TENS Therapy for Back Pain Relief

Back pain is considered to be the number one cause of disability in the world. This type of pain accounts for 264 million lost workdays per year in the U.S. and affects 80% of the human population. And because of how central it is to every movement, back pain can impact practically everything we do.

When it comes to treating back pain, most people are given treatments such as:

  • Medications
  • Hot/cold therapy
  • Muscle relaxants
  • And physical therapy


And while they are effective, they typically don't provide immediate relief. Not only that, but many medications can have harmful side effects and involve the risk of addiction.

If you're struggling with back pain, you may have heard of TENS therapy. Using a TENS unit for back pain is an effective, safe, and holistic way to find relief.

In this guide, we'll go over the essentials including what these devices are (how they work), are TENS machines good for back pain, how to select the ideal settings, best practices, and upper, middle, & lower back pain TENS unit placement.

What is a TENS Machine for Back Pain?

TENS therapy, also called transcutaneous electrical nerve stimulation, involves using a TENS device to send low voltage electrical currents to the skin. These small pulses stimulate nerves to eliminate the sensation of pain.

TENS back therapy is an excellent pain relief tool for various types of back injuries, including:

  • Muscle pain
  • Nerve pain
  • Fibromyalgia
  • Arthritis
  • Post-surgery recovery
  • Spinal cord injuries
  • And more

How Does a TENS Unit Help Back Pain? Endorphin Release and Pain Gating

How Does a TENS Unit Help Back Pain?

TENS treatment for back pain provides relief in two ways:

  • Endorphin Release: Small electrical impulses from the device stimulate nerves to spark the release of endorphins, your body's natural pain killers. When released, endorphins relieve pain, promote happiness, and boost your body's immune system. These devices spark the same endorphin release as pain medications, but without the risk of addiction.
  • Pain Gating: TENS units send an electrical pulse to the large nerve fibers, which blocks the small fibers from sending pain signals to the brain. This helps temporarily reduce the perception of pain.


TENS units provide the advantage of customizing pain relief. Electrodes can be placed over the target area and arranged for the desired treatment. Also, most feature various intensity levels and modes that vary the shocks being administered.

Do TENS Units Work for Back Pain?

The evidence for answering "does TENS help back pain" has been conflicting, but there is some evidence proving it does.

One study concluded that TENS therapy was merely a placebo without additional benefits. However, a 2016 meta-analysis with 267 patients suffering from chronic lower back pain found it to be effective. Additionally, the study found it to as the potential to reduce pain medication reliance.

A 2019 study found that TENS was effective in reducing pain and increasing satisfaction for 44 patients with acute back pain who were waiting for emergency medical treatment.

A study from the University of Florida Health found TENS therapy to relieve lower back pain in older adults. The study found TENS therapy to achieve:

  • A 48% improvement in resting pain,
  • A 34% reduction in pain with movement,
  • And a 14% increase in physical function rating.


While studies have been conflicting in results, users do report positive results:

  • "After having TENS treatments by a physical therapist for both back and shoulder issues, I bought a unit. I have found that TENS really works great when you need pain relief.” - Claddagh in the Chronicle of the Horse forum

Types of Back Pain TENS Units Treat

There are various types of back pain TENS units treat. This section breaks down the various type of back pain TENS devices treat.

TENS Therapy for Back Muscle Pain

Muscle Pain

Muscle pain is the most common pain type TENS units treat. They're recommended by the NHS and many studies have found them to be effective in treating:

  • Sore muscles: A 50-patient study administered cryotherapy and TENS therapy on those with delayed onset muscle soreness (DOMS) for eight weeks, three times per week. After eight weeks, the combination of treatments reduced patient pain significantly.
  • Muscle spasms: A 30-patient study divided participants into two groups: a group using TENS therapy for back spasms and a control group using passive exercises. After the research was finished, the study found the TENS therapy group experienced a significant decrease in muscle spasms and improved range of motion. Muscle spasms were also more effectively reduced when extended stimulation periods were applied.
  • Muscle knots: You may be wondering, "do TENS units help muscle knots?" A 60-patient study found TENS therapy to be effective in relieving pain for those with myofascial trigger point pain.
  • Muscle atrophy: TENS therapy was applied during physical therapy for muscle atrophy and was found to be an excellent addition to rehabilitating and strengthening muscles.


TENS therapy provides a calming effect which makes them effective in muscle rehabilitation. This makes stretching the injured muscle more manageable.


Nerve Pain

TENS therapy is recommended by the Brain and Spine Foundation and the Foundation of Peripheral Neuropathy as a neuropathic pain treatment. It targets nerves to disable them from sending pain signals to the brain, making it an ideal method of nerve pain relief.

TENS Therapy for Back Pain: Fibromyalgia

Fibromyalgia

One of the most common fibromyalgia pain relief methods is TENS therapy. This condition is well under-researched and understood by healthcare professionals. However, it is commonly characterized by widespread muscle and bone pain. TENS therapy for fibromyalgia has been found to be effective in a few studies:

  • A study conducted in 2020 found TENS therapy to relieve fibromyalgia pain in 50% of participants.
  • A 2019 study found TENS therapy to increase alpha power in the frontal lobe of fibromyalgia sufferers thus reducing pain.
  • A 2018 study found that 44% of participants had 30% less pain after using a TENS unit.

TENS Therapy for Arthritis Back Pain

Arthritis

When applying TENS therapy to back arthritis, results have been 50/50. A Cochrane review conducted in 2015 found some evidence showing pain reduction. However, 50% experienced a placebo. More research on the effects of TENS on arthritis is needed.

TENS Therapy for Post Surgery Recovery Back Pain

Post-Surgery Recovery

TENS units are regularly used and recommended for those in surgery recovery. These devices have been found to minimize post-surgery pain while reducing dependency on prescription medications.

TENS Therapy for Spinal Cord Injury Pain

Spinal Cord Injuries

Spinal cord injuries can make movement challenging because of pain from damaged nerves. TENS therapy can enhance physical therapy by minimizing pain to make movement less painful.

How to Use a TENS Unit for Back Pain: Best Practices

How to Use a TENS Machine for Back Pain

When it comes to using a TENS unit to relieve back pain, there are a few best practices. Below, we offer our most essential tips for those new to TENS.


  • Start with low intensity and increase as needed: Starting at a higher setting can cause a zapping sensation, resulting in pain. Start at the lowest setting and increase it until the pain is minimized.
  • Don't use TENS while operating heavy machinery: TENS therapy will make your muscles twitch, making it vital to never drive or operate heavy machinery as this can cause an accident.
  • Avoid using your device in or around water: While TENS therapy is relatively safe, it does not mix well with water. Avoid using your device around any liquids.
  • Turn your device off before going to sleep: If pain is hindering your sleep, use your device before bed. However, make sure you turn it off before falling asleep. Failure to do so can cause electrodes to lose their stick and zap you.
  • Avoid using TENS with hot & cold packs: TENS therapy and hot & cold therapy can be used in combination with each other. However, it's important to use each one at a time. Failure to do so can cause moisture to seep into the pads.
  • Keep testing settings until the pain is minimized: TENS therapy, by nature, may require some testing to find the ideal setting. Keep testing your device's settings until finding one that reduces pain. If you're just starting with TENS therapy, start with the preset modes.
  • Use a combination of pain relief methods: TENS therapy only blocks pain and does not heal the injury. Because of this, it's important to add other methods of pain management. This can be in the form of hot & cold therapy, stretching, or physical exercise. A great practice is to use your devices before exercise. This will make movements easier as endorphins continue to be released after treatment.

How to Select the Best TENS Settings for Back Pain

One of the most common questions asked is, "which TENS unit setting is best?" There is no best setting as no pain is universally the same. Also, some people are equipped with nerves that are more responsive to TENS therapy. Meanwhile, others may require a higher setting. Below, we've highlighted our essential tips for selecting TENS unit settings.

How to Select the Best TENS Settings for Back Pain: Selecting a Mode

Choosing a Mode

It's standard for most TENS units to have preset modes which set the pulse rate and width automatically. This is great for those new to TENS therapy or looking for a quick setup. Standard modes include:


  • Normal: This delivers a constant stimulation via the frequency and width settings. It's mostly used for acute pain through pain gating.
  • Burst: This uses bursts of electrical stimulation to relieve chronic pain.
  • Modulation: This setting is great for both acute and chronic pain. While in this mode, the device will variate settings while using a cyclical to prevent nerve adaptation.

How to Select the Best TENS Settings for Back Pain: How to Choose a Pulse Rate

Choosing a Pulse Rate (Frequency) Setting

Pulse rate (measured in hertz (Hz)) refers to the number of electrical pulses delivered per second. Lower pulse rates are more effective for chronic pain whereas larger rates are better for acute pain. Below, you'll find which range of Hz is ideal for muscle stimulation, acute, and chronic pain.


  • Acute Pain: 80-120Hz
  • Muscle Stimulation: 35-50Hz
  • Chronic Pain and Endorphin Release: 2-10Hz

How to Select the Best TENS Settings for Back Pain: How to Choose a Pulse Width

Choosing a Pulse Width (Duration) Setting

The length of the pulse administered is the pulse width. This equates to the amount of time the shock is delivered, measured in microseconds. A larger pulse width provides stronger stimulation.


How to Select the Best TENS Settings for Back Pain: Choosing an Intensity Level

Choosing an Intensity Level

The strength of the electrical pulse equates to the intensity level. The standard range of intensity for TENS devices is 0 to 80mA. However, there are stronger OTC devices able to go up to 100mA. The stronger your pain, the higher the intensity required. Just be sure to start at the lowest setting and increase it as needed.


How to Select the Best TENS Settings for Back Pain: Time Duration for Acute and Chronic Pain

Choosing a Time Duration

One of the many advantages of TENS therapy is that it can be used as often as needed with no side effects. Based on your pain type, we recommend these time durations:


  • Chronic Pain: 20-30 minutes, four times per day
  • Acute Pain: 20-60 minutes, five times weekly

TENS Unit Placement for Back Pain - Best Practices

To effectively treat the pain, pads must be placed properly to conduct the electrical current through the pain area. The proper placement allows the device to block the pain nerves. Follow these best practices when using electrode placement for back pain.


  • Identify where the pain is and its most tender location: Use your fingers to softly touch and locate where most of your pain stems from. This will be your target area.
  • Use a minimum of two pads in even quantities: TENS therapy works by sending an electrical current from two pads through the pain area. It's important to use a minimum of two pads in even numbers to deliver that current.
  • Ensure each channel alignment is crossed: If you'll be using four or more electrodes, it's important to have each channel cross align. The pads on each channel should be diagonal to one another and not directly next.
  • Use more pads for larger surface areas: If your back pain is broader, you may want to consider a device capable of using four channels. This will give you the option to use up to eight pads at once for a larger surface area.
  • For a stronger sensation, place pads closer to each other: Placing your pads closer or further apart allows you to control the electrical sensation felt. Placing pads closer together increases the sensation whereas further apart decreases it. Don't place them too far apart as this reduces effectiveness.
  • Place pads at least 1" apart: Be sure to place electrodes at least 1" apart and make sure they never touch.
  • Avoid placing them over joints: Doing so can reduce pad adherence with movements. This can cause parts of the pads to unstick and zap you.
  • Clean and dry your skin before placing pads: Skin contaminated with dirt or debris reduces the lifespan of electrodes. Make sure you place electrodes on clean skin to extend the life of the pads.
  • Don't place electrodes over broken skin: Let your skin heal before placing electrodes. Broken skin can become infected.
  • Continuously test your placement for pain relief: TENS therapy may require testing pad placement to block pain. There is no right or wrong placement as the type and area of pain vary. Placing your pads at various angles is another tip to try.
  • Remove hair: Body hair can diminish electrode life. Try to shave any hair over the pain area before treatment.

How to Use a TENS Unit for Upper Back Pain

TENS Placement for Upper Back Pain

Most causes of upper back pain are from poor posture or soft tissue injuries including sprains and strains from looking down continuously. If you're using a TENS unit for upper back pain, this placement guide showcases the proper pad positioning for relief.

TENS Pad Placement for Upper Back Pain

How to Use a TENS Unit for Middle Back Pain

TENS Pad Placement for Middle Back Pain

Spinal arthritis, spinal stenosis, and herniated discs are a few common middle back pain causes. This pad placement guide showcases the best placement for middle back pain.

TENS Pad Placement for Middle Back Pain

How to Use a TENS Unit for Lower Back Pain

TENS Unit Placement for Lower Back Pain

Lower back pain is typically caused by lifting heavy objects or unsafe methods. Use this guide for low back TENS placement. Using your device for lower back pain may prevent you from bending over. When bending over, your pads can become undone.

TENS Pad Placement for Lower Back Pain

Relieving Back Pain with a TENS Unit

No back pain is the same, making customized treatment essential.

TENS therapy offers a safe and customizable method of back pain relief. However, the device you use is important. You'll want a brand that's reputable and delivers true TENS. Be sure to read the reviews of the device you're considering and ensure it has the settings and capabilities you'll need for relief. 

More TENS Therapy Resources

Brandon Landgraf

About the Author

Brandon Landgraf is the Digital Marketing Manager for Carex Health Brands. He finds passion and fulfillment in creating content that enhances, improves, and enlivens others' quality of life. All of his written work is formulated to not only offer essential advice and tips but back it with proven studies and experts. His mission is to connect with readers and provide steps to make their lives better.


You can connect with him on LinkedIn here.

About TENS 7000

Pain sucks. It affects millions of people each year with adverse physical and mental side effects. TENS 7000 provides tools to combat pain and let people live life on their terms, pain-free. Our TENS 7000 TENS Unit is one of the top-rated over-the-counter TENS units, having sold over two million since 2008. Stop letting aches and pain hold you back — live life on your terms.

Brandon Landgraf