SPECIALTY TOPICS · GUIDE
Other Physical Modalities: Evidence and Demand
TENS, ultrasound, interferential current and other physical therapy devices: what Cochrane reviews and NICE guidance say, and where exercise-based care fits instead.
Content last updated . This page has not been medically reviewed.
Back to Emerging Wellness ScienceWhy this page exists
Clinics and home-device sellers offer many electrical and sound-based tools for pain. Each is a different technology with its own evidence. Hearing that "physical therapy devices work" says little about TENS versus ultrasound versus shockwave. We give no device settings or treatment schedules.Labels used: promising but limited, mixed, insufficient evidence, no good evidence of benefit. See How We Label Evidence.
TENS (transcutaneous electrical nerve stimulation)
US regulations describe a TENS unit for pain relief as a device used to apply an electrical current to electrodes on a patient's skin to treat pain, in Class II. [1] Read 2026-10-22 from the eCFR.For chronic pain, a Cochrane overview covering eight reviews and 51 trials (2,895 participants) found the evidence was consistently very low quality, with small studies. [2][3] It could not say much about adverse effects or other outcomes because of limits in the data. [3] Label: insufficient evidence (not "does not work": the studies are too weak to tell).
What NICE says for low back pain
The 2016 NICE guideline for low back pain and sciatica, updated 2026, says not to offer ultrasound, percutaneous electrical nerve stimulation, TENS or interferential therapy. [4][5] The same guideline says to consider manual therapy (spinal manipulation, mobilisation or massage) only as part of a treatment package that includes exercise. [6] This is England's guidance for one condition, not a rule for every pain or country.The devices side by side
| Modality | What we read | Where to read more |
|---|---|---|
| TENS | Very low quality evidence for chronic pain [3] | This page |
| Therapeutic ultrasound | Mixed by condition | More about Therapeutic ultrasound → |
| Shockwave | Varies by condition | More about Shockwave → |
| Percussive massagers | Separate technology | More about Percussive massagers → |
| Massage | Hands-on care | More about Massage → |
What the evidence does favor
For low back pain, the NICE guideline says manual therapy should come only as part of a package that includes exercise. [6] For recovery after exercise see Recovery After Exercise.How to judge a modality claim
Ask: which condition, which device, what comparison (sham or no treatment), and what outcome (pain you feel or a lab number)? A device being cleared does not validate every marketing claim; see Claim Check: "FDA Registered" vs Product Approval and How to Evaluate a Health Device.Frequently asked questions
Does TENS relieve chronic pain?
A Cochrane overview rated the evidence as very low quality, so benefit is uncertain. [3]
Does NICE recommend TENS or ultrasound for low back pain?
No. NICE says not to offer either for low back pain with or without sciatica. [4][5]
Should I buy a physical therapy device for home?
We do not give buying advice. Talk with a clinician and check the evidence for your specific condition and device.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety
References
- Electronic Code of Federal Regulations: 21 CFR 882.5890 Transcutaneous electrical nerve stimulator for pain relief. Read 2026-10-22.
- Gibson W, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019 (size). Read 2026-10-22.
- Gibson W, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019. Read 2026-10-22.
- NICE: Low back pain and sciatica in over 16s (NG59), Recommendations. Read 2026-10-22.
- NICE: Low back pain and sciatica in over 16s (NG59), Recommendations (TENS). Read 2026-10-22.
- NICE: Low back pain and sciatica in over 16s (NG59), Recommendations (exercise and manual therapy). Read 2026-10-22.