TENS Machine – All You Need To Know

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This article is a one-stop-shop guide to the TENS Machine – All You Need To Know about what it is and how to use it.

Do you live with pain every day?

A 2012 study by the NIH uncovered that approximately 25 million Americans experienced regular, daily pain in the last three months. Nearly 40 million (17%) had severe pain.

These are alarming numbers, but thankfully modern medicine has kept abreast. Newer and better technologies to manage and reduce pain are emerging every day.


TENS Machine - All You Need To Know


One of these technologies is a Transcutaneous Electrical Nerve Stimulation (TENS) machine. A TENS machine works on a very simple idea – small electrical impulses applied directly to your body can help reduce pain.

This is not a new idea in itself; it has been around since the days of the Romans. However, what a TENS machine does so well is that it provides this pain relief in a simple, transportable, easy to use, non-invasive, non-medicinal, and non-addictive package!

What Is a TENS Machine and How Does a TENS Machine Work?

While the idea of using electrical impulses to numb pain had been around, the theory caught the fancy of the medical community when the “Gate-control” theory was published in 1965.

The idea was that pain happens because of some thin nerve fibers activity, and it’s possible to mitigate that pain by stimulating thicker nerve fibers. 

The authors, Melzack and Wall, believed that there is a gating method, which you can open or close by using TENS at “conventional” high frequency (90-130 Hz). If similarly, you were to use TENS at a lower frequency (2-5HZ), the body produces endorphins (stress relievers). 

You can enjoy the benefits of both the modes (pain relief and stress relief) by running them in short “bursts” in rapid succession. 

Today, many TENS machines are available in the market that can help you reduce your pain in a non-anesthetic, non-medicinal and easy to use way.

TENS Machine Benefits

Compared to conventional pain relief methods, TENS machines have many advantages. TENS machines are:

  • Non-invasive
  • Non-analgesic (and hence non-addictive)
  • Portable devices
  • Easy to operate
  • Give instant relief


TENS Machine- All You need to know


What Do TENS Machines Look Like?

TENS machines are typically handheld devices. Most machines on the market are portable TENS machines. They have pads connected to them through wires. These pads will stick on to your body, the same way the pads of an ECG machine stick to your chest.

You can put the pads anywhere on the body, as long as they touch your skin directly. These pads send a small electrical shock to the area that is in pain. You get a sensation as though you are tingling.

Who Should Use a TENS Machine?

You can use TENS machines for pain. There are some pains for which TENS machines are good and some for which they are not recommended. Let us take a look at the TENS machine uses for different kinds of pain relief.


Research has shown that TENS machines are effective in reducing Sciatic pain. Sciatica is a pain in the legs originating from the hip and radiating towards the knee that is caused due to the sciatic nerve getting pinched or damaged. TENS machines for Sciatica will help reduce the intensity of the shooting or radiating pain that the patient feels.

Labor Pain & Pregnancy

TENS machines are popular with pregnant couples because they are a drug-free way to reduce pain during labor. Research suggests that TENS machines might allow women to feel a sense of control, which is why pain is reduced.

Many pregnant couples prefer this pain control method because no harmful chemicals are involved, which can hurt the mother or the child.

In general, TENS machines are to be avoided during the rest of pregnancy, though they can help with lower back pain during the third trimester.

Period Pain

Research and evidence suggest that TENS can be an effective way to deal with painful menstrual cramps that most women suffer three to four days a month.

Muscle spasms

There is scientific evidence to support the use of a TENS machine for muscle spasms. TENS machines can reduce spasms and increase movement range in patients


TENS machines can help to increase blood flow to the head, which helps to reduce headaches. If you suffer from headaches, try lying down while placing the two pads on the back of the neck on either side.


TENS Machine- All You need to know - Headache


Joint Pains

Joint pains happen because the joint gets inflamed or swollen, mostly because of the cartilage that lubricates the joint decays with age. TENS machines are easy to apply to the joint (unlike braces and compressions belts). They give instant relief and, combined with medication, can be an effective way to cure joint pain.

Back & Neck Pain

Another important usage for TENS machines is with back pain sufferers. A TENS machine for back pain can improve flexibility and increase joint strength. 

Weight Loss

On their own, there are no TENS machines for weight loss. However, when used in conjunction, a TENS EMS combo machine can help you lose weight and reduce pain from exercise.

Face Pain

Certain nerve-related conditions can cause pain in the face, such as Trigeminal Neuralgia. In such conditions, you can use a TENS machine for face pain.

Plantar Fasciitis

While TENS machines cannot help heal plantar fasciitis, you can certainly use a TENS machine for pain relief from Plantar Fasciitis, especially the intense pain that patients feel when they put their first step on the floor in the morning.

Tennis Elbow

Tennis elbow is a type of tendonitis. TENS machines for tennis elbow can help you regain control and increase how much you can move your elbow.



TENS Machine- All You need to know - Tennis Elbow

Neck Pain

You can use TENS machines for neck pain. However, you should be cautious about where to place the pads; they should not get too close to your head.


TENS machines can provide a lot of relief to migraine patients as well, as per research studies.

Muscle Building

TENS machines alone cannot help with muscle building. But TENS EMS combo machines can help with this. Many athletes and sportspersons use TENS EMS combo machines for quick relief and recovery.


TENS machines can provide relief to arthritis patients as well. In the case of arthritis, it is important to place the TENS unit pads nearest to the pain point.

Blood Circulation

It is well established in research that TENS machines help to stimulate blood flow. Proper blood flow is very important for the body, and increasing circulation can help reduce the extent of many wounds and diseases.


Fibromyalgia patients can use a TENS machine to block pain signals and release endorphins in the body, thereby reducing consistent pain all over the body.


You can also use a TENS machine for tendonitis. Tendonitis is a condition where one of your tendons gets inflamed. You would be surprised to know that the human body has close to 4000 tendons. The largest one is the Achilles tendon, which connects the heel bone to the calf.


Bursitis is a disease related to joints, where the sac filled with fluid that cushions the connecting bones bursts, creating a lot of pain. TENS machines can help relieve this pain.


TENS Machine- All You need to know - Knee Pain


Knee Pain

TENS machines can help alleviate regular knee pain due to OA or other musculoskeletal problems. You should place the TENS machine pads on either side of the knee cap to get the best results.

Chronic pelvic pain

Pelvic pain is another area where TENS machines can help relieve pain.

Diabetic neuropathy 

Diabetic neuropathy happens when too high a blood sugar level leads to nerve damage. You can also use a TENS machine for nerve pain that can happen due to diabetic neuropathy. 

Peripheral artery disease 

PAD is a disease where the arteries that circulate blood to the body get blocked. TENS machines can help increase the range of motion in PAD patients.

Who Should Not Use a TENS Machine?

While TENS machines can be very beneficial to you if you have chronic pain, there are certain conditions under which you should never use them:


Suppose you have a pacemaker or similar implanted device. TENS machines might make these devices function incorrectly.


TENS therapy can help increase the circulation of blood. Deep Vein Thrombosis patients should not use it because the higher blood pressure can end up causing a blood clot to get dislodged.


TENS Machine - All You Need To Know



While it is ok to use TENS machines for labor pain, you should not use them otherwise during pregnancy for pain in the pelvis, abdomen, back, or near the acupuncture points of your hands, ankles, and knees.


Epilepsy patients are prone to seizures. TENS machines might end up stimulating seizures, especially if you apply them to the neck, shoulders, and head area.


If you have cancer or suspect that you might have it, don’t use a TENS machine. Even if you have beaten benign cancer in the past, do not use a TENS machine for at least five years after. 

Cardiac Disease

If you have any kind of arrhythmia, heart disease, or are prone to heart failure, never use a TENS machine. They could end up aggravating your heart condition, causing you to go into cardiac arrest.


If you have a disease that causes you to bleed or have some actively bleeding issues right now, TENS machines could increase the bleeding due to higher blood flow.

Besides, TENS should not be applied:

Trying a TENS Machine

Before starting with TENS therapy, make sure to consult your physician about your symptoms. Try to get a proper pain assessment first so that the cause of pain is isolated.

Rent or Buy?

TENS machines are fairly cheap (anywhere between thirty to a hundred dollars). You can choose to buy them, or if you just want to try them out, that is also possible.

It might make sense to get your physiotherapist to help you in setting up your TENS machine. TENS machines work best when their settings are attuned correctly for your specific condition. Therefore, it’s best if your physiotherapist helps you in adjusting your machine as well.

In most cases, TENS machines can help reduce your pain. If you are wondering where to buy TENS machines, you can get them over the counter at most pharmacists. But if you want to get them covered under Medicare, you will need to have a doctor’s prescription for them. 


TENS Machine- All You need to know - Rent or buy


How To Use a TENS Machine

TENS machines are lightweight, easy to use, and safe. This is what makes them very popular for people who suffer from chronic pain. You can use them while working, going out for a walk or relaxing at home. 

As long as you are not using them around water or operating heavy machinery (like a car), TENS machines are effective and safe. We have given below a guide on how to use most TENS machines, though you should always consult your device’s manual as well.

Putting on the Pads

  • Firstly, always ensure that your machine is completely switched off before attaching, detaching, or moving the pads.
  • Identify the source of pain, and apply either two pads or four pads on either side, depending on the machine. Keep them at least one inch apart from each other.
  • You can put the pads in three ways: horizontal, vertical, or at an angle.
  • You can change the flow of the sensations by changing the distance between or the direction in which the pads are aligned.
  • Now turn on the TENS machine. You will feel a slight tingle as the electrical impulses travel through your body.
  • TENS machines will have a mechanism to adjust how strong the impulses should be. 
  • Start on the lowest setting, and increase it till you feel a strong tingling sensation but are comfortable.
  • If the tingling sensation starts to turn into pain, adjust the strength of the impulses downwards
  • Always switch off after use, and remove the pads from your skin.


TENS Machine- All You need to know - Medicare


Tips for Positioning the pads

  • If you have pain in a large portion of the body (such as sciatic pain between your knee and lower back), You should put the pads vertically at the pain area’s top and bottom.
  • If the pain is limited to a small area (such as calf pain), put the pads on each side parallel.
  • If the pain is over a particular joint (such as elbow pain), you should put one pad above the joint on the muscle in the horizontal direction and the other in a parallel direction.
  • If the pain is widespread (such as below the neck and between the shoulders), you should vertically put the pads on the left and right sides. You can even put them at an angle if the pain is spread very far to cover the whole area.

TENS Safety

Where Should You Not Use Them?

  • Pressure sores and wounds that have not healed properly (unless under doctor supervision)
  • Skin inflammation, red spots, sores, and cankers
  • Dead skin, or skin that does not have any sensation in it
  • Skin lesions
  • Varicose Veins
  • Face, head, throat, eyes, mouth, neck, backbone, genitals
  • Simultaneously on both sides of your chest
  • If you have any mental disability
  • Infected tissue, or if you have TB. TENS therapy can increase the spread of infection
  • Any tissue which has undergone radiation therapy

When Should You Not Use Them?

  • When using heavy machinery, including while driving a car
  • When going to sleep, take off your TENS machines.
  • When exposed to water (like bathing)

Safety Precautions When Using TENS Machines

  • Consult a doctor before use. Use as per instructions only.
  • The machine should be off when you are in the process of putting on, taking off, or moving the pads.
  • Never share your pads with others.
  • Keep away from children.
  • Some electronic equipment such as EKG alarms and monitors may stop working if used along with TENS machines.


TENS Machine- All You need to know-Side Effects


TENS Machine Side Effects

Below are some of the possible side effects of TENS machines

  • Sore Muscles or twitching muscles
  • Tingling in skin
  • Skin irritation, especially under the pads
  • Headache 
  • Nausea or Dizziness 

Always consult with your doctor if you are experiencing side effects. While some of these side effects are documented, you should still always check with a health practitioner.

Overuse of TENS machines may also be causing side effects, so you can also reduce usage.

Will Medicare Cover TENS Machine?

Medicare recognizes TENS machines as a treatment for three types of pain, as listed below. You will need a Certificate of Medical Necessity(CMN) in all cases, but it is needed only for purchases, not rentals. The criteria for coverage is different in each case:

Chronic Lower Back Pain (CLBP)

Medicare considers CLBP if you have been experiencing pain for at least three months and the pain is diagnosed not to be caused by any major disease such as rheumatoid arthritis.

You will need to have a medical record that contains proof of:

  • Having participated in a study, as approved by Medicare
  • A diagnosis from your medical practitioner states that the therapy is medically necessary
  • You provided has to include a diagnosis which describes your conditions


TENS Machine- All You need to know - Medicare


Chronic Pain other than Lower Back Pain

In this case, your medical record should describe all of the below:

  • Where the pain is located
  • Since when have you had the pain
  • What is the likely reason for pain
  • What treatment has been tried so far, and what are the results

At the end of your TENS trial period, your report should also show:

  • How many times a day and how many hours a day you used the machine
  • What were the results, or how effective was the machine?

Post-operative Pain

For post-surgical pain, your medical record should have:

  • Surgery date
  • Type of surgery
  • Where and how severe is the pain

In this case, Medicare will only support payments for a rental, not for purchasing a machine. The coverage will only be for thirty days from the surgery date.

Taking Care of Your TENS Pads (Or How To Make Them Sticky Again)

Taking Care of Your Skin

Clean the area where you are about to apply the pad with soap and water. Dry it off. You can also use TENS wipes for cleaning.

Cleaning the Pads

Sometimes a gentle clean is enough to bring back stickiness in a used pad. Clean your pads with a slightly moist towel or washcloth after using them every time. Stickiness can reduce if your pads accumulate dirt and natural skin oils due to overuse. Take care that your washcloth should be slightly moist and should not make the pads wet.


TENS Machine- All You need to know - Pads


Brushing the Pads

Brushing the pads is almost similar to brushing a pet. You take a toothbrush and then gently move it in one direction. Brushing can help improve stickiness.

Electrode Gels and Sprays

Electrode gels and sprays help to extend the life of a pad which needs replacement. You can effectively use a pad about twenty to thirty times by taking good care of it.

TENS Machine Replacement Pads

Eventually, your pads will lose their stickiness, at which point you might like to buy a new set of replacement pads. Many TENS machine replacement pads are available in the market, which will get your machine working just like new.

Does TENS Machine Work?

That really is a big question, and to be honest, the scientific research so far has been inconclusive. If you consider adopting TENS therapy for pain, it is important to form your own opinion by studying the reports available.

Below we have shared some of the major studies and their results on the effectiveness of TENS machines in reducing certain kinds of pain:

Post-Operative Pain

Below are the results of studies that have tried to measure TENS machines’ efficacy in post-operative pain. The results are mixed, but promising in certain cases.

  • Reeve et al. (1996): 12 out of 20 studies showed a positive benefit in post-operative healing pain using TENS machines
  • Bjordal et al. (2003): This is the only study where the effect of TENS was monitored along with other analgesics. They concluded that TENS is more effective than a placebo in reducing pain during the first three days after surgery.
  • A 1990 study in England concluded that TENS should not be the only treatment in post-operative pain, which is a fair statement. 

Labor Pain

A study by McQuay and Moore, 1998 concluded that TENS machines are effective in reducing the need for other pain medications, which always have a risk associated with them, thereby giving the parents-to-be a risk-free birth


TENS Machine - All You Need To Know


Healing A Wound

This is one area where there is a lot of scientific evidence to support the use of TENS machines. For example, Kaada, 1983; Kaada and Emru, 1988; and Asbjornsen et al., 1990 have shown that TENS machines help in reducing pain from leg ulcers.

Chronic Pain

Nnoaham and Kumbang, 2008: The study showed a positive result for TENS in 13 of 22 RCT’s when used in conjunction with analgesics. 

Lower Back Pain 

Many studies do show a positive outcome for TENS therapy in lower back treatment


TENS machines are proven to be successful in alleviating knee and other joint pain in Osteoarthritis.


Cruccu et al., 2007 found that TENS might be better than a placebo for neuropathies. Dubinsky and Miyasaki, 2010 also found TENS to be useful in diabetic neuropathy pain.

Other studies have shown positive outcomes for fibromyalgia and musculoskeletal pain.

TENS Machine – Frequently Asked Questions

What are TENS EMS combo machines?

TENS and EMS are both techniques that work by applying electrical impulses to the body. While TENS helps reduce pain by influencing nerves in the body, EMS helps to stimulate your muscles. The combination of these two machines is very popular in athletes and sportspersons, who need to enhance muscle growth as well as reduce pain from a workout.

What is the usual price of TENS machines?

There is a wide range of TENS machines available in the market. Depending on the quality, durability, and features that you choose, a TENS machine can cost you anywhere between $30 to $100.


TENS Machine - All You Need To Know


Is it safe to use a TENS machine with a heart condition?

As explained earlier, you should not use a TENS machine if you are using a pacemaker or similar device. This is because the electrical impulses from TENS machines can interfere with the operation of such a device.

How often can you use a TENS machine?

TENS machines are perfectly safe to use for most people, as long as you keep in mind the conditions which we have spelled out in this article. Therefore, you can use a TENS machine for as long as you like. Some people recommend the usage of 30-60 minutes, up to four or five times a day for consistent pain.

What are the accessories that one can use with a TENS machine?

There are many accessories that can help improve your experience with a TENS machine, including massager shoes, travel cases, wiring pad holders, replacement gel, and pads.

Wrap Up

TENS machines are a proven and effective method of pain relief for most people. They provide a good way to treat pain without the use of medication and at a cost-effective price. TENS machines are portable, easy to use anywhere, and can be used as many times a day as you like.