How To Choose Your Ideal TENS Unit Settings

If you’ve been dealing with chronic pain, arthritis, temporary muscle soreness, or discomfort following injuries or surgery, you might have encountered TENS. Or perhaps your healthcare provider has recommended it as part of your pain management plan. 

TENS, which stands for Transcutaneous Electrical Nerve Stimulation, is a valuable tool in pain relief. However, like many valuable tools, TENS units can initially seem tricky. 

You see, the effectiveness of your TENS therapy isn’t solely dependent on owning the device — it hinges on how you set it up, where you place the electrode pads, and whether you combine it with other treatments.

In this blog, we’re focusing on the first one: how to set up your TENS machine. We’ll answer a question we often hear: “How high should I set my TENS unit?” 

What Is TENS?

TENS (Transcutaneous Electrical Nerve Stimulation) units are straightforward devices that use electrical currents to target specific nerves where you’re experiencing pain, like muscle spasms or backaches. They’re portable, battery-operated devices that connect to small electrode pads placed on your skin. ⁽¹⁾

Initially, you might receive TENS therapy in a clinical setting, guided by a healthcare professional. After some sessions, you could be sent home with one. It can take a few tries to determine the correct settings, such as the frequency (measured in Hz) and electrode placement.

TENS is FDA-approved for pain relief in: ⁽²⁾

• Chronic pain
• Arthritis
• Temporary muscle soreness
• Post-injury or surgery recovery

The Science Behind TENS Pain Relief

Before we delve into the specifics of using TENS units, let’s pause to explore the biology behind how these compact devices effectively manage pain. TENS operates through two primary mechanisms to achieve this goal: ⁽³⁾

Endorphin Boost

TENS units send mild electric impulses to your nerves to trigger the release of endorphins – natural mood boosters. Endorphins are messengers that help your brain and body communicate.

When TENS gets them flowing, it’s like turning on a positivity switch. Endorphins help reduce pain, improve mood, and boost your immune system. 

Pain Gatekeeping

Your spinal cord is a gatekeeper for pain signals trying to reach your brain. Sometimes, it swings the gate wide open for intense pain, while other times, it blocks pain signals.

Pain is a conversation between your brain and body. Messages zip back and forth through your nervous system. When you touch something hot, large nerve fibers tell your brain it’s hot. Pain signals work the same way. 

TENS activates these nerve fibers and stops pain messages in their tracks. It’s like intercepting a letter before it reaches its recipient. When this happens, your pain lessens, whether chronic or from a recent injury.

Setting Your TENS Unit

When setting your TENS unit, remember that everyone’s response varies due to overall health, emotions, posture, and medications. TENS offers adjustable parameters such as pulse rate (speed), pulse width (duration), and intensity (strength), which produce different sensations.

The key is personalization. Consult your healthcare provider to determine the settings that work best for you. You might need to adjust settings when pain levels fluctuate. 

Here’s a breakdown of the settings: ⁽⁴⁾

Mode

There are three modes:

• Normal Mode: This mode provides constant stimulation at the selected frequency and pulse width settings.
• Modulation: In this mode, the frequency varies across different settings in a cyclical pattern.
• Burst Mode: It delivers a burst of pain-relieving power.

Pulse Rate (Frequency)

Pulse rate determines the number of electrical pulses you feel per second. Pain relief can be achieved at different frequencies, depending on your pain type.

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Pulse Width

The pulse width refers to the ON periods of the current. For pain relief, lower to mid-time periods are generally effective. Muscle stimulation, on the other hand, requires a more extended pulse width to induce muscle contractions.

Now, to answer the common question, “How high should I set my TENS unit?” let’s look at the common settings and their applications.

Standard TENS techniques used⁽⁵⁾

Settings

Rate

Width

Mode

Use

Low-intensity, high-frequency

10–200 pps*

100–200 µs**

Continuous

Acute pain

High-intensity, low-frequency

≤10 pps

200–500 µs

Continuous and burst

Chronic pain

High-intensity, high-frequency

50–200 pps

> 500 µs

Continuous

Post procedures or breakthrough pain

*pps: pulse per second, **µs: micro-seconds

It’s important to note that if you’re using a TENS unit on your own, these guidelines serve as a good starting point. However, consulting your doctor is essential, as they might recommend specific settings tailored to your condition. Attempting to adjust settings without professional guidance can lead to injury.

It’s also essential to remember higher frequencies don’t necessarily provide better pain relief and can even cause skin burns or muscle tenderness if set too high.

Frequently Asked Questions

#1. What is the difference between high TENS and low TENS?

Low TENS: This involves a low frequency, typically under 10pps, combined with high intensity. It’s primarily used to induce muscle contractions, making it effective for stimulating and strengthening muscles. ⁽⁶⁾

High TENS: In contrast, high TENS utilizes high frequencies, generally exceeding 50pps, but with low intensity. Its primary goal is to produce paresthesia, a tingling or buzzing sensation, without triggering muscle contractions. This sensation can help relieve pain without the side effects of muscle movement. ⁽⁶⁾

#2. How often should you use a TENS unit?

There’s no one-size-fits-all rule here. The frequency of TENS unit usage varies. Some experts suggest using it up to four times daily, while others find a few sessions per week sufficient. 

It’s also a matter of personal choice and how you perceive your pain. Some individuals reserve it for pain flare-ups, while others opt for daily use based on their comfort and needs. ⁽⁷⁾

Conclusion

TENS unit shines as a versatile tool for pain management, offering relief for chronic pain, arthritis, muscle soreness, and post-surgery discomfort. While they may seem a bit complex initially, understanding their settings can make all the difference in your pain relief journey.

TENS units offer various frequencies and pulse widths to tailor your pain relief experience. You also have options, whether it’s the constant stimulation of normal mode, the cyclical variations in modulation, or the burst of power in burst mode.

Everyone’s response to TENS varies, influenced by factors like overall health, emotions, posture, and medications. So, it’s best to consult with your healthcare provider to determine the settings that suit you best, adjusting them as pain levels fluctuate.

Curious about which pain relief method might be best for you? Take our pain quiz, and our experts would love to help you discover the perfect solution tailored to your needs.

References:

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2. The FDA. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf20/K202159.pdf Accessed on: 2023 Sep 1.
3. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014 May;4(3):197-209. doi: 10.2217/pmt.14.13. PMID: 24953072; PMCID: PMC4186747. 
4. Tashani O, Johnson M. Transcutaneous Electrical Nerve Stimulation (TENS) A Possible Aid for Pain Relief in Developing Countries? Libyan J Med. 2009 Jun 1;4(2):62-5. doi: 10.4176/090119. PMID: 21483510; PMCID: PMC3066716.
5. Johnson MI. Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome. Medicina (Kaunas). 2021 Apr 14;57(4):378. doi: 10.3390/medicina57040378. PMID: 33919821; PMCID: PMC8070828.
6. Teoli D, An J. Transcutaneous Electrical Nerve Stimulation. [Updated 2023 Jan 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537188/
7. Gibson W, Wand BM, O’Connell NE. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Sep 14;9(9):CD011976. doi: 10.1002/14651858.CD011976.pub2. PMID: 28905362; PMCID: PMC6426434.

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