Non-Invasive Neuromodulation: Focus on Transcutaneous Electrical Nerve Stimulation (TENS)
Seance of wednesday 01 april 2026 (La douleur post-opératoire, Neuromodulation)
DOI number : 10.26299/ztz4-0648/emem.2026.14.02
Abstract
Transcutaneous Electrical Nerve Stimulation (TENS) is one of the most widely used non-invasive neuromodulation techniques in pain management. This method involves the delivery of low-intensity electrical currents through surface electrodes placed on the skin, allowing modulation of peripheral nerve activity involved in nociceptive signal transmission.
The analgesic mechanisms of TENS are primarily explained by the gate control theory, according to which stimulation of large-diameter sensory fibers inhibits the transmission of nociceptive signals at the spinal level. In addition, certain stimulation parameters may promote the release of endogenous opioids and activate descending inhibitory pain pathways.
TENS is commonly used in the management of a variety pain conditions. The French National Authority for Health (HAS) recommends its use in the management of chronic pain. For over 25 years, health insurance has reimbursed this treatment for chronic neuropathic pain administered in chronic pain clinics, and for the past two years for knee osteoarthritis pain, at the initiative of rheumatologists, orthopedic surgeons, and physiatrists. In practice, this treatment is also used for acute and chronic pain, including musculoskeletal, neuropathic, and postoperative pain. Its ease of use, non-invasive nature, and favorable safety profile make it an accessible therapeutic option that can be integrated into a multimodal pain management strategy. The recent expansion of prescribing rights to several medical specialties should facilitate patient access to this treatment.
However, clinical outcomes reported in the literature remain heterogeneous, partly due to variability in stimulation parameters and patient populations. Improved standardization of treatment protocols and better identification of patient profiles likely to benefit from TENS may enhance its clinical effectiveness.
Overall, TENS represents a promising non-invasive neuromodulation technique within a personalized and multimodal approach to pain management.
The analgesic mechanisms of TENS are primarily explained by the gate control theory, according to which stimulation of large-diameter sensory fibers inhibits the transmission of nociceptive signals at the spinal level. In addition, certain stimulation parameters may promote the release of endogenous opioids and activate descending inhibitory pain pathways.
TENS is commonly used in the management of a variety pain conditions. The French National Authority for Health (HAS) recommends its use in the management of chronic pain. For over 25 years, health insurance has reimbursed this treatment for chronic neuropathic pain administered in chronic pain clinics, and for the past two years for knee osteoarthritis pain, at the initiative of rheumatologists, orthopedic surgeons, and physiatrists. In practice, this treatment is also used for acute and chronic pain, including musculoskeletal, neuropathic, and postoperative pain. Its ease of use, non-invasive nature, and favorable safety profile make it an accessible therapeutic option that can be integrated into a multimodal pain management strategy. The recent expansion of prescribing rights to several medical specialties should facilitate patient access to this treatment.
However, clinical outcomes reported in the literature remain heterogeneous, partly due to variability in stimulation parameters and patient populations. Improved standardization of treatment protocols and better identification of patient profiles likely to benefit from TENS may enhance its clinical effectiveness.
Overall, TENS represents a promising non-invasive neuromodulation technique within a personalized and multimodal approach to pain management.