TENS effectively delivers post-CS pain relief

A prospective quasi-randomized controlled trial presented at SMFM 2026 has demonstrated the potential of transcutaneous electrical nerve stimulation (TENS) to reduce postoperative pain following caesarean delivery.

A group of investigators from Israel evaluated 140 women undergoing caesarean delivery at a tertiary medical centre. The participants received either postoperative TENS (n=70; mean maternal age 34.9 years) or standard care (n=70; mean maternal age 32.9 years) according to a predefined allocation scheme.

A majority of the participants had elective caesarean delivery (84.3 percent and 65.7 percent in the TENS and standard care groups, respectively), while the rest had urgent caesarean delivery. Over three-quarters of the women had received regional anaesthesia.

Pain intensity was evaluated before and after each TENS session using a visual analogue scale (VAS). Apart from assessing the efficacy of TENS in reducing postoperative pain following a caesarean section, the investigators also sought to explore its potential impact on maternal-infant bonding, postnatal anxiety, and depressive symptoms.

The VAS pain scores significantly dropped following each TENS session: from 6.79 to 4.36 (p<0.001) during session 1, from 7.19 to 4.19 (p=0.009) during session 2, and from 7.52 to 4.13 (p=0.009) during session 3. [SMFM 2026, abstract 364]

The use of an oral analgesic also declined following TENS therapy as opposed to standard care (0.4 vs 0.9 doses during hospitalization; p=0.012). This effect remained statistically significant after adjusting for maternal age (β, –0.2, 95 percent confidence interval [CI] –0.8 to –0.05; p=0.029) and surgical history (β, –0.2, 95 percent CI, –0.8 to –0.04; p=0.032) using multivariable linear regression models.

However, there were no statistically significant differences between the TENS and the standard care arms in terms of the proportion of women with high medication use (>4 doses during hospitalization; 18.5 percent vs 31.7 percent; p=0.108), as well as in the scores on the Mobility: Sit to Stand test (12.71 vs 12.27; p=0.541), Edinburgh Postnatal Depression Scale (11.9 percent vs 16.4 percent; p=0.458), State-Trait Anxiety Inventory (28.9 vs 28.86; p=0.962), and Postpartum Bonding Questionnaire (6.94 vs 6.96; p=0.438).

A critical component in postop care

“Post-caesarean pain management is a critical component of postoperative care, directly influencing maternal recovery,” said Dr Shir Zagdon-Keidar from the Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, and colleagues, at SMFM 2026.

Despite the widespread use of pharmacological analgesia, there is growing interest in non-pharmacological methods, such as acupuncture or acupressure, electromagnetic therapy, aromatherapy, massage, hypnosis, relaxation, Reiki, music, and TENS. [Cochrane Database Syst Rev 2020;2020:CD011216]

“[Our study shows that] TENS therapy after caesarean delivery significantly reduces postoperative pain, with the potential to reduce the use of oral analgesics,” said Zagdon-Keidar and colleagues.

The findings add to the growing literature supporting the role of TENS in post-caesarean delivery care encompassing pain control, comfort, and healing. [J Midwifery Womens Health 2024;69:681-688; Eur J Midwifery 2024:doi:10.18332/ejm/191740]

The investigators called for larger studies to confirm the results and further explore the psychosocial benefits of TENS, to strengthen its potential for incorporation into post‐caesarean care regimens to improve patient outcomes and maximize healthcare resources.