Introduction
Transcutaneous Electrical Nerve Stimulation is a therapeutic-purpose, noninvasive method of electrical stimulation used to reduce pain.
Definition
TENS is a commonly used treatment approach to alleviate acute and chronic pain to deliver electric stimulation across the intact surface of the skin to active nerves. It is a simple, noninvasive, and analgesic method of electrical stimulation.
Purposes
- To treat pain.
- To stimulate injured muscles or manipulate nerves to reduce pain.
Indications
- Osteoarthritis.
- Fibromyalgia.
- Tendinitis.
- Labor pain.
- Low back pain.
- Chronic pelvic pain.
- Diabetes-related neuropathy.
- Peripheral artery disease.
Contraindications
- Implantable device.
- Pregnant mother.
- Cancer.
- Epilepsy.
- Deep vein thrombosis.
- Hemorrhage.
- Heart disease.
- Infected wounds.
Types of TENS
| Types | Parameters | Patient’s Feelings | Duration | Responses |
| Conventional TENS | Low amplitude and high frequency (90-130 Hz). | Painless sensation, minimal muscular activity. | Use as needed. | To relieve pain quickly. |
| Acupuncture | High amplitude and low frequency (1-to 5-Hz transmissions). | Painless sensation, strained muscles. | Limited use, 20-30 minutes at a time. | Delayed pain relief. |
| Pulsed or intense TENS | High amplitude. | Painful sensation of electrical impact in the affected area. | Short time, 5-15 minutes at a time. | Fast response with the therapy. May be delayed after the therapy is completed. |
Placement of Electrodes
- Deltoid.
- Biceps, triceps, and quadriceps muscles.
- Abdominal muscles.
- Flexors and extensors of the wrist and fingers.
- Peroneus muscles and calf muscles.
- Erector spinae muscles.
- Gluteus muscle.
- Low back muscles.
Settings & Modes
- High-frequency (50–120 Hz): Targets sensory nerves for immediate pain relief.
- Low-frequency (2–10 Hz): Stimulates motor nerves to trigger endorphin release.
- Some units offer mixed or modulated modes to prevent nerve adaptation.
Articles
| Articles | Purpose |
| A trolley containing: | |
| Self-stick electrodes with lead wires. | To localize the pain area. |
| Warm water and soap. | To prevent microorganisms. |
| Charged battery pack/battery recharger. | To prevent electrical issues. |
| Alcohol pads. | To clean the area. |
| TENS stimulator. | To relieve pain. |
Procedure
| Nursing Action | Rationale | |
| 1. | Provide privacy. | To feel comfortable. |
| 2. | Arrange the articles near to the patient table. | For easy convenience. |
| 3. | Check the TENS stimulator with charger/battery. | For time management. |
| 4. | Instruct the patient to lie in the prone position (the patient’s position is obtained according to the affected area). | To prepare the patient for the application of electrodes. |
| 5. | Wash hands. | To prevent contamination. |
| 6. | Clean the patient’s stimulated or painful area using warm water with soap solution. | To prevent microorganisms. |
| 7. | Apply lubricant jelly. | To aid in easy conduction. |
| 8. | Stimulate the patient using TENS stimulator. | To reduce pain. |
| 9. | Document the procedure name, age, gender, time, date, types of TENS with duration, before pain score, after pain score, and next schedule for stimulation. | Serves as legal evidence and prevents duplication of care |
Special Consideration
- Do not place electrodes over the heart, carotid arteries, or broken skin.
- Avoid use if you have a pacemaker or are pregnant (unless advised by a provider).
- Side effects are rare but may include skin irritation or muscle twitching.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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