What Makes A Good TENS Machine?

Why Is This Important…

The purchase of any medical device is a decision not to be taken lightly. The is most certainly true for TENS and TENS/EMS machines, where poor quality can mean complete failure. But how can you decide, if you don’t know (from a medical perspective), what makes a good TENS machine?

This decision is further complicated because just purchasing the TENS machine with the most features or the highest price won’t necessarily mean your TENS machine will be any more effective.

In this article, I break down the features and try to explain just what makes a good TENS Machine, because buying badly will only lead to more pain. 

What Makes A Good TENS Machine?

All too often I see sufferers give up on a new treatment because they didn’t try it properly in the 1st place and so don’t get the results they need.

This happens regularly with people trying hypnosis who don’t commit themselves to it or put a half-frozen bag of peas across a small section of their knee and wonder why it hasn’t delivered the desired numbing effect.

Almost every chronic condition relies on the same moto – get a diagnosis early and fight it fully with a variety of treatments. Back pain is no different.

TENS machines (or  transcutaneous electrical nerve stimulation machines) are devices for doing exactly this. Small electrical charges are designed to numb and block the nerve messages to the brain.

I have written a number of articles on the science behind TENS machines including ‘How Does A TENS Unit Work‘ and ‘Do TENS Units Really Work?‘. You can always read those for more about how and why they work.

As with every item available for purchase however, there is a great variety between different makes and models of TENS machines. It is perhaps no great surprise then that results vary from person to person – given that the unit they use can vary so greatly.

In order to help you, should you decide to invest in a TENS unit in the future, I have listed below what to consider and what to look for when choosing a suitable TENS machine –

1. Number of Outputs/ Channels.

In the case of what a TENS machine can do – the more channels the better. A single output will supply the impulses required for two electrode pads.

Multiple channels however will allow you to use more electrode pads at the same time.

This means you can cover larger areas of your body and save time. It also means you can potentially cover the entire painful area and treat it in one go.

If you have just one sore knee, you may not need this extra coverage, but if it is back pain or even both knees that cause you problems, then having multiple outputs is a real advantage.

2.Intensity Levels.

Again, having more intensity levels typically means you can try different levels of stimulation and decide which achieve better results.

In clinical trials, the machines had two basic levels – low intensity and high intensity. High intensity is intended for acute pain and low frequency is for the more long-term chronic pain.

Throughout the tests, the high intensity levels far outperformed the lower levels (perhaps no surprise there).

However it does allow you to try different ones, reduce the chances of building up a tolerance to it’s effect and find the lowest effective level.

In the same way that a doctor will always try to alter drug doses to find the lowest effective level, you can do exactly the same with an adjustable intensity level.

3. EMS

As mentioned previously when answering the original question ‘what does a TENS machine do?’ the electrical impulses are designed to target the nerves that carry pain. An EMS machine targets muscles instead of nerves, albeit in a similar way.

The aim of an EMS unit is to provide a stimulating massage to your muscles.

The advantage of having a TENS unit that offers both TENS and EMS, is obviously that you can get both a stimulating muscle massage and a nerve blocking pain relief stimulus from the same machine.

4. Specialised Modes.

Modes or programs are either predefined settings for different types of treatment or the option of creating customised programs yourself.

Some models will have what they consider to be the best settings for different parts of your body for either pain relief or massage.

Other models go one step further and offer you the option of selecting different settings and saving them for later use.

Either style gives you an advantage over a standard device – that being the option of trying different types/ styles and comparing which ones are the most effective for you.

WARNING – I carried out a study into the average price of a TENS machine (‘How Much Does A TENS Machine Cost‘) and while comparing over 100 different machines, I found some that had as many as 300 different levels. Don’t be fooled into thinking that more is better though – having that many levels just made testing virtually impossible and it’s use over-complicated.

5. Battery Life.

Before making a final decision, it is important to consider whether you would benefit more from rechargeable batteries or standard replacement ones. Some machines have built-in rechargeable ones – these are great for cost and can be recharged at any wall outlet or in your car.

The benefit of selecting ones with external batteries (either AA or AAA size) is that you don’t have to keep remembering to recharge your device and the chances of finding it flat again and having to wait for it to charge are nil.

The only thing to be careful of is picking one with 9v batteries – these are still ok, but are harder to find and more expensive than AA or AAA.

6. Rechargeable Options.

Even better than having to worry about batteries, some of the TENS machines are now fully rechargeable. If you assume that one session with the unit will be 20-30mins, you want a fully charged capacity of at least 1 hour.

7. Size.

TENS machines come in all shapes and sizes. If you travel a lot with work or think you might be taking it away from home, then this should be an important consideration.

Many handheld TENS machines are no larger than a smartphone and fit neatly in a hard case, which is ideal for travelling.

Others may be a bit larger and require either their original box or a different box/ backpack for them to fit safely in to.

Some manufacturers also supply special hard plastic cases to protect your TENS machine.

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8. Portability

Some TENS units come with belt attachments in their case. This can be really handy if you are looking to use your TENS machine away from home. Especially if you want to use it while travelling as the belt attachment will make this much easier.

You may also want to consider whether your brand/ machine has a wireless option available. There are pros and cons to using a wireless machine, but if you intend to use one while travelling, this can make all the difference. 

9. Timer

Most units come with some form of timer, which can be essential. In the new units, it is included for safety reasons (some will have an automatic switch off), but is also great for measuring effectiveness.

You can try different lengths of use to see at which point you stop seeing any further benefit. Using a TENS machine for too long can cause bruising, although this is very unlikely unless it is your first ever session.

10. Screen Size

Whether you are looking to use you TENS machine at home or at work (or anywhere else for that matter), having a screen that you can actually see and comfortably use, will make a lot of difference.

A good screen should be big enough to see and use with ease, allowing you to change the settings quickly without complication. It is also a real advantage if it is a backlit one as this will help with use in all situations.

Although screen size is listed at number 9 it is perhaps one of the most important factors, especially when it comes to usability.

11. Pad Size

Image of a TENS Machine Pad attached to someone's back

Electrode pads can vary greatly in size. Large pads are ideal for non-specific back pain or covering large areas.

Medium pads are a safe compromise and the most common to be supplied with your TENS machine.

Small pads are perfect for treating muscle knots (under an EMS setting) or joint pain. They are ideal for treating small, sometimes confined, areas.

12. Replacement Pads

If you use your TENS machine for any period of time, you will need to replace the pads from time to time. Most models will only work with dedicated pads from the same manufacturer.

However, there are some generic pads that will work with most machines if you find that you don’t like the supplied pads, for whatever reason.

13. Ease Of Use

To put it simply – if you select a good machine, with all the features above that suit your requirements (good screen size, large pads, a belt clip, a timer, an easy set intensity changes, a good selection of channels to try and the option of EMS…. And you will have a brilliant machine that already is easy to use.

14. Positive Approval.

This is more than just a few online reviews. Anybody can get those. Your TENS/ EMS device ideally needs to be FDA approved for safety and preferably recommended by medical professionals who know what they are talking about.

15. Guarantees

This is far less important if you buy well in the first place, but a warranty/ guarantee is always a good thing to consider.

These are increasingly hard to find because of the personal nature of the TENS machine. This is further heightened in today’s climate with Covid-19 as good companies won’t re-sell personal medical equipment.

16. Pulse Rate Data

TENS machines work on the basis of the pads passing electrical pulses into your body. Most TENS machines will have a series of modes and each mode will contain a different rate of pulses.

This will be less important to you, but as a medical researcher comparing the data for pulse rates to their effectiveness in different people and on different parts of the body is essential. Some modes are very similar, but for others a jump from program 6 to program 7 may constitute a big change.

Many TENS/ EMS makers don’t make this data freely available – but some do and this allows an analysis on a whole new level (if like me you are interested enough of course!)

A Personal Recommendation With Reasons As To Why You Should Consider Choosing Ireliev For Your TENS/ EMS Machine Provider

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Conclusion –

When considering what makes a good TENS machine, there are many different features to consider.

The most important is whether you want to go with a full TENS/ EMS unit or just a TENS unit. The combination is likely to provide better results, but is likely to be approx 30% more expensive (How Much Does A TENS Machine Cost?). This is because the TENS side will concentrate on your nerve endings/ pain messages, while the EMS focuses on sore muscles/ ligaments supporting your back.

Other key features include the number of channels (which affects the size of the area you can treat), the screen size, the approvals/ safety standards and the depth of modes available. By ‘depth of modes’ I don’t mean number of modes, but rather a good sequence of spaced pulses providing great variety.

Whether you decide to go wireless or not, depends on your personal preference. The important factor is to find the right machine for you, from a brand you can rely on. I recommend Ireliev, but their are other good brands available – just be careful of the cheaper or overly-marketed versions that put sales before medical effectiveness. 

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References –

1. DeSantana JM, Santana-Filho VJ, Sluka KA. (2007) Modulation between high- and low-frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats. Archives Of Physical Medicine And Rehabilitation.

2. Carol GT Vance, Dana L Dailey , Barbara A Rakel & Kathleen A Sluka. (2014). Using TENS for pain control: the state of the evidence. Pain Management

3. Adedoyin RA, Olaogun MO, Fagbeja OO. (2002) Effect of interferential current stimulation in management of osteo-arthritic knee pain. Physiotherapy 88, 493–499 (2002).

4. Lauretti GR, Chubaci EF, Mattos AL. (2013). Efficacy of the use of two simultaneously TENS devices for fibromyalgia pain. Rheumatol. Int. 33, 2117–2122 (2013)