TENS pad placement guide: where to put your electrode pads

How should I get ready before I place TENS pads?

Turn the TENS unit off and clean your skin. Dry skin lets the electrode pads make firm contact. The NHS says: “Make sure the TENS machine is turned off before you start.”

University of Iowa Health Care (UI Health Care) says it is “very important” to put pads on clean, dry skin. If a pad is not secure, the stimulation can change and cause discomfort. Clean off oil and lotion first.

Follow these steps for any placement:

1. Turn the TENS unit off.
2. Clean the skin where the pads will go. Let it dry.
3. Plug the lead wires all the way into the pads. UI Health Care says no bare metal pins should show.
4. Plug the lead wire plugs into the unit.
5. Peel the pads off the plastic liner. Save the liner for storage.
6. Press the pads onto your skin.
7. Turn the unit on. Turn the dial slowly until you feel tingling. The NHS says it should not be painful.

Read your device’s leaflet for the full list of rules. Follow your clinician’s and your device’s instructions. For the full safety list, see the TENS unit safety guide.

What are the basic rules for pad spacing and position?

Place pads near the pain, on fleshy areas, with a gap between them. These are the rules the two sources agree on.

Neither page gives a distance in inches or centimeters. Do not guess one. Ask your clinician to show you.

UI Health Care says two sets of pads go on the body, and you may try any placement shown on its pages. Your own plan may differ, so use the one your clinician gave you.

Where do TENS pads go for low back pain?

Place them on the muscle beside the painful area. Do not place them on the backbone. UI Health Care says not to use TENS “directly on your backbone.” The NHS says not to use TENS on your chest and back at the same time.

Pad placement for the lumbar spine depends on the person. Ask your doctor or physical therapist to mark the spots on your skin or draw them on paper. Then follow that plan.

One coverage fact matters here. Medicare’s local policy (LCD L33802) says TENS for chronic low back pain “will be denied as not reasonable and necessary.” That is a payment rule, not a statement about what a clinician may suggest. Read more in the TENS for lower back pain guide and on the back pain page.

Where do pads go for the neck and shoulder?

Ask your clinician first. The two sources give different wording, so this area needs a person who knows your case.

• The NHS says: “Do not use TENS on your neck, mouth or eyes.”
• UI Health Care says not to use TENS on “any part of your head or face” or “any part of your throat.”

Both list places to avoid. There is no safe pad map for the neck. Do not place a pad on the neck, front of the throat, head or face unless your clinician tells you to. If your clinician does, follow that plan and your device’s instructions.

Headache is also a coverage topic. LCD L33802 lists headache as an example of a condition where TENS therapy “is not considered to be reasonable and necessary.”

Where do pads go for the knee and foot?

Use the same rules: clean skin, near the pain, fleshy areas, and a gap between pads. UI Health Care says to avoid bony sites. A knee or foot has many bony spots, so a clinician’s guidance matters more here.

Pad placement for the knee or foot depends on the person. Ask your doctor or physical therapist for one. For a place to start reading about foot pain, see our posts on causes of foot pain and morning foot pain.

Where should I never place TENS pads?

Never place pads on skin that is damaged or numb, or on the head, face or throat. These lists come from the NHS and UI Health Care. They list the same kinds of places to avoid, in different words.

If a source does not list a place, that does not make the place safe. Use the stricter rule. People with a cardiac pacemaker or another implanted medical device should not use TENS. Both the NHS and UI Health Care say so. The NHS also says not to use TENS if you have epilepsy, or if you are pregnant unless your doctor or midwife tells you to.

What should the pads feel like once they are on?

You should feel tingling, and it should not hurt. The NHS says to turn the dial slowly until you feel a tingling sensation and says “It should not be painful.”

UI Health Care adds that you may feel tingling, tapping, buzzing or muscle twitching. It says the feeling can seem weaker after a few minutes as your body gets used to it. It then says to turn up the stimulation intensity to keep it “strong but comfortable.” Your device and your clinician decide the rest. The settings guide covers intensity in more detail.

If one pad feels much stronger than the others, turn the unit off. Check that every pad is flat against the skin and every wire is plugged in. A loose pad can change the feeling.

What should I do if the pads will not stay in place?

Check the skin first, then the pad. UI Health Care gives these steps for pads that slip or lift:

1. Turn the unit off and unplug the wire from the pad.
2. Clean the skin and let it dry.
3. Wet your fingertip with water and gently rub the pad surface. Let it dry for 60 seconds. Then try again.
4. If that does not work, use a new pad.

Sweat can move pads. UI Health Care says a skin prep product can help the pads stick, and that medical tape can hold them if sweating is a problem. Ask your health care team for instructions before you use tape.

Never pull on the wires to remove a pad. UI Health Care says pulling or yanking on the wires could damage the electrodes. Unplug the wire from the pad first, then peel the pad off gently.

How do I take pads off and store them?

Turn the unit off first. UI Health Care says to turn it off before you put on, move or take off the pads. Then follow these steps:

1. Pull the wires out of the pads with care.
2. Peel the pads off your skin gently.
3. Place the pads back on the plastic liner.
4. Put the liner and pads in the plastic storage bag.
5. Keep the bag in a cool, dry place.

UI Health Care says pads can be used over and over until the adhesive wears out. It also says not to share your pads with other people. Check your device’s manual for how to order new pads. The electrode pads and supplies guide explains supplies in more detail.

When should I stop using the pads?

Stop at the first sign of a problem. Turn the unit off before you move or remove pads.

The NHS says: “If your skin becomes itchy, irritated or red (redness may be harder to see on brown or black skin), turn off the machine and remove the pads.” UI Health Care says to stop and talk with your doctor or health care team if you have skin irritation, headache, dizziness or nausea.

Skin irritation in the first 24 hours is a reason to call your health care team, according to UI Health Care. People who are allergic to nickel or adhesives may react to the pads.

Other stop rules from both sources:

• Do not use TENS in the bath or shower.
• Do not use TENS while you sleep.
• Do not use TENS while driving or using tools or machinery.

Next step

Ask your doctor or physical therapist to mark your pad spots, then follow the plan and your device’s instructions. If you have questions about getting a TENS unit, call Analgesic Healthcare at (800) 749-1188 or use the contact page.

This page gives general information, not medical advice. Talk with your doctor or physical therapist about your own care, and follow your clinician's and your device's instructions. In an emergency, call 911.