FND Education Project

REFERENCE · RECOVERY TECHNIQUE

TENS and Electrical Stimulation: Specialist Review and Safety

Most likely fit: A qualified clinician is considering electrical input for a specific pain or rehabilitation goal and needs to establish whether it is suitable. [Emerging and uncertain FND evidence; safety review is essential]

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What this approach is for

A TENS machine sends electrical pulses through pads on the skin. It is commonly used for pain relief. Other electrical devices may be designed to contract muscles; those are different treatments with different instructions.

This page is a decision aid, not a home stimulation protocol. Do not apply TENS over numb skin or turn it up until a numb area responds. Ask a qualified clinician about another approach if sensation is unreliable.

Terms in everyday language

Transcutaneous means through the skin. TENS stands for transcutaneous electrical nerve stimulation. Neuromuscular electrical stimulation aims to produce a muscle contraction. An electrical response does not by itself establish the cause of a symptom or predict lasting recovery.

A practical example and flare adaptations

Before trying a device, ask what it is intended to improve, what evidence applies to your symptom, and how benefit and harm will be reviewed. Share information about implanted devices, epilepsy, pregnancy, skin problems and difficulty feeling the proposed pad area.

Follow the device instructions and professional advice. Do not use it while asleep, driving or bathing. Turn it off if the skin becomes irritated. A flare is not a reason to increase the setting or move pads onto a numb area.

These are choices to discuss with your care team, not a required exercise schedule. Helpful activity, comfort and access matter even when sensation remains altered. The evidence and its limits are explained below. (Sources: 1, 2)

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Do not select settings or reposition pads unless the treating professional has explicitly taught you to assist. Never turn up a device because the person reports little sensation.

Help communicate an adverse response and obtain clinical advice. Safer task adaptations remain available if electrical treatment is unsuitable or does not help.

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Selection and assessment

The 2015 physiotherapy consensus described high-intensity TENS in marked sensory loss. Current NHS patient guidance advises against application over numb skin. This collection therefore does not reproduce the older high-setting practice as an instruction. Review the device-specific contraindications and local governance; a citation to historical practice does not establish safety.

Explicit procedure

  1. Clarify the proposed modality and whether the goal concerns pain, sensory feedback or muscle activation.
  2. Assess protective sensation, skin integrity, circulation and ability to report discomfort at each proposed site.
  3. Review implanted electronic devices, epilepsy, pregnancy and other device-specific contraindications; do not conflate functional seizures with epilepsy.
  4. If contraindicated or sensation is inadequate, choose a non-electrical alternative; do not compensate by increasing intensity.
  5. For an appropriate clinician-supervised trial, document consent, device, placement, settings, duration and monitoring according to the applicable protocol.
  6. Set a review date and discontinue for harm or absence of meaningful benefit rather than escalating indefinitely.

Review, progression and stopping

Record the target activity or pain outcome separately from the immediate tingling or muscle response. Check skin and later effects. No universal current, frequency or pad placement is provided because suitability depends on the modality, indication and person.

The procedures are educational implementation examples requiring clinical adaptation, not validated standalone protocols. (Sources: 1, 2)

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Research and Sources

Older FND consensus and small motor-disorder reports are not proof of efficacy for functional sensory loss. NHS guidance supports device safety, not FND treatment efficacy. The safety boundary here explicitly differs from the older high-intensity sensory-loss description.

Citation Full citation
[1] Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. JNNP. 2015;86:1113–1119. FND-CIT-0028. Source
[2] NHS. Transcutaneous electrical nerve stimulation (TENS). Reviewed February 14, 2025; accessed September 15, 2026. FND-CIT-0102. Source

Source check: September 15, 2026 · Occupational-therapy, physiotherapy, neurology, pain, equipment, lived-experience, supporter and accessibility review pending.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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