5 Ways to Maximize Chronic Pain Relief with TENS

09/01/2020 • Shai Gozani M.D., Ph.D.

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Transcutaneous electrical nerve stimulation (TENS) is a safe, non-pharmacological approach to chronic pain management.  In this post we discuss five ways that you can maximize the pain relief you experience with TENS.

Use a Strong, Comfortable Intensity

Stimulation intensity, that is how much electrical power is stimulating your nerves, is the most important factor determining the effectiveness of TENS.  A common error made by many people using TENS is setting an inadequate stimulation intensity.  It is imperative that you feel the stimulation, because if it is imperceptible it will not work.  In general, the higher the intensity the more pain relief that you will experience. A good intensity target is one that feels strong but remains comfortable so that you can use TENS regularly.  Quell® handles this for you through an automated calibration process.

Increase Intensity During Therapy

Nerves naturally desensitize during TENS, meaning they become less responsive during continuous stimulation longer than about 10 minutes.  As a result, if your typical TENS session is 20 minutes or longer, and you do not increase the intensity regularly, then your pain relief will diminish during the course of the session.  You should assess the intensity every 5 minutes and increase to maintain a strong, comfortable sensation.  Alternatively, you can use a TENS device like Quell which does this automatically for you.

Minimum Session Duration of 30 Minutes

The biological mechanisms underlying TENS are complex and involve modulation of how the nervous system communciates pain signals.  Studies show that it can take 15 minutes or longer after stimulation starts for these processes to become effective.  As a result, short therapy sessions of 10-20 minutes are unlikely to consistently provide pain relief.  You should target a minimum of 30 minutes per session and preferably 60 minutes.  Quell offers 30- and 60-minute session options.

Use TENS Regularly

Conventional TENS stimulation provides transient pain relief and needs to be used regularly to reduce pain.  It is unrealistic to use TENS sporadically, such as a few times a week, and expect substantial improvement in chronic pain.  Moreover, you should be skeptical of devices with claims that a single brief TENS treatment will provide prolonged pain relief.  You should try to use TENS regularly, at least several hours a day, in order to experience meaningful relief.  Wearable devices like Quell, that you put on in the morning and can wear all day and even overnight, make this convenient.

Use a TENS Device With a High Frequency Option

Although the impact of stimulation frequency on TENS effectiveness remains an open question, on balance, high frequency (defined as at least 50 Hz) or both low and high frequency stimulation appears to provide the best pain relief.  One reason is that low and high frequency stimulation have distinct pain relief mechanisms.  Low frequency increases endorphins, an endogenous pain-relief molecule, while high frequency increases enkephalins, a different pain-relief molecule.  Most prescription pain medications mimic endorphins, so individuals currently (or recently) taking these drugs may not experience pain relief from low frequency stimulation.  Another reason is that high frequency stimulation tends to be more comfortable than low frequency for regular TENS users.  Quell offers two high frequency options, 80 Hz and 160 Hz.


About The Author
Shai Gozani M.D., Ph.D.
Shai Gozani M.D., Ph.D.

Dr. Gozani is an expert in non-invasive neurostimulation. He received his M.D. degree from Harvard Medical School and the Harvard-MIT Division of Health Science and Technology. Dr. Gozani earned his Ph.D. in Neurobiology, M.S. in Electrical Engineering & Computer Science and B.A. in Computer Science from the University of California at Berkeley. Following his studies, Dr. Gozani conducted post-doctoral research at Harvard Medical School and MIT. He holds 36 U.S. patents and has authored over 30 articles in scientific and clinical peer-reviewed journals. Dr. Gozani is founder, president and CEO of NeuroMetrix, Inc.; which designs and manufactures Quell.


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