Non-pharmacological strategies are taking on a growing place in pain management. In this context, transcutaneous electrical nerve stimulation, commonly known as TENS, is drawing renewed attention. Despite more than fifty years of research, its clinical effectiveness continues to provoke debate. Yet recent evidence shows that when this modality is properly understood and correctly applied, it can genuinely contribute to pain relief and to improved functional participation. For clinicians, understanding the mechanisms underlying TENS and the factors that shape its effectiveness allows for more accurate support of patient decision making and helps promote treatment adherence. 1- Back to basics, the gate control theory TENS is based on a concept introduced in the 1960s: the gate control theory proposed by Melzack and Wall. This model transformed the understanding of pain by demonstrating that nociceptive signals do not travel directly from the periphery to the brain. Rather, they pass through a modulatory center within the spinal cord, where they can be either amplified or attenuated. When a mild electrical current is applied to the skin, TENS activates nerve fibres associated with tactile and pressure sensations. These fibres conduct information more rapidly than nociceptive fibers, and their activation contributes to the “closing of the gate” to incoming pain signals, thereby reducing the amount of nociceptive input that reaches the brain. Most individuals perceive a comfortable tingling or vibrating sensation beneath the electrodes. This sensation reflects the activity of fibers that temporarily inhibit the transmission of pain impulses. In essence, TENS diminishes nociceptive signaling before the brain can interpret it. 2- Endorphin release The effects of TENS extend beyond the spinal gate. Electrical stimulation also elicits a chemical response, prompting the brain and spinal cord to release endogenous analgesic substances such as endorphins. These molecules act on the same receptors targeted by certain opioid medications, yet without producing their adverse effects. Research by Vance and colleagues indicates that the mechanisms engaged by TENS vary according to stimulation frequency. Low-frequency TENS promotes the release of endorphins, producing a more generalized and longer-lasting analgesic effect. High-frequency TENS, in contrast, acts on distinct neural circuits that inhibit pain more rapidly. Together, these mechanisms support the nervous system in regaining partial control over pain, which helps explain why some individuals experience relief that persists after the stimulation session. 3- Why stydy results vary Studies and systematic reviews on TENS frequently report heterogeneous findings. This variability largely reflects differences in how the modality is applied. Parameters such as intensity, frequency, duration, electrode placement and individual patient characteristics all influence treatment outcomes. These sources of variation help explain why some trials demonstrate marked benefits while others remain inconclusive. Intensity consistently emerges as the most critical parameter. For TENS to be effective, the stimulation must be sufficiently strong to generate a distinct yet comfortable sensation. If the intensity is too low, it will not activate the spinal gating mechanism nor promote the release of endogenous endorphins. Clinicians typically advise patients to increase the current until a stable, non-painful tingling is perceived, and to readjust it whenever the sensation diminishes. With repeated use, the nervous system may gradually adapt to stimulation, which can reduce its analgesic effect. Modifying the frequency, duration, or electrode placement often helps re-establish an adequate therapeutic response. Patient adherence is equally crucial. TENS is not a modality that can be prescribed and then left unattended. Individuals who understand when and how to use their device generally adjust the stimulation more effectively and obtain more meaningful outcomes. Conversely, insufficient instruction or follow-up often results in early discontinuation, which can be mistakenly interpreted as a lack of therapeutic efficacy. 4- What recent research shows Recent studies offer more compelling evidence of TENS effectiveness when the modality is applied appropriately. A 2022 meta-analysis conducted by Johnson and colleagues reported significant pain reduction across several conditions, including postoperative pain, knee osteoarthritis, chronic low back pain, diabetic neuropathy and fibromyalgia. In a separate study involving women with fibromyalgia, Vance and his team observed that participants who experienced improvement during the initial session were also those who showed the greatest benefit after several weeks of treatment. This finding suggests that early response may serve as a predictor of longer-term outcomes and underscores the importance of early follow-up and professional support. Together, these results indicate that TENS can be effective when intensity, frequency and clinical guidance are optimally aligned. 5- The clinician's role Although TENS can be used autonomously, its effectiveness relies heavily on the education and support provided by health professionals. The clinician must first assess whether TENS is suitable for the patient’s clinical presentation. Clinicians also play a central role in shared decision making. They outline the expected benefits, the limitations and the possibility that relief may be partial or temporary, thereby helping patients develop realistic expectations and reinforcing therapeutic trust. In addition, clinicians guide patients in electrode placement, in adjusting intensity and frequency and in identifying the most appropriate moments to use the device. Ultimately, TENS achieves its full therapeutic value when integrated into an active and collaborative clinician–patient relationship. 6- A tool for autonomy and participation When integrated into a multimodal treatment plan, TENS offers patients a concrete means of influencing their pain. This sense of control contributes meaningfully to adaptation and overall well-being. Although TENS does not replace core interventions such as exercise, rehabilitation or psychological approaches, it serves as a complementary modality that helps patients remain active. By supporting patients in understanding how TENS functions and how to adjust its parameters, clinicians foster autonomy and strengthen shared decision making. Ultimately, understanding TENS involves guiding patients toward informed choices that enhance their autonomy and their capacity to live well despite pain. References Travers, M. J., O’Connell, N. E., Tugwell, P., Eccleston, C., & Gibson, W. (2020). Transcutaneous electrical nerve stimulation (TENS) for chronic pain: The opportunity to begin again. The Cochrane Database of Systematic Reviews, 2020(4), ED000139. https://doi.org/10.1002/14651858.ED000139 Johnson, M. I. (2021). Resolving long-standing uncertainty about the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) to relieve pain: A comprehensive review of factors influencing outcome. Medicina, 57(4), 378. https://doi.org/10.3390/medicina57040378 Johnson, M. I., Paley, C. A., Jones, G., Mulvey, M. R., Wittkopf, P. G., & Eardley, W. J. (2022). 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 (BMJ Open 2022;12:e051073). BMJ Open, 12(12), e051073. https://doi.org/10.1136/bmjopen-2021-051073 Vance, C. G. T., Dailey, D. L., Chimenti, R. L., Van Gorp, B. J., Crofford, L. J., & Sluka, K. A. (2022). Using TENS for pain control: Update on the state of the evidence. Medicina, 58(10), 1332. https://doi.org/10.3390/medicina58101332 Vance, C. G. T., Zimmerman, M. B., Dailey, D. L., Rakel, B. A., Geasland, K. M., Chimenti, R. L., Williams, J. M., Golchha, M., Crofford, L. J., & Sluka, K. A. (2021). Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts TENS responders in women with fibromyalgia. Pain, 162(5), 1545–1555. https://doi.org/10.1097/j.pain.0000000000002144 Vance, C. G. T., Dailey, D. L., Rakel, B. A., & Sluka, K. A. (2014). Using TENS for pain control: The state of the evidence. Pain Management, 4(3), 197–209. https://doi.org/10.2217/pmt.14.13

Stay Active This Summer: Take Control with Self-Care Summer is the perfect time to explore, travel, get moving, and finally tackle all those projects that were on hold. Whether you're road-tripping, hiking, renovating, or simply soaking up the sun, this vibrant season invites us to push our limits and enjoy life to the fullest. But with increased activity often comes unexpected physical strain. Long hours on the road, repetitive movements, and intense efforts can quickly lead to discomfort or pain. When that happens, your body is sending a clear message: it’s time to act—before it disrupts your plans. The good news? You can take care of yourself right from home, without putting your summer on pause. Self-Care: Your Best Ally for an Active Summer Self-care is about listening to your body and taking proactive steps to maintain your well-being. It's a way to stay in control, especially when pain tries to slow you down. One of the most effective and user-friendly tools for self-care? The TENS unit. Why Choose TENS This Summer? TENS (Transcutaneous Electrical Nerve Stimulation) is a proven, drug-free method to relieve pain. It’s safe, easy to use, and fits perfectly into an active lifestyle. Here’s why it’s worth bringing along on your summer adventures: Fast and effective relief : Feel better in minutes, with results lasting between 2 to 8 hours. 100% natural, medication-free solution : No side effects—just relief. Discreet and portable : Wear it under your clothes while you go about your day. Stay active without compromise : Keep doing what you love, at your own pace. Supports professional care : Complements physiotherapy and rehabilitation treatments. Effective for various pain types : Including musculoskeletal, discogenic, and postural pain. Easy to use: no steep learning curve — you can start using it today, with guidance from healthcare professionals. Personalized and proactive pain management : Empower yourself to respond quickly and consistently. Listen to Your Body—and Keep Moving Pain doesn’t have to hold you back. With the right tools and a bit of guidance, you can enjoy all that summer has to offer—without sacrificing your comfort or well-being. By adding TENS to your daily routine, you’re taking a step toward freedom, movement, and greater autonomy over your health. Need advice or personalized support? Our experts are here to help you choose the right device and guide you in using it effectively. Get in touch with us today!

Imagine living with constant pain. It never fully leaves you. Sometimes dull, sometimes sharp, it colours your days and haunts your nights. This persistent discomfort keeps you from moving as you’d like, working, sleeping, or simply enjoying a quiet moment. Over time, you become more tired, more irritable, more withdrawn. You feel alone, discouraged, and sometimes even misunderstood. What if it’s not just the pain... but everything that comes with it? This scenario, far from rare, reflects the daily reality of many people living with chronic pain. What is less often acknowledged — even in healthcare settings — is how deeply mental health and physical pain intertwine. They interact, feed into each other, and sometimes become entangled in a vicious cycle that is hard to break. The connection between chronic pain and mental health conditions such as anxiety, depression, or post-traumatic stress is now well documented. Yet, as Bhatt and colleagues (2024) point out, “there is often no explicit recognition of the role of comorbidities and the bidirectional relationship between mental health and pain.” Comorbidities refer to the simultaneous presence of multiple health conditions that can interact and reinforce each other. In this case, it refers to the coexistence of chronic pain and mental health disorders. This means that even when both issues are present, they are often treated separately, as if unrelated. And yet… Chronic pain increases the risk of developing depressive, anxiety, or sleep disorders. Poor mental health can amplify pain, reduce physical and emotional tolerance, and interfere with treatment. Together, they can weaken motivation, reduce mobility, impact social relationships, and even jeopardize employment. This combination—often referred to as a dual burden—is more than a sum of symptoms: it is a state of prolonged vulnerability that demands urgent attention. A double burden still too often overlooked The combination of chronic pain and psychological distress is often invisible to others—and unfortunately also to healthcare systems. Too often, therapeutic approaches are siloed: physical pain is treated on one side, mood disorders on the other, with no bridge between the two. Yet the data is clear: these problems are not merely coexisting—they are interconnected. For instance, individuals with bipolar disorder are twice as likely to experience chronic pain compared to the general population (Nicholl et al., 2014). These individuals are also at greater risk of social and occupational exclusion. Indeed, those affected by this dual reality contribute disproportionately to higher rates of absenteeism (frequent work absences) and presenteeism (being at work but with reduced effectiveness). Despite this, as Bhatt et al. emphasize, “pain is not typically assessed in individuals with mental health disorders,” and the reverse is also true: many people living with chronic pain suffer from undiagnosed, unrecognized, and therefore untreated psychological distress. When only one side of the equation is treated Ignoring one of the two dimensions—mental or physical—risks repeated therapeutic failures. An intervention plan focused solely on physical activity, without accounting for depressive symptoms, may be poorly received or difficult to follow. Conversely, a psychological therapy that neglects persistent and disabling pain may seem disconnected from the person’s lived reality. This observation may seem discouraging, but it also points to solutions. Pathways out of the vicious cycle Breaking the spiral between pain and mental health is not easy, but it is possible. And most importantly: it is not just a matter of individual willpower. It is a collective, clinical, and societal challenge. Here are some tangible strategies that can truly make a difference: 1.Think in terms of interactions, not silos The first step is to explicitly recognize the link between pain and mental health. This means training healthcare professionals to ask the right questions, approach sensitive topics without judgment, and use tools that take the whole person into account. For example, prognostic tools can help rehabilitation clinicians identify biopsychosocial factors that influence recovery, including mood, motivation, fear of movement, or social support. (Tousignant-Laflamme et al., 2023) 2. Promote integrated and interdisciplinary care The most effective care often comes from bringing together multiple perspectives: physiotherapy, psychology, medicine, social work, etc. These combined approaches allow for intervention on the body, emotional experience, and life context. This is the essence of the biopsychosocial approach, which seeks to understand how these three spheres interact in each individual. It is especially relevant for those living with chronic pain, as their situation cannot be reduced to a simple injury or isolated mental disorder. 3.Encourage practical and accessible strategies Simple interventions can have a meaningful impact on well-being, especially when they are supported and personalized: Gradual and adapted physical exercise Body awareness programs (yoga, Tai Chi, breathing exercises) Relaxation or mindfulness activities Cognitive-behavioural therapies to better manage pain and emotions Pain education, to demystify it and regain agency These approaches are still underused, often due to lack of training or resources, but are supported by scientific literature. 4.Actively combat stigma Too often, individuals living with chronic pain or psychological disorders feel judged, ignored, or dismissed. This stigma prevents them from seeking help or accessing adequate care. (Roughan et al., 2021) Awareness campaigns, training for healthcare workers, and personal testimonies can help break isolation and foster a more compassionate care culture. 5.Acknowledge the importance of social roles and work Work is not just a means of earning a living: it contributes to identity, self-esteem, and social connection. Bhatt et al. emphasize that good working conditions can have a protective effect on mental health, even in the presence of pain. This implies supporting gradual return-to-work plans, adapting tasks when needed, and valuing the person’s other social roles (parent, caregiver, volunteer…). (Bhatt et al., 2024) A broader perspective, a more humane response Chronic pain is not just a physical symptom. And psychological distress is not healed through talk alone. These are complex realities, deeply rooted in lived experience, the body, and life context. Attempting to treat one without the other risks failure. But acknowledging their interaction opens the door to more comprehensive, fair, and effective care. Sources: · Bhatt, K., Palomares, A. C., Jutila, L., Rohde, I., Forget, P., & Societal Impact of Pain Platform (SIP). (2024). The pain and mental health comorbidity. Epidemiology and Psychiatric Sciences, 33, e46. https://doi.org/10.1017/S204579602400057X · Nicholl, B. I., Mackay, D., Cullen, B., Martin, D. J., Ul-Haq, Z., Mair, F. S., Evans, J., McIntosh, A. M., Gallagher, J., Roberts, B., Deary, I. J., Pell, J. P., & Smith, D. J. (2014). Chronic multisite pain in major depression and bipolar disorder : Cross-sectional study of 149,611 participants in UK Biobank. BMC Psychiatry, 14, 350. https://doi.org/10.1186/s12888-014-0350-4 · Roughan, W. H., Campos, A. I., García-Marín, L. M., Cuéllar-Partida, G., Lupton, M. K., Hickie, I. B., Medland, S. E., Wray, N. R., Byrne, E. M., Ngo, T. T., Martin, N. G., & Rentería, M. E. (2021). Comorbid Chronic Pain and Depression : Shared Risk Factors and Differential Antidepressant Effectiveness. Frontiers in Psychiatry, 12, 643609. https://doi.org/10.3389/fpsyt.2021.643609 · Tousignant-Laflamme, Y., Houle, C., Longtin, C., Gérard, T., Lagueux, E., Perreault, K., Beaudry, H., Tétreault, P., Blanchette, M.-A., & Décary, S. (2023). Prognostic factors specific to work-related musculoskeletal disorders : An overview of recent systematic reviews. Musculoskeletal Science and Practice, 66, 102825. https://doi.org/10.1016/j.msksp.2023.102825

Pain and stress: from natural defense to potential threaths

Chronic pain is a major challenge for many employees, affecting about one in five Canadians. In 2018, absenteeism in Quebec accounted for 7% of working time, costing companies between 16 and 17 billion dollars.