsiness, personality changes, dependence, or limit ones daily activities. It may also decrease the reliance on oral analgesics.


Khadikar, et al (2013) has undertaken the most recent Cochrane review into the use of TENS versus placebo for chronic low back pain. The authors found four high-quality randomized controlled trials (RCTs; 585 patients) comparing TENS with placebo for chronic low-back pain which were included in this study. The authors concluded:
• Due to conflicting evidence, it is unclear if TENS is beneficial in reducing back pain intensity.
• However, there was consistent evidence in two trials (410 patients) that TENS did not improve the level of disability due to back pain.
• There was moderate evidence that use of medical services and work status (e.g. loss of work, sick days) did not change during treatment.
• Finally, there did not seem to be a difference between conventional and acupuncture-like TENS.


In summary, the review authors found conflicting evidence regarding the benefits of TENS for chronic low back pain, which does not support the use of TENS in the routine management of chronic LBP.


Ultimately a clinical decision regarding the use of a TENS should be based on the expected outcomes achieved from its use greater than what is achieved from the continued and concurrent use of other more validated pain management strategies.


From a workers compensation perspective this decision should be considerate of specific vocational outcomes. Any compensable based approval for TENS should also consider future liability/ costs for replacement batteries and adhesive electrodes.


Workplace Physiotherapy is highly experienced in the development of evidence based best practice strategies for the management of musculo-skeletal pain.



Ref: Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain Cochrane Database Syst Rev.2013.



The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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