EVA in the Postpartum Period: A Versatile Tool for Pain Management

When we think of the postpartum period, pelvic floor recovery, muscle rehabilitation, and breastfeeding often come to mind. Yet, for many women, pain remains one of the greatest barriers to recovery. Pain may result from perineal trauma following vaginal birth, cesarean delivery, low back pain, neck and shoulder tension associated with breastfeeding, uterine cramping, or breastfeeding-related difficulties. These conditions can limit mobility, disrupt sleep, interfere with breastfeeding, and delay a return to daily activities.

For healthcare professionals, this raises an important question: how can pain be managed effectively while ensuring treatment is safe, compatible with breastfeeding, and minimizes medication use whenever possible?

EVA offers a promising solution. By combining transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES), it can address several conditions commonly encountered during the postpartum period. It may be used for both pain management and pelvic floor rehabilitation.

However, the evidence supporting these applications varies. The following sections summarize what current research allows us to conclude.

1.Why TENS?

TENS has been used for decades to treat musculoskeletal and postoperative pain. Its analgesic effects rely on two complementary mechanisms.

At high frequencies, TENS stimulates large-diameter sensory (Aβ) fibers, reducing the transmission of nociceptive signals within the spinal cord through the gate control mechanism. At low frequencies, TENS activates descending inhibitory pathways and promotes the release of endogenous opioids. Together, these mechanisms contribute to longer-lasting analgesia (Smith et al., 2023).

Recent evidence also suggests that TENS may influence inflammatory and immune responses. This mechanism may partly explain its benefits across a variety of pain conditions, including postpartum pain (Chen et al., 2025).

2.Perineal pain: the strongest evidence

Perineal pain is currently the postpartum indication best supported by evidence for the use of TENS.

A meta-analysis including 17 randomized controlled trials and nearly 2,000 participants found that TENS, when added to standard postpartum care, significantly reduced pain compared with standard care alone (Beleza et al., 2026). The certainty of the evidence was rated as moderate. This representing the strongest scientific support currently available for TENS in postpartum care.

When TENS was compared with placebo, the findings also remained encouraging. However, the certainty of evidence was rated as very low because of methodological limitations.

Clinical implications

TENS can be incorporated into routine postpartum care alongside cryotherapy, positioning advice, therapeutic exercise, and analgesic medication when indicated. EVA therefore provides healthcare professionals with an additional non-pharmacological option for improving patient comfort without interfering with breastfeeding.

3.Post-cesarean pain: an adjunct to multimodal analgesia

Pain after cesarean delivery can delay mobilization. It may also complicate newborn care and make breastfeeding more difficult.

A Cochrane review of ten studies concluded that TENS reduces postoperative pain when used in addition to standard analgesia. Some studies also reported reduced use of rescue analgesics and improvements in physiological measures such as heart rate and respiratory rate (Zimpel et al., 2020).

Clinical implications

TENS is not intended to replace pharmacological analgesia. Rather, it can complement a multimodal pain management strategy aimed at improving pain control and promoting early mobilization.

4.Musculoskeletal pain: supporting functional recovery

Low back, thoracic, and neck pain are common after childbirth. These symptoms are associated with pregnancy-related postural changes, infant care, breastfeeding, and the gradual return to daily activities.

A review published in Frontiers in Neurology concluded that TENS effectively reduces several types of postpartum musculoskeletal pain while maintaining an excellent safety profile (Chen et al., 2025).

Similarly, a network meta-analysis of pregnancy-related low back pain found significant improvements in physical function, with moderate-certainty evidence (Chen et al., 2021).

Clinical implications

EVA can complement therapeutic exercise, manual therapy, and postural education. Together, these interventions may promote a more comfortable recovery and facilitate a return to daily activities.

5.Pelvic floor rehabilitation: an additional advantage of EVA

Pain is only one aspect of postpartum recovery. Many women also experience pelvic floor muscle weakness or difficulty activating these muscles effectively after childbirth.

The NMES mode expands EVA's clinical applications. When neuromuscular electrical stimulation is indicated, it can support pelvic floor rehabilitation. For some patients, NMES may improve muscle awareness and facilitate muscle activation. It should be used alongside a supervised exercise program rather than as a stand-alone intervention.

As with any rehabilitation strategy, NMES should be integrated into a comprehensive approach that includes clinical assessment, therapeutic exercise, and patient education.

6.Breast health: a promising area for future research

Breastfeeding difficulties are another important source of postpartum pain. Plugged milk ducts, breast engorgement, and mastitis may interfere with breastfeeding and reduce quality of life.

TENS is not currently recommended for these conditions. However, its potential is beginning to attract research interest.

A case report by Smigelski and Gallagher described the use of TENS in a woman who experienced two episodes of plugged milk ducts. The authors reported rapid pain relief and complete resolution of the palpable breast mass after one or two treatment sessions.

They hypothesized that electrical stimulation promoted contraction of the myoepithelial cells surrounding the mammary alveoli. This mechanism could facilitate milk ejection and help resolve ductal obstruction.

How should these findings be interpreted?

These findings are encouraging but should be interpreted cautiously. The report describes a single patient and did not include a control group. It also did not compare outcomes with the natural progression of the condition. Furthermore, outcomes relied primarily on patient-reported pain and clinical examination of the palpable mass. Consequently, no conclusions can be drawn regarding the effectiveness of TENS, and these findings cannot be generalized to breastfeeding women as a whole. The authors also emphasized that controlled clinical trials are needed before this approach can be recommended in clinical practice.

7.Key takeaways

The postpartum period presents diverse and evolving clinical needs. Having a device that can address multiple aspects of recovery is therefore valuable for healthcare professionals.

By combining TENS and NMES, EVA supports both pain management and pelvic floor rehabilitation.

Current evidence particularly supports its use for:

1.        Perineal pain following vaginal birth.

2.        Post-cesarean pain.

3.        Postpartum musculoskeletal pain.

Other applications, particularly in breast health, remain investigational. Although preliminary findings are promising, high-quality clinical trials are needed before these indications can be incorporated into clinical practice guidelines.

Overall, EVA is not a single solution for every postpartum challenge. Rather, it is a versatile device supported by evidence for several important indications. It can be integrated into a comprehensive, individualized, and woman-centred approach to postpartum care.

Références:

Beleza, A. C. S., Jorge, C. H., Liebano, R. E., et al. (2026). Electrophysical resources for the treatment of acute perineal pain after vaginal delivery: A systematic review with meta-analysis. The Journal of Pain.

Bernard, A., Oyler, D. R., Anglen, J. O., et al. (2020). Best practices guidelines for acute pain management in trauma patients. American College of Surgeons.

Chen, B., Chen, C., Zhao, X., & Xu, Y. (2025). An update comprehensive review on the effects of transcutaneous electrical nerve stimulation for postnatal physical and psychological disorders. Frontiers in Neurology.

Chen, L., Ferreira, M. L., Beckenkamp, P. R., et al. (2021). Comparative efficacy and safety of conservative care for pregnancy-related low back pain: A systematic review and network meta-analysis. Physical Therapy.

Deussen, A. R., Ashwood, P., Martis, R., Stewart, F., & Grzeskowiak, L. E. (2020). Relief of pain due to uterine cramping/involution after birth. Cochrane Database of Systematic Reviews.

Gibson, W., Wand, B. M., Meads, C., Catley, M. J., & O'Connell, N. E. (2019). Transcutaneous electrical nerve stimulation (TENS) for chronic pain: An overview of Cochrane reviews. Cochrane Database of Systematic Reviews.

Martimbianco, A. L. C., Porfírio, G. J., Pacheco, R. L., Torloni, M. R., & Riera, R. (2019). Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database of Systematic Reviews.

McCahill-Riley, M., Downey, K., & Clarke, V. (2026). Electrotherapy in lactation care. Journal of Human Lactation.

Smith, T. J., Wang, E. J., & Loprinzi, C. L. (2023). Cutaneous electroanalgesia for relief of chronic and neuropathic pain. The New England Journal of Medicine.

Smigelski, C., & Gallagher, L. (2024). The use of transcutaneous electrical nerve stimulation (TENS) to relieve pain and resolve blocked milk ducts in lactating women: A case report [Affiche scientifique]. Oregon Health & Science University.

Zimpel, S. A., Torloni, M. R., Porfírio, G. J., Flumignan, R. L., & da Silva, E. M. (2020). Complementary and alternative therapies for post-caesarean pain. Cochrane Database of Systematic Reviews.