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Wired for Relief: Can TENS Ease the Pain of Complex Regional Pain Syndrome (CRPS)?
Living with Complex Regional Pain Syndrome (CRPS) is like being trapped in a body that no longer follows the rules. What starts as a minor injury can spiral into relentless, burning pain, swelling, and sensitivity that disrupts every part of life. Tasks once taken for granted—walking, sleeping, even being touched—become sources of agony. The emotional toll is just as heavy, with anxiety and depression often joining the bodily pain. CRPS doesn’t just affect limbs—it affects livelihoods, relationships, and mental health. Transcutaneous electrical nerve stimulation (TENS) is one technique that has been used to alleviate painful symptoms associated with CRPS.
In an effort to better understand the potential of TENS for CRPS, I recently co-authored a systematic review with Natiele Righi, Richard Liebano, Mary Cimen, and Rodrigo Plentz titled “Effects of transcutaneous electrical nerve stimulation in complex regional pain syndrome: a systematic review”. Our team, spanning institutions in Brazil, the United States, and the UK, conducted a comprehensive search across five major databases—PubMed, EMBASE, Cochrane CENTRAL, Web of Science, and PEDro—up to June 2025.
Out of 517 records screened, only two randomized controlled trials met our inclusion criteria, involving a total of 38 participants (58% women). One study showed promising results, with conventional TENS leading to improvements in pain, mobility, and oedema compared to sham TENS. The second study, a feasibility trial in which I was a co-author titled “Transcutaneous electrical nerve stimulation using an LTP-like repetitive stimulation protocol for patients with upper limb complex regional pain syndrome: A feasibility study”, was unable to meet its recruitment target and offered only individual-level data without between-group comparisons.
While these findings hint at the potential benefits of TENS, the limited sample size and methodological concerns associated with the included studies mean that direct evidence is insufficient to make definitive clinical recommendations about TENS specifically for CRPS, emphasising the need for more rigorous, large-scale studies.
Our systematic review on TENS for CRPS aligns with findings from a large-scale meta-analysis our team at Leeds Beckett University published in 2022 titled “Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)”. That meta-analysis pooled data from 381 randomized controlled trials involving over 24,000 participants and found moderate-certainty evidence that TENS significantly reduces pain intensity during or immediately after treatment, regardless of diagnosis or pain type. These findings support the view that TENS should be indicated based on the presence of pain symptoms rather than specific medical diagnoses.
Professor Mark Johnson
Mark Johnson is Professor of Pain and Analgesia. Mark is an international expert on the science of pain and its management and the world leader on transcutaneous electrical nerve stimulation (TENS). He has published over 300 peer reviewed articles.
