How to Use a TENS Unit for Upper Back Pain
TENS therapy shows no significant difference compared to sham TENS for pain intensity or function in treating back pain, according to high-quality evidence. 1
Understanding TENS Therapy
- Transcutaneous Electrical Nerve Stimulation (TENS) involves using a small, battery-operated device to provide continuous electrical impulses via surface electrodes to manage pain 1
- TENS is designed to selectively activate large diameter non-noxious afferents (A-beta) to reduce nociceptor cell activity and sensitization at the central nervous system level 2
- Pain relief with conventional TENS is typically rapid in onset and offset, occurring when the patient experiences a strong but non-painful sensation beneath the electrodes 2
Proper TENS Application for Upper Back Pain
- Place electrode pads on clean, dry skin around the painful area of the upper back, avoiding placement directly over the spine 3
- Use a modulating frequency of 2-125 Hz with variable pulse duration and maximal tolerable intensity that remains comfortable 3
- Apply TENS for approximately 30 minutes per session, which aligns with protocols used in clinical research 3, 4
- For optimal effect, the intensity should be strong enough to produce a noticeable but non-painful sensation (paresthesia) 2
Important Considerations
- TENS may cause minor skin irritation in approximately one-third of users, with rare cases of dermatitis requiring discontinuation 1
- The evidence suggests TENS provides only short-term relief that does not persist after treatment ends 4, 5
- TENS should not be applied over areas with broken skin, metal implants, or cardiac pacemakers 2
- Patients should be instructed to gradually increase intensity to a comfortable level rather than starting at maximum intensity 3
Alternative and More Effective Approaches
- Exercise therapy provides more consistent improvements in pain relief and function compared to TENS for back pain 6, 5
- Heat therapy shows moderate pain relief and reduced disability compared to placebo with stronger evidence than TENS 6
- Massage therapy demonstrates moderate effectiveness for chronic back pain and may be superior to TENS 1, 6
- Combining exercise with heat therapy may provide enhanced pain relief compared to TENS alone 6
Clinical Pitfalls to Avoid
- Relying solely on TENS without incorporating more evidence-based treatments like exercise therapy 6, 5
- Using TENS as a long-term solution when evidence shows limited sustained benefit beyond the treatment period 5
- Setting expectations too high for pain relief, as research indicates modest short-term benefits at best 4, 7
- Failing to properly instruct patients on electrode placement and intensity settings, which can reduce potential effectiveness 3, 2