Adding TENS (transcutaneous electrical nerve stimulation) to outpatient physical therapy reduced exercise-based pain and fatigue in patients with fibromyalgia, and the effects lasted for at least six months, according to a new study led by researchers at the University of Iowa Health Care.
The study, led by Dr. Kathleen Sulka PT, is the first real-world clinical trial of TENS for fibromyalgia. The findings were published March 27 in the journal JAMA network openshowing that TENS is a safe, effective, inexpensive, and readily available treatment for fibromyalgia, a chronic disease that causes pain, tenderness, and fatigue throughout the body.
It is one of the few treatments that specifically targets exercise-induced pain and fatigue, which can be a major barrier to participating in daily activities. ”
Kathleen Sluka, PT, PhD, UI Professor of Physical Therapy and Rehabilitation Sciences
TENS uses a small device with adhesive electrodes to deliver gentle electrical pulses to the skin to block or reduce pain. The study found that TENS was as effective at reducing pain as, or better than, current FDA-approved fibromyalgia treatments.
“We were excited to see that patient fatigue was also reduced,” Sulka added. “Currently, there are no effective treatments for fatigue, so the fact that we had something that was effective against fatigue was very powerful.”
Fibromyalgia: complex, misunderstood, and difficult to treat
Fibromyalgia affects approximately 4% to 7% of the population. It has a significant impact on a person’s physical functioning, cognitive performance, and sleep. In addition to chronic pain, the main feature of this condition is general fatigue, which interferes with daily life and makes it impossible for the patient to concentrate and perform functional activities.
Exercise is often the first line of treatment recommended for people with fibromyalgia, and research has shown it to be beneficial. However, fibromyalgia causes fatigue and pain, which is the main reason the research team focused on reducing pain with movement.
“Pain with movement can interfere with your ability to participate in an effective exercise program and perform daily activities,” Sulka says.
science has real-world benefits
Sluka and her colleagues have spent decades studying the biological mechanisms affected by TENS, developing ideal parameters for TENS stimulation, and testing the effectiveness of TENS to treat chronic pain and fatigue in human clinical trials.
Researchers have previously shown that under ideal conditions in a randomized controlled clinical trial, TENS combined with physical therapy can significantly reduce pain during exercise.
The new Fibromyalgia TENS in Physical Therapy (FM-TIPS) study was designed to test the effectiveness of TENS under real-world conditions. The study was conducted at 28 outpatient physical therapy clinics across six health systems in the Midwest and included 384 participants of varying ages, education levels, and socioeconomic backgrounds. Approximately 50% of the participants were from rural areas.
“It was difficult to recruit participants for this study, but the clinics and physical therapists we worked with were amazing. None of this would have happened without them,” Sulka says.
Clinics were randomized to provide either physical therapy (PT) with TENS or physical therapy alone. In the PT-TENS group, participants were asked to use TENS for 2 hours a day for 6 months. That time can be divided into shorter periods or done all at once. TENS electrodes were placed on the upper and lower back and transmitted mixed frequency signals at an intensity that the participants could tolerate.
After 60 days, exercise-induced pain during TENS treatment was significantly improved in the PT-TENS group. Adding TENS also significantly reduced pain at rest and fatigue at rest and during exercise. In contrast, participants who received physical therapy alone had no change in exercise-induced pain.
The response was also dose-dependent, with those who used TENS daily for 60 days having the best results.
While many pain medications can become less effective over time as the body develops tolerance to the drug, this study shows that TENS maintains its ability to improve pain and fatigue at significant levels over time.
After the primary endpoint at day 60, the PT-only group also received TENS, and all participants continued on the study for an additional four months.
“When we gave PT-only patients a TENS unit and started using it, we saw the same improvements as PT for TENS patients, which is powerful,” Sluka says.
Overall, the study showed that 80% of patients found TENS helpful. Six months later, 80% were still using TENS once a week, and more than 70% reported feeling better after using TENS.
TENS adds benefits
Dana Daly, PT, PhD, UI assistant research scientist and lead author of the study, says it’s important that people understand that the benefits of TENS can be achieved by using it as part of a comprehensive treatment plan that includes physical therapy.
“TENS alone does not provide the same benefits,” Daly says. “However, this study shows that TENS provides additional benefits over and above the relief provided by other treatments. All of the study participants were also using pain medication and receiving physical therapy, but TENS still provided additional relief.”
Fibromyalgia often requires multiple interventions to reduce a patient’s pain, fatigue, and improve overall function. The new findings suggest that TENS may be particularly useful as part of a multifaceted approach, as it can be safely and easily used as a self-management tool to uniquely target exercise-related pain and fatigue.
“When you translate randomized controlled clinical trials into real-world settings, they often fail because there are too many confounders. But this intervention still works,” Sulka says. “Not only did this treatment reduce pain and fatigue during exercise during the test period, but patients continued treatment six months later.”
The research team included researchers from the University of Iowa Health Care and the University of Iowa School of Public Health. University of Illinois at Chicago and UI Health. Advanced Physical Therapy and Sports Medicine. Cepros Physical Therapy and Performance. Advanced Physical Therapists; Big Stone Therapy; Rock Valley Physical Therapy; Iowa City Veterans Affairs Health System; Grand Valley State University; and Vanderbilt University Medical Center.
This study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases as part of the HEAL Initiative.
sauce:
University of Iowa Health Care
Reference magazines:
DL State Daily, Others. (2026). Transcutaneous electrical nerve stimulation and pain during movement in patients with fibromyalgia. JAMA network open. DOI: 10.1001/jamanetworkopen.2026.2450. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847027
