Transcutaneous electrical nerve stimulation (TENS) uses a battery operated device that applies electrical stimulation at the site of the pain by wired electrodes that are taped to the surface of the skin. TENS can also be delivered by a form-fitting conductive garment (i.e., a garment with conductive fibers which are separated from the patients’ skin by layers of fabric) and is used when a condition exists that precludes conventional TENS electrode placement. TENS has been used to relieve pain related to musculoskeletal conditions, or pain associated with active or post trauma injury. Percutaneous electrical nerve stimulation (PENS) is similar in concept to TENS, but differs in that needle electrodes are implanted just beneath the skin instead of being taped to the surface of the skin. There are many published reports regarding the use of TENS (1-12) and PENS (13-21) for various types of conditions such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, neurogenic pain, visceral pain, diabetic neuropathy and postsurgical pain. While randomized trials have focused on both TENS and PENS, all of the studies have methodologic flaws limiting interpretation, including adequate blinding, drop outs, stimulation variables and outcome measures. It is guideline recommended for post-stroke rehab. A 2009 guideline issued by the American Academy of Neurology found inds that transcutaneous electric nerve stimulation is not effective. The guideline is published in the December 30, 2009, online issue of Neurology®, the medical journal of the American Academy of Neurology.
The FDA issued the following guidance for what patients should be told in the device manual:
TENS is not effective for pain of central origin, including headache;
TENS is not a substitute for pain medications and other pain management therapies;
TENS devices have no curative value;
TENS is a symptomatic treatment and, as such, suppresses the sensation of pain that would otherwise serve as a protective mechanism;
Effectiveness is highly dependent upon patient selection by a practitioner qualified in the management of pain patients
The long-term effects of electrical stimulation are unknown;
Since the effects of stimulation of the brain are unknown, stimulation should not be applied across your head, and electrodes should not be placed on opposite sides of your head
The safety of electrical stimulation during pregnancy has not been established;
You may experience skin irritation or hypersensitivity due to the electrical stimulation or electrical conductive medium (gel);
If you have suspected or diagnosed heart disease, you should follow precautions recommended by your physician; and
If you have suspected or diagnosed epilepsy, you should follow precautions recommended by your physician.
However, it is recognized that both TENS and PENS are widely accepted in the physician community as a treatment of a variety of etiologies of pain.
There advantages for either buying or leasing TENS. I was able to find one discussion of the issue in Fauser PE. TENS: for lease or sale?Phys Ther. 1989 Apr;69(4):299. It should be noted that some recommenced at trial of TENS before using it long term. That is for example, what PCP as recommended in 2010. If it is not expected that TENS use is long-term and leasing the unit or using it in an outpatient PT facility appears more appropriate than third party covered purchase.
Brosseau L, Wells GA, Finestone HM, Egan M, Dubouloz CJ, Graham I, Casimiro L, Robinson VA, Bilodeau M, McGowan J. Clinical practice guidelines for transcutaneous electrical nerve stimulation (TENS). Top Stroke Rehabil 2006 Spring;13(2):61-3.
Carroll D, Moore RA, McQuay HJ, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic pain (Cochrane Review). In: The Cochrane Library, Issue 3, 2002. Oxford: Update Software.
Milne S, Welch V, Brosseau L, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (Cochrane Review). In: The Cochrane Library, Issue 3, 2002.
Osiri M, Welch V, Brosseau L, et al. Transcutaneous electrical nerve stimulation for knee osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue 3, 2002. Oxford: Update Software.
Brosseau L, Yonge KA, Robinson V, et al. Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand. Cochrane Database Syst Rev 2003; (3):CD004287.