The Buzz on TENS Units for Back Pain

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When your back hurts—and even when it doesn’t—an electric shock is the last thing you want, right? Don’t be so sure. As part of a pain reduction regimen, a transcutaneous electrical nerve stimulation (TENS) unit may be a low-cost option for chronic targeted back pain relief.

TENS unit for back painTENS units for back pain: buzzworthy or not?

What is a TENS Unit?

A TENS unit is a battery-operated device that delivers low or high intensity electrical impulses through electrodes that you attach to the skin near the painful area. A TENS unit for back pain doesn’t treat an underlying spinal condition, but it may be a helpful in treating pain and other symptoms. Still, “for some patients, a TENS device may be all that’s needed,” says Stuart Kahn, MD, orthopedic spine surgeon at The Mount Sinai Health System in New York City.

What Does a TENS Unit Do?

“There’s still a lot of science we don’t understand,” Dr. Kahn says. But a TENS unit for back pain is believed to work on two theories:

  • On the low frequency, it stimulates larger diameter pain fibers so the brain doesn’t hone in on the pain generated from smaller diameter pain fibers. Known as the gate control theory of pain, “it’s a diversion technique,” Dr. Kahn says.
  • On the high frequency, a TENS unit for back pain is believed to work by releasing local neurotransmitters, such as endorphins, at nerve endings to block pain signals. The lesser of the two theories, “that’s very hard to prove,” Dr. Kahn says.

“A TENS unit doesn’t work as effectively as some of the other modalities, such as pain medication, a home exercise program, biofeedback, meditation and stretching. But as a supplement, it can be very effective to eliminate 25 to 40 percent of someone’s focal pain for the period the machine is on and potentially up to several hours afterwards,” Dr. Kahn says.

TENS unitA typical TENS unit

How Much Does a TENS Unit Cost?

A TENS device is available online and can be used at home. It’s not typically covered by insurance, but you also don’t need a prescription for one.

A TENS unit is a $30 to $100 expense. Dr. Kahn explains that is it is not so helpful for acute back pain, “but for almost all of my patients with chronic back pain, I do use it and prescribe it.” You can typically count on a TENS unit to last several years, but you will need to replace the electrodes as frequently as weekly, which feature transmitting gel built in to the disposable pads. A month’s supply of electrodes costs roughly $10 to $15. Some units can be much more expensive, but it’s not clear that there’s a benefit to devices in this premium price point.

TENS units on the higher end of the price range typically offer intensity levels that are powerful enough to stimulate and contract muscles for treating muscle spasms. “Almost always, when you have spine pain, you’re going to have muscle spasm and muscle irritability in the surrounding muscles of the spine,” Dr. Kahn says.

Best Practices for TENS Unit Use

So, you’re now the proud owner of a TENS unit. Congratulations! Here are some tips to make the most of your device.

  • Check with your doctor first. A TENS unit is not recommended if you have a pacemaker. Similarly, if you have another type of electrical implant, you’re pregnant, or you have epilepsy or a cardiac problem, get your doctor’s okay first before using a TENS unit for spine or other pain.
  • Try out different intensities, adjusting the setting for comfort. “Go up to a point where you feel tingling, but not where it’s contracting muscles,” Dr. Kahn says. If you think you’re having a muscle spasm, aim for a low level of muscle stimulation if your TENS machine offers muscle stimulation mode. “TENS units are made to use long term,” Dr. Kahn says. Over time, as you adapt to using a TENS device, the tingly, prickly sensation of electricity may dissipate, but the treatment can still be therapeutic.
  • Watch the time. For the most potential benefit, limit TENS unit use to 10 to 15 minutes sessions in muscle stimulation mode. In pure TENS mode, a TENS unit can be used for up to two hours per treatment, up to two to three times daily, in the same body area. For total spine pain —cervical, thoracic and lumbar— it would be feasible to use a TENS unit on each area for up to two hours at a time, Dr. Kahn says. But after two hours, a TENS unit is not recommended because the electrical current may irritate the skin.

Overall, pain can be mysterious and idiosyncratic. “Some patients respond beautifully to a TENS unit and not to prescription pain medication. Others don’t respond at all to a TENS unit but respond well to something as mild as acetaminophen or ibuprofen,” Dr. Kahn says.

Still, a TENS unit is a relatively low-cost way to try to manage chronic focal back pain and potentially worth a try. Chronic pain is generally defined as pain that lasts three to six months, or after the expected time for healing has passed. An ideal candidate for a TENS unit at home is someone who found relief while using the unit in physical therapy treatments, Kahn says.

The goal of using a TENS unit is to provide pain relief to improve your ability to function in your daily life. “It gives you something you can use on your schedule rather than taking a pill and puts the you back in control, which is a good psychological treatment for pain as well,” Dr. Kahn says.

Updated on: 05/05/20
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