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Understanding the Role of TENS Application in Therapy

September 3, 2014

Not long ago a prominent company released a home tens unit to the public available “over the counter, without a prescription”.  Since then I have heard many patients ask why they should come to therapy if this product can “cure” their pain.  As a therapist, I cringe when that commercial comes on now, but it has made the PT community aware of the confusion surrounding the use of E stim units (such as the TENS unit) and strengthened our resolve to educate those around us as to when and why the unit would be used.

So what is TENS?
TENS stands for Transcutaneous Electrical Nerve Stimulation.  It is applied topically to the skin (meaning the skin is not punctured to place the electrodes at the muscle level) and it is used most often for pain control.  It is typically applied in a rehab setting either prior to a therapy session or directly after.  Home units have been available by prescription for many years, where medical necessity has been shown and training given on the correct use of the units.

How does it work?
TENS units apply a low level electric current over the site of pain, which is registered by the nerve endings in the body’s tissue.  These currents are translated to the brain essentially drowning out pain impulses and overloading the brain with information.  The brain is not able to process all of this information so the pain impulses that would normally be received by the brain are missed or drastically reduced.  This effect can last several hours.  Also the influx of neural sensation causes a release of endorphins from the brain which is the body’s “feel good” response.  The result is a temporary window in which the patient feels less or no pain. 

The takeaway:
Of course as health care providers we want our patients to have access to things that help them manage their pain.  However it is important to know how something works and why you would use it prior to attempting it.  Everyone knows someone who has taken over the counter medications for prolonged amounts of time to manage pain.  However, it is common knowledge that doing so does not “cure pain” and is not recommended.  The same applies to this situation.

 Home TENS units are NOT A CURE for pain.  They are a TEMPORARY source of relief and if overused become less effective.  The ideal is to use them as part of a rehab program to help to make exercises, functional activities and manual treatments more tolerable in order to eventually return to a pain free and functional life.  Unfortunately, the way they are currently presented to the public holds the danger that people in pain will use them incorrectly as a substitute for traditional therapies and continue in movements and activities that further injure themselves.  This creates a potential of long lasting injury and by the time they finally realize their need to see a professional, the pain relieving qualities of the modalities used will be less effective or completely ineffective, meaning their overall healing time will be longer. 

If you or someone you know is using an over the counter device to manage pain please make sure to seek the opinion of a health care professional to see what other options can be used to actually cure pain and not just cover it up.  You can also contact Kimberly Snider at 803-781-3353 or

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