Treatments and gadgets. 15 minute read.
TENS machines for back pain: what they do, what the evidence says, and how to place the pads
By the PocketPhysio editorial team. Published 2026-10-01.
What a TENS machine actually does
A TENS machine for back pain is a small battery-powered box with wires and sticky pads, and what it sends through those pads is a weak electrical current aimed at your nerves. The NHS calls it a treatment that gives temporary pain relief, and says it is thought to work by encouraging your body to release its own painkillers, the endorphins, and by stopping pain messages from your nerves reaching your brain. Note the two words that do most of the work in that description: temporary, and messages.
It acts on the message, not on the sender. Nothing a current passing between two pads can do will change a stiff joint, a sensitive disc or a deconditioned muscle, and no study on this page claims it does. That is not an argument against using one. It is the reason a TENS machine belongs beside the thing that actually changes a back, rather than instead of it.
In the United States the same device is usually called a TENS unit. The machine is the same, the pads are the same, and so is the evidence.
Does a TENS machine work for back pain?
The honest answer has two halves, and most pages only give you one of them.
Start with the back pain reviews, because they are the ones that apply to you. The Cochrane review of TENS against placebo for chronic low back pain found 4 high-quality randomized trials with 585 patients between them. It could not run a meta-analysis at all, because the trials were too clinically different to combine, so it synthesized them in words instead. On pain intensity the evidence was conflicting. On back-specific function, two of those trials, covering 410 patients, agreed that it did not improve, and the review concluded that the evidence from this small number of placebo-controlled trials does not support using TENS in the routine management of chronic low back pain (Khadilkar and colleagues, 2008).
That review is from 2008, which matters, so look at what has been done since. A systematic review commissioned to inform a World Health Organization guideline found 17 randomized trials in 1,027 adults with chronic primary low back pain. Pooling 9 of them for pain against sham in the immediate term gave a mean difference of -0.90 (95% confidence interval -1.54 to -0.26), which did not reach the threshold the authors had set for a difference that matters, 1 point on that 0 to 10 scale, and they graded the certainty of that evidence very low. For function, pooling 4 trials gave a standardized mean difference of -0.96 with an interval from -3.20 to 1.28, which is an interval so wide it tells you nothing, also at very low certainty (Verville and colleagues, 2023).
That review has two gaps that change who its result applies to. No included trial compared TENS against usual care, and only 28 of the 1,027 participants were aged 60 or over. Two small trials reported pain in that group, and in the single one that compared TENS against sham the difference was 0.13 on a 0 to 10 scale, with an interval from -9.80 to 10.06, which is nothing at all. If you are 70 with an old back, almost nothing here was measured in anyone like you.
A 2024 systematic review and meta-analysis of transcutaneous electrotherapies for chronic low back pain reaches the same place from a different angle. It included 14 studies and could pool only 6, all of them TENS or mixed TENS, and found no significant difference for TENS against active controls or passive controls for pain, and none for disability either. Its conclusion is that there is moderate evidence that TENS is similar to all controls for improving pain and disability (Wolfe and colleagues, 2024).
Why one big review sounds more positive
Now the other half, because there is a result that points the other way and leaving it out would be dishonest.
The largest synthesis in this field looked at TENS across every kind of pain rather than only backs. It took 381 randomized trials with 24,532 participants, and for pain intensity during or immediately after treatment compared with placebo it pooled 91 trials and 92 samples from 4,841 people, finding a standardized mean difference of -0.96 (95% confidence interval -1.14 to -0.78) at moderate certainty. Against the drug and non-drug treatments that make up standard care it pooled 61 trials and 3,155 people, finding a standardized mean difference of -0.72 (-0.95 to -0.50) at low certainty. The authors' conclusion is narrow and precise: there was moderate-certainty evidence that pain intensity is lower during or immediately after TENS compared with placebo, and without serious adverse events (Johnson and colleagues, 2022).
Who wrote it is worth knowing, as it is with any result that cuts against the guidelines. The paper's lead author declares a grant from a pharmaceutical company during the work, payments or other interests from several companies, one of them a maker of TENS devices, and authorship of trials that were considered for inclusion. All of that is declared in the paper, which is how it should be. It is a reason to read this result beside the Cochrane work rather than in place of it.
Read those two halves together and the disagreement mostly dissolves. The outcome with the best evidence behind it is pain while the machine is running, measured in people whose electrodes were placed close to the pain at a strong but comfortable intensity. The outcomes with the worst evidence behind them are the ones you care about over months: back-specific function, disability, and pain on a day when the machine is in a drawer.
The Cochrane overview of TENS for chronic pain is the bluntest statement of that second problem. It drew on nine Cochrane reviews, taking data from eight of them, representing 51 trials and 2,895 participants who received TENS. The evidence inside those reviews was rated very low quality throughout, most trials had fewer than 50 people per group, and the overview was unable to conclude with any confidence that TENS is harmful, or beneficial for pain control, disability, quality of life, medication use or global impression of change (Gibson and colleagues, 2019).
What the guidelines say
Formally, in the UK this is a do-not-offer treatment for back pain, and almost no page about these machines mentions it.
NICE guideline NG59, low back pain and sciatica in over 16s, puts TENS in a short run of electrotherapy recommendations that all say the same thing. Recommendation 1.2.11 reads: "Do not offer transcutaneous electrical nerve simulation (TENS) for managing low back pain with or without sciatica." The word printed in the guideline is "simulation", which is a typo in their document for stimulation. It sits between 1.2.10 on percutaneous electrical nerve stimulation and 1.2.12 on interferential therapy, and both of those are do not offer as well, as are ultrasound at 1.2.9 and traction at 1.2.6.
Two dates belong with it. The recommendation is marked 2016, and NG59 was last updated on 29 July 2026, an update that changed other parts of the guideline and left this one standing. NICE does not publish its recommendations as a strength and certainty pair, so there is no grading to quote beside it. It is an instruction to clinicians, not a graded estimate of effect.
What NG59 does recommend for a painful back is the plain stuff. Recommendation 1.2.1 asks clinicians to give you advice and information tailored to you so that you can manage the problem yourself, including encouragement to carry on with normal activities, and 1.2.2 says to consider a group exercise program for an episode or flare-up.
The American College of Physicians guideline gets there by leaving TENS out of the treatments it recommends. For long-standing low back pain it makes a strong recommendation to start with non-drug treatment, naming exercise, multidisciplinary rehabilitation, acupuncture and mindfulness-based stress reduction on moderate-quality evidence, then tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy and spinal manipulation on low-quality evidence. TENS is in none of it.
Where that guideline does discuss TENS, the reading is flat rather than silent. It reports low-quality evidence of no difference between TENS and sham TENS for pain intensity or function at short-term follow-up, from 4 trials for pain and 2 for disability, and no difference between TENS and acupuncture in the short or long term. Its own summary says that neither ultrasound nor TENS was shown to be effective compared with controls. For a new or recent episode it goes further and calls the evidence insufficient to judge. On harms it reports limited evidence of an increased risk of skin reactions, without an increased risk of serious adverse events (Qaseem and colleagues, 2017).
The World Health Organization came to the same place in its 2023 guideline on chronic primary low back pain, meaning back pain of more than three months that is not explained by a disease or an injury, which is most long-standing back pain. Its recommendation B.7 reads: "Transcutaneous electrical nerve stimulation (TENS) should not be used as part of routine care for adults, including older people, with CPLBP", and unlike NICE, WHO prints a strength and a certainty next to it: a conditional recommendation against use, on very low certainty evidence. In the guideline's own operational definition, conditional against use means the panel concluded that the undesirable effects of following the recommendation probably outweigh the desirable ones but was not confident of that, that most fully informed people would not want the treatment while some might still consider it, and that the decision therefore needs clinical judgement and a conversation. Very low certainty means the estimate could easily turn out wrong.
What the panel gave as its reasons is worth more than the verdict. It noted that the nine sham-controlled trials showed no clinically important benefit, that no outcome data existed beyond the short term, and that only a minority of trials looked for harms at all, so the balance of benefit against harm was judged uncertain rather than unfavorable (World Health Organization, 2023). That is the same gap the review commissioned for this guideline found (Verville and colleagues, 2023).
Two parts of that decision change what it means for someone who already owns a machine. Cost and fairness were part of the reasoning rather than effect alone: the panel named the moderate to high cost of equipment, training and repeated sessions, and the possible harm to equity where people pay for their own treatment. And four panel members disagreed with the decision, judging that making no recommendation at all would have been more appropriate, which is the kind of detail a one-line summary of a guideline never carries.
One thing a do-not-offer recommendation does not say. It is written for the clinician deciding what to provide as treatment, and it is not a warning that using a machine you already own is harmful. If a session makes the evening easier, nothing in NG59 or the WHO guideline contradicts that, and the WHO wording is specifically about routine care. What it does mean is that a clinic offering you a course of this as the treatment for your back, in place of an exercise plan, has the order the wrong way round.
What about a new, short episode of back pain?
This is where the answer is an absence. The Cochrane review of TENS for acute pain found 19 trials in 1,346 participants and pooled 6 trials, seven comparisons, for pain intensity, giving a mean difference of -24.62 mm in favor of TENS on a 100 mm scale (95% confidence interval -31.79 to -17.46), with substantial disagreement between the trials and a high risk of bias from small treatment arms and failed blinding. The authors call that tentative evidence (Johnson and colleagues, 2015).
The catch is what counted as acute pain in those trials: procedures such as a cervical laser treatment, a blood draw or a flexible sigmoidoscopy, plus the uterine contractions women get after giving birth, and rib fractures. Acute low back pain is not in there. The review also left out trials of TENS in labor, for period pain and during dental work, so those are separate questions it does not answer either.
So nobody can tell you from trials whether a TENS machine shortens a new bout of back pain. What is known is that most new episodes settle with movement and time, which is what our low back pain program is built around, and that a machine which helps you keep moving in the first painful week is doing something useful even if it is not treating the back.
Where do you put TENS pads for back pain?
Pad placement is one of the most asked questions about these machines, and the answer is simpler than the diagrams suggest.
Put the pads on clean, unbroken skin near the part that hurts, with a gap between them, which is the NHS instruction. The big meta-analysis describes its trials as delivering a strong but comfortable sensation within or close to the site of pain, so close to the sore area and not across the room from it is the principle (Johnson and colleagues, 2022). Turn the machine on only after the pads are on and the wires are plugged in, then bring the dial up slowly until you feel a tingling that is not painful.
The NHS is specific about where pads should not go: not on irritated, broken, infected or numb skin, not on your neck, mouth or eyes, and not on your chest and back at the same time. Cleveland Clinic would add varicose veins, the front or side of the neck, the head, the genitals, and skin that has recently had radiotherapy. If the pads make your skin itchy, irritated or red, turn the machine off and take them off; the NHS notes that redness can be harder to see on brown or black skin.
If your pain runs into a leg, the pads follow the pain rather than the spine. And if you are not sure, the NHS says a GP, physiotherapist or midwife can show you, which takes two minutes in a clinic and saves a week of guessing.
How long to use it, and how to judge it
Minutes, not hours, and several times a day rather than all day. Cleveland Clinic describes sessions of up to 60 minutes used several times a day, with relief beginning soon after a session starts and stopping within an hour of it ending.
Judge it on that hour. If a session takes the edge off enough that you can walk, sleep or get through a shift, it is doing the job the evidence supports. If three weeks of daily use has changed nothing between sessions, the machine is not the problem to solve.
The NHS also lists when not to use one at all: not while you sleep, not in the bath or the shower, and not while driving or using tools or machinery. Read the leaflet that came with the machine, because the full list belongs to whoever made it.
Who must not use one
This is the part to get right before anything else, and the lists published by two well-known health services do not match, which is itself informative.
The NHS gives three: do not use TENS if you have epilepsy, if you have a pacemaker, or if you are pregnant, unless your doctor or midwife tells you to.
Cleveland Clinic's list is longer: an implanted device such as a pacemaker, cancer, epilepsy, deep vein thrombosis, bleeding disorders, heart disease, and pregnancy. Where two reputable sources differ, the longer list is the safer one to follow, and the gap between them is a sign that this is cautious practice rather than something settled by trials.
A pacemaker or any other implanted electrical device is the one to treat as absolute. Do not use a TENS machine if you have one without asking the team that looks after the device. The worry is that an outside current could interfere with an implanted one, which is reasoning rather than a published finding here, and the NHS separately says never to put the pads on your chest and back at the same time.
The NHS adds two more, both easy to skip. If you do not know what is causing your pain, see a healthcare professional before you use a TENS machine: numbing a signal nobody has explained is how problems get missed, and the warning list below is the short version of what should not be masked. And if you want to try one, the NHS says it is a good idea to check with a GP or another healthcare professional first that TENS is safe for you.
The machine has its own small harms, and the trials barely looked for them. Cleveland Clinic lists an allergic reaction to the pad adhesive, a prickling sensation some people dislike, and burns under the electrodes, which it calls rare, and it says to tell your clinician if you get a skin rash, itchy skin, dizziness, headaches or nausea. Two of the reviews on this page report mild redness and itching under the pads as the usual side effect (Khadilkar and colleagues, 2008; Johnson and colleagues, 2015). In the WHO-commissioned review, only 1 of the 17 trials assessed harms at all, so the quiet safety record of this device is partly a record of nobody measuring (Verville and colleagues, 2023).
Pregnancy
This page does not answer the pregnancy question, on purpose. The NHS position is that TENS is not for use in pregnancy unless your doctor or midwife tells you to, and back and pelvic pain in pregnancy needs its own assessment, its own warning signs and its own exercise plan.
Our pregnancy back and pelvic pain page is where that sits, including what the obstetric and pelvic health guidance says about pain relief. If you are pregnant, read that page and ask your midwife, rather than taking a general answer from here.
Where it fits beside the work that changes a back
A TENS machine is a comfort measure with a short reach, and that is a reasonable thing to own. Used to get you through the painful part of the day, it costs you nothing clinically. Used instead of the exercise and the gradual return to normal load, it costs you the months it would have taken to get better.
The order to put things in is the one the evidence supports. Keep moving and build back up with the staged plan on our low back pain program. If the pain runs down a leg, sciatica sets out what to expect and what not to ignore. If a scan has named a disc, lumbar disc herniation explains how those usually behave over time, which is better news than most people are told.
When to see a physio (physical therapist)
Early, if nobody has yet worked out why the back hurts. An assessment tells you which movements provoke it, what it tolerates, and whether anything in the warning list applies, and that changes your plan far more than any device does.
Book sooner if the pain has lasted more than a few weeks, if it is stopping you sleeping, if it runs below the knee, or if you have found yourself avoiding things you used to do. Take the machine into the appointment and say how long you have used it and what changed, because that is useful information rather than something to feel awkward about.
See a doctor promptly if
- Emergency: back or leg pain that started after a serious accident, such as a car crash or a fall from a height, or back pain with chest pain. Call emergency services.
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you find it hard to start peeing, cannot pee, cannot feel yourself peeing or cannot control when you pee, or you do not notice when you need to poo or cannot control when you poo, and this is not normal for you. The same applies to a new change in how your genitals feel during sex, or new trouble getting an erection or ejaculating. Call emergency services or go to an emergency department straight away. These can also be signs of cauda equina syndrome.
- Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away.
- Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or comes with pain spreading down an arm or leg, weakness, numbness or pins and needles in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: back pain after a minor fall or strain if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time. Get medical advice the same day.
- Same day: back or leg pain with a fever, or you feel hot, cold, shivery or generally unwell. Get medical advice the same day, and go to an emergency department if you feel very unwell.
- Same day: severe pain that comes on suddenly or is getting worse quickly. Get medical advice the same day.
- Same day: new back pain and you have had cancer, now or in the past. Get medical advice the same day and mention your cancer history. If you are being treated for cancer now, contact your cancer team the same day.
- Same day: you have back pain and have lost weight without trying. Get medical advice the same day and mention the weight loss.
- Within a few days: pain that is worse at night, or does not ease at all when you rest. See your doctor within a few days. If you have had cancer, now or in the past, or you have lost weight without trying, get medical advice the same day. If you are being treated for cancer now, contact your cancer team the same day.
Common questions
Does a TENS machine work for back pain?
While it is switched on, it may reduce how much pain you feel; for changing long-standing back pain it has not been shown to work, and the UK guideline tells clinicians not to offer it: recommendation 1.2.11 of NICE guideline NG59 reads "Do not offer transcutaneous electrical nerve simulation (TENS) for managing low back pain with or without sciatica", dated 2016 and still in place after the guideline was updated on 29 July 2026; NICE publishes no strength and certainty pair with its recommendations, so that is a plain instruction rather than a graded one. The Cochrane review of TENS against placebo for chronic low back pain found 4 high-quality trials in 585 patients, could not pool them because they were too different from each other, reported conflicting evidence on back pain intensity, and found consistent evidence in two trials covering 410 patients that back-specific function did not improve; its conclusion was that the evidence does not support using TENS in the routine management of chronic back pain (Khadilkar and colleagues, 2008). The review commissioned for the World Health Organization's 2023 guideline, which recommends against TENS as part of routine care (a conditional recommendation on very low certainty evidence), found 17 randomized trials in 1,027 adults, pooled 9 of them for pain against sham in the immediate term, and reported a mean difference of -0.90 (95% confidence interval -1.54 to -0.26), which did not reach its own threshold for a difference that matters, 1 point on a 0 to 10 scale, at very low certainty (Verville and colleagues, 2023). A 2024 systematic review of transcutaneous electrotherapies for chronic low back pain included 14 studies, could pool only 6, and concluded that there is moderate evidence that TENS is similar to all controls for improving pain and disability (Wolfe and colleagues, 2024). Set against that, the largest meta-analysis in this field, covering 381 trials and 24,532 people across all kinds of pain, found pain lower during or immediately after TENS than with placebo, pooled from 91 trials and 4,841 people with a standardized mean difference of -0.96 (-1.14 to -0.78) at moderate certainty, which is a real but short-lived effect (Johnson and colleagues, 2022).
Where do you put TENS pads for lower back pain?
On clean, unbroken skin either side of the area that hurts, close to the pain rather than far from it, with a gap left between the pads. That is the principle the NHS gives, and the big meta-analysis describes its trials as delivering a strong but comfortable sensation within or close to the site of pain (Johnson and colleagues, 2022). The NHS also says not to put the pads on irritated, broken, infected or numb skin, not on your neck, mouth or eyes, and not on your chest and back at the same time, and to turn the dial up slowly until you feel a tingling that is not painful. If your pain runs down a leg, the pads go where the pain is felt rather than on the spine, and a physio, GP or midwife can show you where if you are not sure, which is the NHS's own advice. Read the leaflet that comes with your machine as well, because the full list of what not to use it for belongs to the maker.
How long should you use a TENS machine?
Sessions are usually measured in minutes rather than hours, and the relief does not outlast them by much. Cleveland Clinic describes some people using a TENS unit several times a day for up to 60 minutes at a time, and says relief usually starts soon after a session begins and stops within an hour of it ending. That fits what the trials measured: the one firm finding in this literature is lower pain during or immediately after treatment, pooled from 91 trials and 4,841 people at moderate certainty (Johnson and colleagues, 2022). The NHS says not to use TENS while you sleep, in the bath or the shower, or while driving or using tools or machinery. If you are using it for hours a day and the back is no different between sessions, that is information worth taking to a physio rather than a reason to turn it up.
How does a TENS machine work?
The NHS describes it as a treatment that gives temporary pain relief by passing a weak electrical current to your nerves, and says it is thought to work by encouraging the body to release its own painkillers, called endorphins, and by stopping pain messages from the nerves reaching the brain. Two things follow from that. It acts on the message rather than on the disc, joint or muscle the message is coming from, so nothing it does is treatment of a cause. And because it is thought to work while the current is flowing, the sensible test is how you feel during a session and in the hour after it, which is also what the trials measured (Johnson and colleagues, 2022). The NHS adds plainly that TENS does not work for everyone, and that if you are not sure what is causing your pain you should see a healthcare professional before using one.
Can you use a TENS machine in pregnancy?
Not without being told to by your doctor or midwife. The NHS lists pregnancy as a reason not to use TENS unless your doctor or midwife says otherwise, which is a conversation to have rather than a decision to make from a web page. Back and pelvic pain in pregnancy has its own assessment, its own warning signs and its own exercise plan, and our pregnancy back and pelvic pain page is where that belongs, including what the obstetric and pelvic health guidance says about pain relief options. TENS is also used during labor, which is a separate situation handled by your maternity team. The warning signs for back and pelvic pain in pregnancy are not the same as the ones on this page either, and they are set out on that page.
Who should not use a TENS machine?
The NHS gives three absolute exclusions: epilepsy, a pacemaker, and pregnancy unless your doctor or midwife tells you to. Cleveland Clinic's list is longer and includes an implanted device such as a pacemaker, cancer, epilepsy, deep vein thrombosis, bleeding disorders and heart disease, and it says to keep the pads away from infected tissue, damaged skin, varicose veins, the eyes, the mouth, the front or side of the neck, the head, the genitals, any area of numbness, and skin that has recently been treated with radiotherapy; the two lists do not match, which tells you this is cautious practice rather than settled trial evidence, so take the longer list as the safer one and check with your own clinician. If you have any implanted electrical device, including a pacemaker or defibrillator, do not use a TENS machine without asking the team that looks after it. The machine's own side effects are small and worth knowing: a reaction to the pad adhesive, a prickling sensation some people dislike, and rarely burns under the electrodes, with a skin rash, itchy skin, dizziness, headaches or nausea listed as things to tell your clinician about. And if nobody has worked out what is causing your back pain, that comes first: the NHS says to see a healthcare professional before using a TENS machine if you are not sure what is causing your pain, and that it is a good idea to check with a GP or another healthcare professional that TENS is safe for you.
References
- Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews. 2008;(4):CD003008. https://doi.org/10.1002/14651858.CD003008.pub3
- Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE. Transcutaneous electrical nerve stimulation (TENS) for chronic pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2019;(4):CD011890. https://doi.org/10.1002/14651858.CD011890.pub3
- Johnson MI, Paley CA, Howe TE, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database of Systematic Reviews. 2015;(6):CD006142. https://doi.org/10.1002/14651858.CD006142.pub3
- Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022;12(2):e051073. https://doi.org/10.1136/bmjopen-2021-051073
- Verville L, Hincapie CA, Southerst D, et al. Systematic review to inform a World Health Organization (WHO) clinical practice guideline: benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain in adults. Journal of Occupational Rehabilitation. 2023;33(4):651-660. https://doi.org/10.1007/s10926-023-10121-7
- Wolfe D, Rosenstein B, Fortin M. The effect of EMS, IFC, and TENS on patient-reported outcome measures for chronic low back pain: a systematic review and meta-analysis. Frontiers in Pain Research. 2024;5:1346694. https://doi.org/10.3389/fpain.2024.1346694
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Published 30 November 2016, last updated 29 July 2026. Recommendation 1.2.11. Read 1 October 2026. https://www.nice.org.uk/guidance/ng59/chapter/Recommendations
- World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 4 December 2023. Recommendation B.7. ISBN 978-92-4-008178-9. Read 1 October 2026. https://iris.who.int/handle/10665/374726
- Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530. https://doi.org/10.7326/M16-2367
- NHS. TENS (transcutaneous electrical nerve stimulation). Page last reviewed 14 February 2025. https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/
- Cleveland Clinic. Transcutaneous electrical nerve stimulation (TENS). Last reviewed 25 September 2023. https://my.clevelandclinic.org/health/treatments/15840-transcutaneous-electrical-nerve-stimulation-tens
- NHS. Sciatica. Page last reviewed 3 December 2024. https://www.nhs.uk/conditions/sciatica/
- NHS. Back pain. Page last reviewed 5 March 2026. https://www.nhs.uk/conditions/back-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-01.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.