Summary: For millions living with fibromyalgia, exercise is both essential and difficult: movement often brings intense pain and overwhelming fatigue. A large, real-world clinical trial now shows a simple, drug-free option that helps—adding TENS (transcutaneous electrical nerve stimulation) to standard outpatient physical therapy significantly reduced movement-evoked pain and, importantly, fatigue.
In the multicenter FM-TIPS trial, 384 people across 28 clinics participated. The results indicate that TENS delivers pain relief comparable to FDA-approved medications, with benefits that are dose-dependent and sustained for at least six months. The treatment is safe, low-cost, and widely available.
Key Facts
- Fatigue reduction: Unlike most current options, this approach significantly reduced whole-body fatigue—a major barrier to exercise and daily functioning in fibromyalgia.
- Real-world effectiveness: The trial was conducted in typical outpatient physical therapy settings across the Midwest, showing benefit in routine clinical practice.
- No tolerance buildup: Unlike many medications that lose effectiveness over time, TENS maintained its benefit through the six-month follow-up.
- High patient acceptance: About 80% of participants reported that TENS was helpful and continued to use it at least weekly at six months.
Source: University of Iowa
Overview
A team led by Kathleen Sluka, PT, PhD, at University of Iowa Health Care carried out the first pragmatic, clinic-based trial testing TENS for fibromyalgia. Published in JAMA Network Open, the study evaluated whether adding TENS to usual outpatient physical therapy improved movement-evoked pain compared with physical therapy alone. The answer was yes: patients using TENS experienced meaningful reductions in pain and fatigue, with benefits that persisted over months.
TENS uses a small, wearable device with adhesive electrodes to deliver mild electrical pulses through the skin. These pulses interfere with pain signaling in the nervous system, reducing the sensation of pain and allowing patients to move with less discomfort. In the FM-TIPS trial, TENS applied to the upper and lower back produced reductions in both movement-evoked and resting pain, and also lowered reported levels of fatigue.
Fibromyalgia: a complex, under-treated condition
Fibromyalgia affects an estimated 4% to 7% of people and causes widespread pain, tenderness, sleep disruption, cognitive symptoms, and debilitating fatigue. Exercise and physical activity are important parts of treatment, yet pain with movement often prevents patients from participating in exercise programs that could improve function. Targeting movement-evoked pain directly is therefore a crucial strategy to help patients regain activity and reduce fatigue.
From mechanism to meaningful outcomes
Sluka and colleagues have long studied how TENS affects pain pathways and have refined stimulation parameters to maximize benefit. FM-TIPS translated that work into routine clinical practice by testing TENS across 28 outpatient physical therapy clinics in six health systems. The study enrolled people with diverse ages, socioeconomic backgrounds, and nearly half from rural areas, ensuring results apply to many real-world patients.
Clinics were randomized to deliver either physical therapy with TENS (PT-TENS) or physical therapy alone (PT-only). Participants assigned to PT-TENS were instructed to use TENS for two hours daily, either in one session or divided throughout the day, at a robust but comfortable intensity. After 60 days—the primary endpoint—movement-evoked pain measured during a five-times sit-and-stand test was significantly lower in the PT-TENS group. Users also reported less resting pain and reduced movement- and resting-related fatigue. The more consistently participants used TENS, the better the outcomes.
After day 60 the PT-only group was offered TENS and showed similar improvements, supporting the causal effect of TENS. Across the full six months, 80% of users found TENS helpful, more than 70% reported feeling improved overall, and a substantial portion continued regular use. No serious adverse events were reported; about 30% experienced minor, transient side effects.
How TENS fits into care
The investigators emphasize that TENS works best as part of a comprehensive treatment plan that includes physical therapy and, when appropriate, medication. TENS should not be considered a replacement for guided rehabilitation. Instead, it serves as an accessible self-management tool that reduces movement pain and fatigue, helping patients engage more fully in exercise and daily activities.
Because TENS is inexpensive, widely available, and does not show tolerance-related loss of effect over six months, it represents a practical addition to multimodal fibromyalgia care—especially for patients who struggle with movement-evoked pain and the resulting energy drain.
Frequently asked questions
Q: Can I just buy a TENS unit and skip physical therapy?
A: No. The study found that TENS provides additional benefit on top of physical therapy and medications. It is most effective when used to help patients complete their PT and daily activities without painful flare-ups.
Q: How does a small electrical pulse reduce whole-body fatigue?
A: Chronic pain keeps the nervous system in a heightened state of alert, which consumes energy. By reducing pain signals, TENS helps the nervous system relax, conserving energy that would otherwise be spent processing pain. This can translate into less fatigue and greater capacity for activity.
Q: Will TENS stop working with daily use?
A: The trial found no evidence of tolerance over six months. In fact, a dose-response relationship was observed: participants using TENS consistently (about two hours daily for 60 days) enjoyed the greatest and most sustained benefits.
Study funding and authorship
- This article was edited by a Neuroscience News editor.
- The full journal paper was reviewed.
- Additional context was added by staff.
About this research news
Author: Jennifer Brown
Source: University of Iowa
Contact: Jennifer Brown – University of Iowa
Image credit: Neuroscience News
Original Research: Open access. “Transcutaneous Electrical Nerve Stimulation and Pain With Movement in People With Fibromyalgia” by Dana L. Dailey et al., published in JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.2450
Abstract (condensed)
Importance: Fibromyalgia causes widespread pain that often worsens with movement and limits daily function. Treatments that reduce movement-evoked pain are essential to help people regain activity and reduce fatigue.
Objective: To determine whether adding transcutaneous electrical nerve stimulation (TENS) to outpatient physical therapy reduces movement-evoked pain in people with fibromyalgia.
Design and participants: The FM-TIPS cluster-randomized trial enrolled participants at 28 outpatient physical therapy clinics across six health systems between February 2021 and September 2024. Of 958 screened, 459 enrolled and 384 completed baseline data collection. Final data were collected in March 2025.
Intervention: Clinics were randomized to PT plus TENS or PT only. TENS was applied to the upper and lower back with instructions to use it two hours daily at a comfortable but strong intensity, using modulating frequencies between 2 and 125 Hz.
Main outcomes: The primary outcome was change in movement-evoked pain (0–10 scale) from baseline to day 60 during a five-times sit-and-stand test. Secondary outcomes included patient-reported global improvement and adverse events.
Results: Among 384 participants (mean age 53 years; 91% female), movement-evoked pain at day 60 during TENS treatment was significantly lower in the PT-TENS group compared with PT only. A dose-response effect was observed: consistent TENS users reported higher rates of clinical improvement and larger reductions in movement-evoked pain. At six months, most respondents found TENS helpful and many continued daily use. No serious adverse events occurred; minor adverse events were reported by about 30% of participants.
Conclusions: In a pragmatic, cluster-randomized trial, adding TENS to physical therapy meaningfully reduced movement-evoked pain and fatigue in people with fibromyalgia, with effects sustained for six months. TENS appears to be a safe, affordable, and accessible adjunct to standard care.
Trial registration: ClinicalTrials.gov Identifier: NCT04683042