Transcutaneous electrical nerve stimulation (TENS) is typically offered as part of a pain management program that may include physical therapy, occupational therapy, manipulation therapy, exercise therapy, cognitive behavioral therapy, medication, acupuncture or biofeedback. Patients should receive training from a physician, therapist, chiropractor or other qualified health professional before using TENS on themselves.

Patients receiving instruction in home use of TENS should be able to:

• Express understanding of the technique and precautions
  
  
• Demonstrate how to perform the procedure
  
  
• Demonstrate how to maintain the device

Before using TENS, the site where it will be applied is chosen. Usually this is over or near the painful area, but it may be over a nerve that serves the painful area or over a trigger point or acupuncture point.

The TENS unit is turned on at the recommended settings. For some cases of pelvic pain, TENS may involve use of a device inserted through a woman’s vagina or man’s rectum.

During TENS, the patient may feel a sensation of muscle tingling, vibration or tapping at the site of the electrode. There should be no strong muscle contractions. However there may be discomfort or pain, depending on the method of TENS being used. However, this usually indicates that the intensity of the stimulation is too strong and should be reduced. 

The first time the device is used, a physician or other healthcare provider may start the treatment using a low intensity, which will be gradually increased as the patient’s tolerance to the electrical impulses increases. It may take several minutes for the appropriate level of TENS to be reached.

If used at home, the patient should follow instructions given during training on when to ease intensity or end a session.

Depending on the condition, TENS may be used multiple times during the day. The most common therapy involves 80 to 100 impulses a second for 45 minutes, three times a day, according to the American Pain Foundation. Patients can typically go about their usual routine during the treatment. A physician or healthcare professional may need to adjust the frequency, intensity or duration of a session to identify the most effective settings for a patient.

It is generally recommended that, unless the electrodes need to be placed on noticeable part of the body such as the face, they be left in placed all day, with the unit hooked to the belt or clothing. This allow for TENS to be used frequently throughout the day.  The unit should not be worn while bathing, and it should not be worn at night because of the risk of becoming entangled in the electrode wires.

When the sessions are finished, the TENS unit should be kept in a safe place out of reach of children.