Effectiveness of transcutaneous electrical nerve stimulation (tens) in the management of chronic musculoskeletal pain: A systematic review of randomized controlled trials and primary studies

Introduction

Chronic musculoskeletal pain (CMP) is one of the leading causes of global disability, affecting more than 1.71 billion individuals worldwide and constituting a major burden on healthcare systems. Transcutaneous Electrical Nerve Stimulation (TENS) is a widely utilized, non-invasive electrophysical modality that delivers low-voltage electrical current through cutaneous electrodes to modulate nociceptive transmission and activate endogenous analgesic mechanisms. Despite its broad clinical adoption, heterogeneity in study designs, patient populations, stimulation parameters, and outcome assessments has generated controversy regarding its efficacy. This systematic review aims to synthesize evidence from primary studies investigating TENS efficacy across multiple musculoskeletal pain conditions, addressing the existing research gap on comparative effectiveness across diverse outcomes including pain intensity, physical function, quality of life, analgesic consumption, and psychosocial parameters.