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Currently TENS is one of the most commonly used forms of electro-analgesia. Several studies have been conducted and clinical reports issued in regard to the use of TENS and treatment of arthritic pain, bladder incontinence, myofacial pain, post surgical pain, visceral and neurogenic pain and lower back pain. Due to many of these studies not being carried out under controlled circumstances, and result are inconclusive, there is ongoing debates as to whether TENS is more effective in reducing pain as opposed to placebo. Labs studies suggest that TENS electrical stimulation reduced pain through non-inceptive inhibition in the dorsal horn at a presynaptic level, which limits the central transmission.

Studies have shown marked increases in met-enkephalin and beta endorphin, which demonstrated reversal of the anti-nociceptive effects by naloxone with the use of a low frequency electrical nerve stimulation machine. The current neuro-modulation mechanisms that TENS produces include endogenous pain control through dynorphins, endorphins and enkephalins, afferent input restoration, direct inhibition of a nerve abnormally excited and presynaptic inhibition in the spinal cords dorsal horn. Electrical stimuli activate a low threshold, nerve fibers that are myelinated when applied to the skin. These nerve fibers inhibit nociception propagation in the tiny, un-myelinated C fibers by means of the transmission being blocked along the fibers to the T Cells. Studies however, indicate that TENS analgesia is not reversed by naloxone at a high frequency, implicating a dynorphine binding naloxone resistant receptor. Increased levels of dynorphin A was demonstrated in spinal fluid samples taken from research subjects. The gate control theory explains the mechanism of analgesia TENS produces. The gate is usually closed, and through the C fibers from the periphery to the T Cells inhibits constant nociceptive transmission. The formation carried by C fibers when painful peripheral stimulation occurs, reaches the T cells and the gate opens, allows pain to be transferred to the cortex and thalamus centrally, which is then interpreted as pain. This gate control theory prevents any further central transmission to the cortex. Hence studies on a variety of medical conditions and the effectiveness of TENS, have reported outcomes to be either positive or negative, which means studies are still inconclusive.

Many professional are in favor of TENS, and others differ on its effectiveness with regards to opposing clinical situations. In general 70 to 80% of patients have experienced initial pain relief, and a few months down the line, the success rated has shown to decrease by around 20 to 30%. TEN should be applied for an hour to confirm potential benefits. From the start of TENS stimulation to the onset of pain relief varies from immediate to an hour and may differ in those suffering with acute pain and those with chronic pain.

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