Clinical UM Guideline

This document addresses transcutaneous electrical nerve stimulation (TENS). TENS is used to treat pain by sending electrical impulses through electrodes placed on the skin. These pulses stimulate sensory nerve fibers and are thought to modify pain perception. Other indications for TENS have also been proposed.

Note: Please see the following related documents for additional information:

• CG-DME-03 Neuromuscular Stimulation in the Treatment of Muscle Atrophy
• CG-MED-100 Surface Electrical Stimulation Devices for Headache and Migraine
• CG-SURG-09 Temporomandibular Disorders
• CG-SURG-95 Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence
• CG-SURG-126 Tibial Nerve Stimulation
• DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices (for information on transcutaneous electrical modulation pain reprocessing ([TEMPR], e.g., Scrambler Therapy) using multichannel TENS devices and Zynex NexWave™ combination stimulator device)

Note: Over-the-counter (OTC) devices are generally excluded from benefit plan coverage.

Note: For a high-level overview of this document, please see “Summary for Members and Families” below. 

Medically Necessary:

TENS units are considered medically necessary when prescribed as a treatment for pain for those who have not responded to other modalities, in the following situations:

1. Pain related to musculoskeletal conditions; or
2. Pain associated with active or post trauma injury. 

TENS garments are considered medically necessary when:

1. The TENS criteria above have been met; and
2. Conventional electrodes, adhesive tapes, and lead wires cannot be used because:
   1. A large area or many sites will be stimulated; or
   2. The areas or sites to be stimulated are inaccessible; or
   3. A documented medical condition, for example but not limited to, presence of a skin disorder.

Not Medically Necessary:

Use of TENS is considered not medically necessary when the above criteria are not met, and for all other indications.

This document describes clinical studies and expert recommendations, and explains the appropriate use of transcutaneous electrical nerve stimulation (TENS), a device that sends electrical pulses through the skin to help reduce pain. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

TENS units are devices that deliver small electrical pulses through electrodes placed on the skin. These pulses may help block pain signals. TENS can also be used with a special garment instead of skin electrodes when needed. TENS is most often used to help manage pain caused by muscle, bone, or joint problems, or after injuries. While TENS devices are available without a prescription, they may be prescribed when other treatments have not helped. Experts and some medical groups support using TENS as part of a broader approach to managing long-term pain, including the American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA). However, research on TENS has mixed results. Some studies suggest it may help in certain cases, but others show limited benefit. Better studies are needed to know if TENS improves health for many conditions.

What the Studies Show

TENS has been studied for many types of pain, including back pain, joint pain, nerve pain, surgery pain, and pain from health conditions such as diabetes or cancer. While some research shows it may help certain kinds of pain, many studies have problems such as unclear results or not enough information about how the treatment was given. This makes it hard to know how well TENS truly works. For example, some studies suggest TENS might help with period pain, multiple sclerosis symptoms, or after joint surgery. But other research found it did not clearly help with issues like migraines, phantom limb pain, or post-surgery healing. More high-quality studies are needed to show when TENS is helpful and safe.

When is TENS Clinically Appropriate?

TENS (transcutaneous electrical nerve stimulation) may be appropriate in these situations:

• The person has pain related to muscle, bone, or joint conditions; or
• The person has pain from a current or past injury; and
• Other treatments have not helped.

TENS garments may also be appropriate when:

• The TENS criteria above have been met; and
• Regular electrodes, tapes, or wires cannot be used because:
  • A large area or many body sites need treatment; or
  • The pain areas are hard to reach; or
  • A medical condition affects the skin (such as a rash or wound).

When is this not Clinically Appropriate?

TENS is not appropriate when the conditions above are not met, or for any other uses. This is because studies have not shown that TENS clearly helps in these other situations. Using unproven or unnecessary treatments can lead to confusion or treatment that does not help.

(Return to Description)

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for all other indications.

Summary

Transcutaneous Electrical Nerve Stimulation (TENS) units are considered medically necessary for managing pain associated with musculoskeletal conditions or active/post-trauma injuries when other treatments have failed. TENS garments are also deemed necessary when conventional electrodes cannot be used due to factors like large or inaccessible stimulation areas or certain medical conditions (e.g., skin disorders). TENS is not considered medically necessary when these criteria are not met or for other unapproved uses. While TENS is widely accepted among physicians and supported by professional societies such as the American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) for pain management, many clinical studies on its efficacy suffer from methodological issues, resulting in weak or inconclusive evidence across a broad range of conditions. Nonetheless, some systematic reviews support its use in treating specific conditions such as chronic back pain, dysmenorrhea, pain following total knee arthroplasty, and other indications. TENS devices are also readily available over the counter.

Discussion

TENS units are battery-operated devices that apply electrical stimulation through wired electrodes that are taped to the surface of the skin. TENS can also be delivered through the use of a form-fitting conductive garment (for example, a garment with conductive fibers that are separated from the individual’s skin by layers of fabric). This garment is applied 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.

There are many published reports regarding the use of TENS 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 controlled trials (RCTs) have focused on TENS, many of the currently available studies have methodological flaws that limit interpretation or generalizability, including inadequate blinding, lack of reporting of dropouts, lack of reporting of stimulation variables, and lack of proper outcome measures (Johnson, 2015b; Ögren, 2024). However, it is recognized that TENS is widely accepted in the physician community as a treatment of a variety of etiologies of pain.

The ASA and ASRA support the use of TENS in their revised guideline recommending that “TENS should be used as a multimodal approach to pain management for patients with chronic back pain and may be used for other pain conditions (e.g. neck and phantom limb pain)” (ASA/ASRA, 2010).

Several trials, systematic reviews, and meta-analyses have been published evaluating the use of TENS in a variety of potential indications including, but not limited to, bladder discomfort and function (Park, 2024; Tang, 2024; Zhao, 2024), diabetes (Lu, 2023), fibromyalgia (Mattar, 2025), inguinal hernia repair (Parselenes, 2021), knee osteoarthritis (Chen, 2016; Cherian, 2016; Katagiri, 2025 ; Özbaş, 2025; Reichenbach, 2022; Wu 2022; Yamada, 2025), labor pain (Thuvarakan, 2025), long covid (Zulbaran-Rojas 2024), migraine headache (Domingues, 2021; Hokenek, 2021; Tao, 2018), peripheral neuropathy (Ogle, 2020), pelvic pain (Cottrell, 2019), phantom stump pain (Johnson, 2015a), postoperative gastrointestinal recovery (Karthik 2024; Penfold, 2018), postoperative pain (Henkel, 2025; Oksar, 2024; Opolka, 2024; Öztürk, 2024; Sabancı, 2024), restless leg syndrome (Şanli, 2024), rotator cuff injuries (Desmeules, 2016; Mahure, 2017), sickle cell disease (Pal, 2020), spinal cord injury (Harvey, 2016), soft tissue injuries of the elbow (Dion, 2016), temporomandibular joint pain (Busse, 2023; Fertout, 2019; Nemani, 2024, Serrano-Muñoz, 2023), wound infection (Qin, 2024), and xerostomia (Sivaramakrishnan, 2017).The results of these trials revealed weak or inconclusive support for the use of TENS for these indications.

Support for the use of TENS was found in systematic reviews conducted on its application in the treatment of dyspareunia, (Fernández‑Pérez, 2023), in-office and post hysteroscopy (De Silva, 2020; Ghamry, 2020) chronic back pain (Jauregui, 2016), dysmenorrhea (Arik, 2022; Guy, 2023), total knee arthroplasty (Li, 2017; Yue, 2018; Zhu, 2017), multiple sclerosis (Sawant, 2015), post cardiothoracic surgery (Cardinali, 2021), and limb spasticity (Mahmood, 2019; Mills, 2016).

TENS devices are generally available without a prescription (that is, over the counter [OTC]), and they are widely available at a variety of standard and online retail outlets.

Peer Reviewed Publications:

1. Amer-Cuenca JJ, Badenes-Ribera L, Biviá-Roig G, et al. The dose-dependent effects of transcutaneous electrical nerve stimulation for pain relief in individuals with fibromyalgia: a systematic review and meta-analysis. Pain. 2023; 164(8):1645-1657.
2. AminiSaman J, Karimpour HA, Hemmatpour B, et al. Effect of transcutaneous electrical nerve stimulation on the pain intensity during insertion of needle in patients undergoing spinal anesthesia: a randomized controlled study. J Acupunct Meridian Stud. 2020; 13(3):83-86.
3. Arik MI, Kiloatar H, Aslan B, Icelli M. The effect of TENS for pain relief in women with primary dysmenorrhea: a systematic review and meta-analysis. Explore (NY). 2022; 18(1):108-113.
4. Báez-Suárez A, Martín-Castillo E, García-Andújar J. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials. 2018; 19(1):652.
5. Bai HY, Bai HY, Yang ZQ. Effect of transcutaneous electrical nerve stimulation therapy for the treatment of primary dysmenorrheal. Medicine (Baltimore). 2017; 96(36):e7959.
6. Cardinali A, Celini D, Chaplik M, et al. Efficacy of transcutaneous electrical nerve stimulation for postoperative pain, pulmonary function, and opioid consumption following cardiothoracic procedures: a systematic review. Neuromodulation. 2021; 24(8):1439-1450.
7. Chen LX, Zhou ZR, Li YL, et al. Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clin J Pain. 2016; 32(2):146-154.
8. Cherian JJ, Harrison PE, Benjamin SA, et al. Do the effects of transcutaneous electrical nerve stimulation on knee osteoarthritis pain and function last? J Knee Surg. 2016; 29(6):497-501.
9. Cottrell AM, Schneider MP, Goonewardene S, et al. Benefits and harms of electrical neuromodulation for chronic pelvic pain: a systematic review. Eur Urol Focus. 2020; 6(3):559-571.
10. Dalbem Paim É, Costa Batista Berbert M, Gonzales Zanella V, et al. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region-a randomised clinical trial. J Oral Rehabil. 2019; 46(12):1142-1150.
11. de Abreu GE, de Souza LA, da Fonseca MLV, et al. Transcutaneous electrical nerve stimulation for the treatment of children and adolescents with bladder and bowel dysfunction: a randomized clinical trial. J Urol. 2021; 205(6):1785-1791.
12. DeJesus BM, Rodrigues IKL, Azevedo-Santos IF, DeSantana JM. Effect of transcutaneous electrical nerve stimulation on pain-related quantitative sensory tests in chronic musculoskeletal pain and acute experimental pain: systematic review and meta-analysis. J Pain. 2023; 24(8):1337-1382.
13. De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office hysteroscopy: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2020; 27(5):1034-1047.
14. Desmeules F, Boudreault J, Roy J, et al. Efficacy of transcutaneous electrical nerve stimulation for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2016; 102(1):41-49.
15. de Sousa L, Gomes-Sponholz FA, Nakano AM. Transcutaneous electrical nerve stimulation for the relief of post-partum uterine contraction pain during breast-feeding: a randomized clinical trial. J Obstet Gynaecol Res. 2014; 40(5):1317-1323.
16. Domingues FS, Gayoso MV, Sikandar S, et al. Analgesic efficacy of a portable, disposable, and self-applied transcutaneous electrical nerve stimulation device during migraine attacks: A real-life randomized controlled trial. Pain Pract. 2021; 21(8):850-858.
17. Elboim-Gabyzon M, Andrawus Najjar S, Shtarker H. Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: a double-blinded, randomized trial. Clin Interv Aging. 2019; 14:1841-1850.
18. Fernández-Pérez P, Leirós-Rodríguez R, et al. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health. 2023; 23(1):387.
19. Fernández-Seguín LM, Heredia-Rizo AM, Díaz-Mancha JA, et al. Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: a randomized controlled trial. Medicine (Baltimore). 2019; 98(46):e18018.
20. Ferreira AP, Costa DR, Oliveira AI, et al. Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial. J Appl Oral Sci. 2017; 25(2):112-120.
21. Garaud T, Gervais C, Szekely B, et al. Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation. Medicine (Baltimore). 2018; 97(52):e13782.
22. Ghamry NK, Samy A, Abdelhakim AM, et al. Evaluation and ranking of different interventions for pain relief during outpatient hysteroscopy: a systematic review and network meta-analysis. J Obstet Gynaecol Res. 2020; 46(6):807-827.
23. Gulacti U, Algin A, Turgut K, et al. Transcutaneous electrical nerve stimulation (TENS) for the treatment of renal colic in the ED: a randomized, double-blind, placebo-controlled trial. Am J Emerg Med. 2022; 56:127-132.
24. Guy M, Foucher C, Juhel C, et al. Transcutaneous electrical neurostimulation relieves primary dysmenorrhea: a randomized, double-blind clinical study versus placebo. Prog Urol. 2022; 32(7):487-497.
25. Harvey LA, Glinsky JV, Bowden JL. The effectiveness of 22 commonly administered physiotherapy interventions for people with spinal cord injury: a systematic review. Spinal Cord. 2016; 54(11):914-923.
26. He L, Tan K, Lin X, et al. Multicenter, randomized, double-blind, controlled trial of transcutaneous electrical nerve stimulation for pancreatic cancer related pain. Medicine (Baltimore). 2021; 100(5):e23748.
27. Henkel A, Cahill EP, Chavez S, et al. Transcutaneous electrical nerve stimulation (TENS) for pain control during first-trimester procedural abortion: a blinded randomized controlled trial. Contraception. 2025; 149:110955.
28. Hokenek NM, Erdogan MO, Hokenek UD, et al. Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: a randomize controlled trial. Am J Emerg Med. 2021; 39:80-85.
29. Jauregui JJ, Cherian JJ, Gwam CU, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surg Technol Int. 2016; 28:296-302.
30. Jawahar R, Oh U, Yang S, Lapane KL. Alternative approach: a systematic review of non-pharmacological non-spastic and non-trigeminal pain management in multiple sclerosis. Eur J Phys Rehabil Med. 2014; 50(5):567-577.
31. Juarez MC, Kwatra SG. A systematic review of evidence based treatments for lichen simplex chronicus. J Dermatolog Treat. 2021; 32(7):684-692.
32. Karthik N, Lodha M, Baksi A, et al. Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: a randomized controlled trial. World J Surg. 2024; 48(7):1626-1633.
33. Katagiri N, Kawashima K, Hamasuna M, et al. Effects of TENS with home exercise improve pain and muscle strength in older adults with pre-radiographic to mild knee osteoarthritis. Sci Rep. 2025; 15(1):39992.
34. Kayman-Kose S, Arioz DT, Toktas H, et al. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014; 27(15):1572-1575.
35. Kwong PW, Ng GY, Chung RC, Ng SS. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. Clin Rehabil. 2018; 32(9):1203-1219.
36. Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017; 96(37):e8036.
37. Lin S, Sun Q, Wang H, Xie G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med. 2018; 50(1):3-7.
38. Lu JY, Ou HY, Wu CZ, et al. A randomized trial on the effect of transcutaneous electrical nerve stimulator on glycemic control in patients with type 2 diabetes. Sci Rep. 2023; 13(1):2662.
39. Mahmood A, Veluswamy SK, Hombali A, et al. Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019; 100(4):751-768.
40. Mahure SA, Rokito AS, Kwon YW. Transcutaneous electrical nerve stimulation for postoperative pain relief after arthroscopic rotator cuff repair: a prospective double-blinded randomized trial. J Shoulder Elbow Surg. 2017; 26(9):1508-1513.
41. Marcolino M, Hauck M, Stein C, et al. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil. 2020; 42(5):623-635.
42. Mattar JG, Chalah MA, Ouerchefani N, et al. The effect of the EXOPULSE Mollii Suit on pain and fibromyalgia-related symptoms- a randomized sham-controlled crossover trial. Eur J Pain. 2025; 29(2):e4729.
43. Miller L, Mattison P, Paul L, Wood L. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler. 2007; 13(4):527-533.
44. Nemani SM, Chidambaranathan AS, Muthukumar B, Srinivasan S. Evaluation of the effect of different kinds of treatment modalities for temporomandibular joint pain and its relevance to chronic cervical pain: a randomized controlled trial. J Indian Prosthodont Soc. 2024; 24(2):128-135.
45. Ogle T, Alexander K, Miaskowski C, Yates P. Systematic review of the effectiveness of self-initiated interventions to decrease pain and sensory disturbances associated with peripheral neuropathy. J Cancer Surviv. 2020; 14(4):444-463.
46. Ögren C, Varkey E, Wolf A, et al. High-frequency, high-intensity TENS compared to standard treatment with opioids for postoperative pain relief after laparoscopic cholecystectomy: a multicentre randomized controlled trial. Eur J Pain. 2024; 28(10):1772-1784.
47. Oh H, Kim BH. Comparing effects of two different types of Nei-Guan acupuncture stimulation devices in reducing postoperative nausea and vomiting. J Perianesth Nurs. 2017; 32(3):177-187.
48. Oksar M, Kalaci A, Turhanoglu S. Transcutaneous electrical nerve stimulation for reducing postoperative acute pain after hip fracture surgery: a double-blinded randomized clinical trial. Eur Rev Med Pharmacol Sci. 2024; 28(7):2788-2796.
49. Opolka Y, Sundberg C, Juthberg R, et al. Transcutaneous electrical nerve stimulation integrated into pants for the relief of postoperative pain in hip surgery patients: a randomized trial. Pain Res Manag. 2024; 2024:6866549.
50. Özbaş N, Ersoy E, Korkmaz M, Olçar HA. Effect of Transcutaneous electrical nerve stimulation on patients with total knee replacement: a randomized controlled trial. Pain Manag Nurs. 2025; 26(1):4-13.
51. Öztürk Özen D, Koç G, Nacir B. The effect of progressive relaxation exercises and transcutaneous electrical neural stimulation administered to women delivering via cesarean delivery on pain, breastfeeding success, and comfort levels: a randomized controlled study. J Obstet Gynaecol Res. 2024; 50(3):438-447.
52. Park J, Seo D, Choi W, Lee S. The effects of exercise with TENS on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Med Sci Monit. 2014; 20:1890-1896.
53. Park JY, Yu J, Kim CS, et al. Transcutaneous electrical nerve stimulation and catheter-related bladder discomfort following transurethral resection of bladder tumour: a randomised controlled trial. Eur J Anaesthesiol. 2024; 41(11):821-830.
54. Parselenes A, Paskauskas S, Kubiliute E, et al. Transcutaneous electric nerve stimulation reduces acute postoperative pain and analgesic use after open inguinal hernia surgery: a randomized, double-blind, placebo-controlled trial. J Pain. 2021; 22(5):533-544.
55. Penfold JA, Wells CI, Du, et al. Electrical stimulation and recovery of gastrointestinal function following surgery: a systematic review. Neuromodulation. 2019; 22(6):669-679.
56. Qin Y, Liu CL, Liu L. The role of TENS therapy in reducing the incidence of post-Caesarean section wound infection. Int Wound J. 2024; 21(7):e70001.
57. Qiu S, Bi S, Lin T, et al. Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: a systematic review and network meta-analysis. Asian J Urol. 2019; 6(4):330-338.
58. Reichenbach S, Jüni P, Hincapié CA, et al. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis Cartilage. 2022; 30(3):426-435.
59. Resende L, Merriwether E, Rampazo ÉP, et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain. 2018; 22 (4):663-678.
60. Sabancı Baransel E, Barut S, Uçar T. The effects of transcutaneous electrical nerve stimulation applied in the early postpartum period after cesarean birth on healing, pain, and comfort. J Midwifery Womens Health. 2024; 69(5):681-688.
61. Şanli ZS, Ortaç EA, Binokay H, Aktaş K. Transcutaneous electrical nerve stimulation in the management of restless legs syndrome symptoms: a single-blind, parallel-group clinical study. J Sleep Res. 2024; 33(5):e14167.
62. Sarkies MN, Testa L, Carrigan A, et al. Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis. Age Ageing. 2023; 52(8):afad154.
63. Sawant A, Dadurka K, Overend T, Kremenchutzky M. Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis. Mult Scler Relat Disord. 2015; 4(3):219-227.
64. Serrano-Muñoz D, Beltran-Alacreu H, Martín-Caro Álvarez D, et al. Effectiveness of different electrical stimulation modalities for pain and masticatory function in temporomandibular disorders: a systematic review and meta-analysis. J Pain. 2023; 24(6):946-956.
65. Sharififar S, Shuster JJ, Bishop MD. Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. a systematic review and meta-analysis. Ann Phys Rehabil Med. 2018; 61(5):339-344.
66. Sivaramakrishnan G, Sridharan K. Electrical nerve stimulation for xerostomia: a meta-analysis of randomized controlled trials. J Tradit Complement Med. 2017; 7(4):409-413.
67. Solak O, Turna A, Pekcolaklar A, et al. Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg. 2007; 55(3):182-185.
68. Stepanović A, Kolšek M, Kersnik J, Erčulj V. Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation. Wien Klin Wochenschr. 2015; 127(9-10):369-374.
69. Tang A, Zhang Y, Dong L, Xu F. Observation of the therapeutic effect of transcutaneous electrical stimulation combined with pelvic floor muscle training on post-radical prostatectomy urinary incontinence. Altern Ther Health Med. 2024; 30(8):306-311.
70. Tao H, Wang T, Dong X, et al. Effectiveness of transcutaneous electrical nerve stimulation for the treatment of migraine: a meta-analysis of randomized controlled trials. J Headache Pain. 2018; 19(1):42.
71. Thuvarakan K, Zimmermann H, Hammer A, et al. Investigation of varying frequencies of transcutaneous electrical nerve stimulation for labor pain control: a randomized double-blinded sham-controlled pilot study. Annu Int Conf IEEE Eng Med Biol Soc. 2025; 2025:1-5.
72. Tokuda M, Tabira K, Masuda T, et al. Effect of modulated-frequency and modulated-intensity transcutaneous electrical nerve stimulation after abdominal surgery: a randomized controlled trial. Clin J Pain. 2014; 30(7):565-570.
73. Wu LC, Weng PW, Chen CH, et al. Literature review and meta-analysis of transcutaneous electrical nerve stimulation in treating chronic back pain. Reg Anesth Pain Med. 2018; 43(4):425-433.
74. Wu Y, Zhu F, Chen W, Zhang M. Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil. 2022; 36(4):472-485.
75. Yamada K, Shimizu H, Doi N, et al. Usefulness and safety of a wearable transcutaneous electrical nerve stimulation device for promoting exercise therapy in patients with chronic knee pain: a randomized controlled trial. Arch Phys Med Rehabil. 2025; 106(2):167-176.
76. Yang HL, Liu FC, Tsay PK, et al. Use of transcutaneous electrical nerve stimulation to alleviate thirst after surgery: a randomized controlled trial. J Perianesth Nurs. 2023; 38(2):291-296.
77. Yik YI, Clarke MC, Catto-Smith AG, et al. Slow-transit constipation with concurrent upper gastrointestinal dysmotility and its response to transcutaneous electrical stimulation. Pediatr Surg Int. 2011; 27(7):705-711.
78. Yue C, Zhang X, Zhu Y, et al. Systematic review of three electrical stimulation techniques for rehabilitation after total knee arthroplasty. J Arthroplasty. 2018; 33(7):2330-2337.
79. Zhao L, Wu F, Wang J, et al. Efficacy of transcutaneous electrical nerve stimulation combined with mirabegron therapy compared with mirabegron monotherapy for overactive bladder: a prospective randomized controlled study. World J Urol. 2024; 42(1):370.
80. Zhu Y, Feng Y, Peng L. Effect of transcutaneous electrical nerve stimulation for pain control after total knee arthroplasty: a systematic review and meta-analysis. J Rehabil Med. 2017; 49(9):700-704.
81. Zulbaran-Rojas A, Bara RO, et al. Transcutaneous electrical nerve stimulation for fibromyalgia-like syndrome in patients with Long-COVID: a pilot randomized clinical trial. Sci Rep. 2024; 14(1):27224.

Government Agency, Medical Society and Other Authoritative Publications:

1. Agency for Healthcare Quality and Research (AHRQ). Noninvasive nonpharmacological treatment for chronic pain. Updated June 22, 2022. Available at: https://effectivehealthcare.ahrq.gov/products/noninvasive-nonpharm-pain-update/research. Accessed on February 5, 2026.
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6. Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations. Available at: https://www.cms.gov/medicare-coverage-database/search.aspx. Accessed on February 5, 2026.
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   • Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP). NCD #160.27. Effective June 8, 2012.
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10. Johnson MI, Claydon LS, Herbison GP, et al. Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database Syst Rev. 2017;(10):CD012172.
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TENS (Transcutaneous Electrical Nerve Stimulation)
Transcutaneous Electrical Nerve Stimulation (TENS)

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