CHICAGO — Adding transcutaneous electrical nerve stimulation (TENS) to outpatient physical therapy (PT) reduced movement-evoked pain (MEP) and other types of pain and fatigue for patients with fibromyalgia, according to data presented in a poster at the American College of Rheumatology (ACR) 2025 Annual Meeting.

“People with fibromyalgia have a lot of trouble with movement pain. We really wanted to take a look at whether we could reduce movement-evoked pain, but we also wanted to test giving out a TENS unit in a real-world setting,” researcher Dana Dailey, PT, PhD, associate professor of PT at St Ambrose University in Davenport, Iowa, told Medscape Medical News. “Physical therapists are trained to do that.”

28 Clinics Randomized

The Fibromyalgia TENS in Physical Therapy Study (TIPS) was a cluster-randomized pragmatic trial conducted at 28 outpatient PT clinics from six healthcare systems. Each clinic was randomized either to TENS plus PT or PT only.

“Therapists were given free rein to do they wanted as far as a treatment plan, so we didn’t do any prescriptive activity,” Dailey said. “But we also wanted the physical therapist to do the education about the TENS unit.” She said they asked patients to wear the unit (about the size of a credit card) for 2 hours every day while they were being active.

TENS devices delivered a waveform at a strong but comfortable intensity via butterfly electrodes on the upper and lower back, according to the study protocol.

“We had both groups — the PT only [n = 193] and the TENS + PT [n = 191] — do that for 60 days and then at 60 days everyone went on active TENS,” she said. “We followed people for 6 months, which is unusual in a physical therapy trial.”

Measures Assessed Before and After

Measures were assessed before and after 30 minutes’ use of TENS on each day. The primary outcome was MEP during a sit-to-stand test at day 60, and the pain score was significantly lower (-1.1; CI, -1.58 to -0.7; Cohen’s d, 0.46) in the TENS plus PT group than in the PT-only group.

“There were significant decreases in all measures after 30 minutes of TENS treatment for both pain and fatigue beginning on day 30 and persisting through day 180 for the TENS + PT group,” the researchers stated. “There was no change in the measures for the PT-only group during the first 60 days, the randomized phase. However, after receiving TENS, the PT-only group showed a significant decrease 30 days later” that lasted through day 180.

The global impression of change measure favored TENS plus PT. That measure showed 72% in the TENS plus PT group reported improvement in MEP compared to 51% for those in the PT-only group (P = .001). Pain was unchanged for 19% in the TENS plus PT group and for 34% in the PT-only group.

Change in Resting Pain as Well

Dailey said while this poster is focused on MEP, “we also saw a difference in resting pain, which was a surprise to us.” More in the TENS plus PT group experienced at least a 30% drop in resting pain compared to the control group (P = .004). “We also saw differences in movement fatigue as well as resting fatigue,” Dailey said.

“We’re always looking for treatments for fibromyalgia as it is a large population, and the treatments and modalities are somewhat limited,” Sonali Khandelwal, MD, rheumatologist at the Rush University Medical Center in Chicago, told Medscape Medical News. Khandelwal, who was not part of the study, noted that many patients with fibromyalgia have tried many treatments, including pain medications, which often cause side effects, so a nonmedication treatment is particularly welcome.

She said she was also glad to see improvement in resting pain and fatigue. “We know that patients have pain with activity but when you have baseline pain with no activity, that’s what prevents them from doing activity,” Khandelwal said.

She pointed to the finding that on day 180, 81% of respondents still in the study found TENS helpful, and 55% used TENS daily.

“That’s pretty impressive,” Khandelwal said. “Even though only half by the end of the study were doing TENS daily, they still found it helpful.”

Dailey and Khandelwal reported having no relevant financial relationships.

Marcia Frellick is a Chicago-based, independent healthcare journalist and a regular contributor to Medscape Medical News.