Chronic pain can interfere with everything from work to sleep, making even the simplest tasks feel exhausting. Over the years, Transcutaneous Electrical Nerve Stimulation — more commonly known as TENS therapy — has become a well-recognised method to help people manage long-term pain without relying solely on medication. Understanding how TENS therapy works for chronic pain can help you make informed decisions about using it as part of your broader pain management routine.

The Science: Gate Control & Endorphin Pathways

The effectiveness of TENS therapy is rooted in two key biological mechanisms: the gate control theory and endorphin release.

The gate control theory explains how electrical impulses from a TENS device can “close the gate” to pain signals before they reach the brain. The device sends mild electrical pulses through afferent fibres in the skin, which can override pain messages travelling along slower nerve pathways. This interference helps reduce the sensation of pain, particularly in chronic conditions where pain signals become overactive.

At the same time, TENS can encourage endorphin release — the body’s natural painkillers. These chemicals interact with the brain’s receptors to reduce pain perception and create a feeling of relief and calm. For people managing persistent back, neck, or neuropathic pain, this dual action can make a meaningful difference over time.

Choosing Frequencies: Low vs High, Burst Modes

TENS devices allow users to adjust frequency modulation depending on their pain type and comfort level.

• Low-frequency stimulation (under 10 Hz) tends to promote endorphin release and is often used for long-term use in chronic pain management.
  
• High-frequency stimulation (above 50 Hz) typically provides faster chronic pain relief through nerve interference, making it suitable for acute flare-ups or neuropathic pain.
  
• Burst modes alternate between frequencies, which some users find helps reduce habituation — the gradual reduction in effectiveness when the body becomes accustomed to one setting.
  

Modern PainPod devices include both TENS and EMS modes, meaning users can target nerves for pain relief while also engaging muscles gently, without needing two separate machines.

Chronic Back, Neck & Neuropathic Pain Use Cases

TENS therapy has been widely studied for various types of chronic pain. Research published in the Journal of Pain Research shows consistent improvement in patients with chronic lower back pain and neuropathic pain, including diabetic neuropathy and sciatica.

For neck and shoulder pain, especially due to muscle tension or poor posture, TENS can reduce discomfort and improve range of motion when used alongside physiotherapy or stretching routines.

Those living with neuropathic pain often experience burning, tingling, or shooting sensations caused by damaged nerves. The controlled electrical pulses from TENS help interrupt these pain signals, reducing the intensity of paraesthesia (pins-and-needles sensations) and improving comfort levels throughout the day.

Explore the full range of PainPod devices designed to support chronic pain management here.

Habituation & Rotating Programs

Like any form of therapy, the body can adapt to consistent stimulation. This process, known as habituation, can make the treatment feel less effective over time.

To avoid this, users are encouraged to rotate programs or adjust the intensity and frequency regularly. Many PainPod models include multiple modes designed to minimise habituation and maintain consistent results for long-term users; these are referred to as Modulation modes. Incorporating short breaks between sessions can also help keep the body responsive to the treatment.

When TENS Isn’t Appropriate

While TENS therapy can support comfort and mobility for many individuals, it isn’t suitable for everyone. People with pacemakers, implanted defibrillators, or certain heart conditions should seek professional medical advice before using any electrical stimulation device. Similarly, TENS should not be applied directly over areas with broken skin, reduced sensation, or the front of the neck.

It’s always best to consult a healthcare professional to ensure TENS therapy complements your existing treatment plan — especially if you’re managing complex or chronic conditions.

The Takeaway

Understanding how TENS therapy works for chronic pain offers valuable insight into how electrical nerve stimulation can support long-term relief. Through the gate control theory and endorphin pathways, TENS helps the body manage pain more efficiently, reducing the need for constant medication.

With thoughtful use, the right frequency settings, and awareness of when to apply it, TENS therapy can become a reliable part of a broader approach to living more comfortably with chronic pain.

Learn more about how PainPod technology supports nerve and muscle recovery here.

Resources

• NHS: Transcutaneous Electrical Nerve Stimulation (TENS)
• Healthdirect Australia: TENS Therapy Overview
  
• PubMed: Effectiveness of TENS in Chronic Pain Management
  

References

• Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971–979.
  
• Sluka, K. A., & Walsh, D. M. (2003). Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. The Journal of Pain, 4(3), 109–121.
  
• Johnson, M. I. (2007). Transcutaneous electrical nerve stimulation: Mechanisms, clinical application and evidence. Reviews in Pain, 1(1), 7–11.
  
• Australian Therapeutic Goods Administration (TGA). (2023). Medical Devices — Electrical Stimulation Devices.
  
• PainPod Australia (2025). PainPod Recovery and Wellness Guide.