Percutaneous electrical nerve stimulation and electrical muscle stimulation are two therapies that may be recommended if transcutaneous electrical nerve stimulation (TENS) has not been successful.

Percutaneous Electrical Nerve Stimulation Goes Deeper

Percutaneous electrical nerve stimulation refers to applying electrical stimulation through small needles which penetrate the skin.

As with TENS, small wires are attached to a battery-powered electrical stimulator. A key difference is that needle electrodes deliver current closer to the nerves or the muscles beneath the skin, making the nerves less sensitive to pain. PENS therapy is likely to be used first in a health care or physical therapy setting, but can also be used at home.

See Physical Therapy Benefits For Back Pain


While some people see an improvement right away, multiple treatments may be required. Treatments typically last about half an hour. An easing of muscle spasms from PENS may allow greater range of movement, leading to better physical functioning overall.

Watch: Video: What Is Your Back Muscle Spasm Telling You?

There is considerable variation in the duration of pain relief from PENS. The therapy is long-lasting for many individuals, but others need repeated visits.

Diabetic peripheral neuropathy is one of the conditions in which PENS is often advised. 1 Bril V, England JD, Franklin GM, et al. Evidence-based guideline: treatment of painful diabetic neuropathy--report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation. Muscle Nerve. 2011;43(6):910-7.

Watch: Causes of Neuropathic Pain Video

Electrical Muscle Stimulation Builds Strength

Rebuilding muscle tissue is the goal of electrical muscle stimulation, or EMS.

See Back Muscles and Low Back Pain

An electrical muscle stimulator appears similar to a typical TENS unit, with electrodes attached by wires to the small, battery-powered stimulator. In EMS, the current is directed at weakened muscles, rather than nerves, prompting the muscles to contract and gradually regain their strength.

EMS can be helpful for rehabilitation after muscles have been weakened substantially or for less serious conditions, such as a pulled muscle.

See Pulled Back Muscle and Lower Back Strain


One medical research study looked at EMS to treat muscle atrophy after surgery to reconstruct an anterior crucial ligament. Half the participants were given EMS therapy, with a control group not receiving the therapy. Those using EMS had thicker muscles and better recovery of knee extension strength three months after the surgery. 2 Hasegawa S, Kobayashi M, Arai R, et al. Effect of early implementation of electrical muscle stimulation to prevent muscle atrophy and weakness in patients after anterior cruciate ligament reconstruction. J Electromyogr Kinesiol. 2011 Aug;21(4):622–30.

While EMS may be helpful in gradually strengthening muscle, people considering EMS are advised to be wary of exaggerated marketing claims that EMS is a quick fix for boosting muscle strength.

Dr. John Revord is a physiatrist specializing in the management of spine pain. He has more than 25 years of experience in spine care and practices at the NeuroSpine Center of Wisconsin. Dr. Revord is specially trained in a range of non-surgical procedures, and he has co-authored articles published in peer-reviewed journals.

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