Fibromyalgia Basics

TENS for Pain Relief

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Looking for a way to get better handle on your pain without the side effects of drugs? Transcutaneous electrical nerve stimulation or TENS can offer significant pain relief to round out your treatment plan. Several studies show the effectiveness of TENS in different chronic pain conditions, including fibromyalgia. TENS units are small, portable devices that can be used when you need them the most. They are also an affordable add-on to your fibromyalgia care.

How It Works

TENS units usually have two pairs of electrode pads that are placed on the skin (a mild adhesive is used). The unit generates a tiny electrical current between the two pads and works to reduce the impact of pain-related signals produced by your achy muscles below the surface. In general, these devices prompt the release of your body’s natural endorphins into your spinal cord to relieve pain.

This small hand-held device allows you to control the intensity or strength of the stimulation signal. It should be perceptible (like a tingling sensation), but not painful. Two electrode pads (about one-inch squares) work as a pair to treat one area. If you have a typical TENS unit with four electrodes you can treat two areas at one time. Each pair of electrodes has its own controller to adjust intensity because some places on the body are more sensitive. For example, your face and neck require less stimulation intensity than your hip or thigh regions.

If you are wondering how treating only two areas at a time could possibly help your widespread pain, keep in mind you can change the locations from day to day. Or if you have the time, you can give yourself more than one TENS treatment session per day for added pain relief. Studies in fibromyalgia patients show that treating the most painful area leads to slight improvements everywhere.¹ This means over one or two weeks, you should feel better.

Getting Started

Ask your primary care physician or pain specialist if TENS is a possible treatment method for your symptoms. If they don’t use TENS in their office, ask for a recommendation (typically a physical therapist or chiropractor). Your goal should be threefold:

1. Be evaluated to determine if TENS is a viable treatment approach for you (i.e., you do not have any contraindications and the stimulation doesn’t bother you).
2. Receive education on the proper use of TENS, such as electrode placement and how to set the intensity level.
3. Identify a TENS unit that best suits your needs. Your healthcare provider can either sell you a unit or refer you to one that you purchase directly online. Typical units range between $40 and $90. You can also ask your provider about renting one of their units for a week. However, you will likely incur a fee.

Try to avoid several weekly sessions that can be costly if not covered by insurance. One to two visits should suffice. Make sure you voice your goals to the provider on the first visit, so they know what you expect. Don’t assume all providers commonly use TENS for pain relief or they have a high level of experience with fibromyalgia. So, call around before you book an appointment.

If you do not have a healthcare provider to assist you with a TENS unit, you can still purchase one without a prescription. Keep in mind that fancy and expensive TENS devices are not necessarily better. For your first unit, don’t go overboard on cost. Try keeping it under $100. Also, make sure you can get inexpensive replacement pads and electrodes for the unit (see TENS Resources).

Device Modes

The TENS unit comes with a variety of modes. Some will pulse in a constant rhythm while others will ramp up to a peak intensity and back down again. When using a TENS unit, you will feel a tingling sensation through the electrodes. The intensity of this sensation is at your control, so you set the comfort level. As a fibromyalgia patient, start with a low intensity and work your way up to prevent a next day flare. It should not feel like the muscle is twitching or going into a spasm.

Many TENS units come with multiple preset modes (they may have specific settings for the neck, upper shoulders, lower back, hips, etc.). If you purchase a unit with these settings already programmed but some don’t work well for you, your provider can customize the device to your liking. Keep in mind the type of mode and preferred intensity level differs substantially from person to person. As a result, preset units may not be your best option.

A modified type of unit, called interferential current (IFC), generates a more complicated electrical signal. These devices are advertised as being more effective than standard TENS. However, research comparing the two types of units shows they work equally as well, so there is no need to pay more for an IFC-type device.

What to Expect

Some fibromyalgia patients only experience pain relief while the TENS unit is on, while others reap extended benefits. Either way, a device should help you in the long run, at least if you are in the group that responds to this type of therapy.

“In clinical practice, TENS is usually applied daily over many weeks,” states Richard Leibano, Ph.D., of Brazil.² “Approximately 30 percent of patients fail to respond to TENS. Of the patients who respond initially, only one-third continue to obtain pain relief after two years.” Of course, these might be better odds than you get from any prescription medication.

Since TENS causes an increased release of pain fighters into your spinal cord, somewhat like the action of opioid analgesics, habituation is common. However, studies show that if the TENS sensation fades over the course of a 20- to 40-minute treatment session, the effectiveness of the therapy can be maintained by gradually increasing the intensity setting. You need to continue to feel a tingling sensation for it to work, and the adjustment needed is small (about 10 percent).³

A review of multiple TENS trials in fibromyalgia patients shows promise. Daily use of TENS for ten or more sessions at the highest tolerable intensity produced significant pain relief.⁴ Another study looked at the impact of people taking an opioid on the effectiveness of TENS. They found the pain-reducing effects of the device were not impeded by opioids.⁵ In addition, 44 percent of fibromyalgia patients responded to TENS with a one-third reduction in pain.

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References for TENS Pain Relief

1.  Affaitati G, et al. Eur J Pain 15:61-9, 2011. Abstract
2. Liebano RE, et al. PAIN 152:335-42, 2011. Free Report
3. Pantaleao MA, et al. J Pain 12:581-90, 2011. Free Report
4. Amer-Cuenca JJ, et al. PAIN 164(8):1645-57, 2023. Abstract
5. Dailey DL, et al. J Pain 7(7):1268-81, 2022. Free Report