Comment on “A Pre-Post Prospective Study on the Use of Transcutaneous Electrical Nerve Stimulation (TENS) Unit in the Management of Endometriosis Pain”

Endometrial stroma or glands outside of the endometrium are known as endometriosis, and it affects ~10% of women of reproductive age. Presentation can vary, but typically includes symptoms such as pelvic pain, dysmenorrhea, dyspareunia, and infertility. Many associate endometriosis with pelvic pain disorders, but the reality of the condition is more complex; it is a chronic condition with costs and impacts similar to other conditions like autoimmune diseases. Theories surrounding the pathogenesis of endometriosis are varied, but initial diagnosis is typically based on clinical presentation and surgical pathological confirmation; invasive diagnostic techniques can result in a delay of 7 to 11 years between symptom onset and diagnosis. Standard treatment typically includes lifestyle modification, hormonal and nonhormonal medications for symptom management, and surgical management. Pain management strategies can range from opioid, cannabis, or other drug use to yoga, heat, and diet interventions. Transcutaneous Electrical Nerve Stimulation (TENS) is one option that is less studied and not as widely used, but that shows potential for application in endometriosis. This study was designed to assess the use of TENS for endometriosis pain. This was a prospective pilot study conducted at the Penn State Minimally Invasive GYN Surgery clinic. Inclusion criteria were females between the ages of 18 and 45 with a surgical diagnosis and direct visualization or histopathologic confirmation of endometriosis with monthly flares. Exclusion criteria were pregnancy, breastfeeding, contraindication to TENS use, <12 weeks postsurgery, and planned surgery or hormonal medication changes during the study. The primary outcome for this study was the average daily visual analog scale (VAS) pain score for 3 months of treatment. Secondary measures included quality of life based on the Endometriosis Health Profile-30 (EPH-30) and the Female Sexual Function Index (FSFI). The final analysis included 27 patients who completed the study of 40 originally enrolled. The VAS score obtained before and during TENS use improved by 2.29 points on a 100-point scale, but was nonsignificant. Quality of life on the EPH-30 was significantly improved after TENS treatment ( P <0.001), and average daily ibuprofen use was significantly decreased ( P =0.02). No other significant differences were reported, although both the use of acetaminophen decreased and the scores on the FSFI improved. These results show a positive impact of TENS use on quality of life and overall medication use during endometriosis flares. While overall pain may not be significantly improved by TENS alone, this study encourages the possibility that TENS may be useful as part of an interdisciplinary approach to the management of pelvic pain associated with endometriosis. In addition, since this study included all cases of endometriosis regardless of comorbidities, heterogeneity in the study sample may have contributed to not seeing a decrease in pain scores. Future research should evaluate this association in more specific endometriosis subpopulations and aim to assess if TENS is more effective for some patients than others. Future studies should also focus on increasing the sample size and assessing the impacts of long-term TENS use. (Summarized from Li L, Moyer R, Stetter C, et al. A pre-post prospective study on the use of transcutaneous electrical nerve stimulation (TENS) unit in the management of endometriosis pain. Eur J Obstet Gynecol Reprod Biol . Published online February 24, 2026. doi: 10.1016/j.ejogrb.2026.115042).