--- title: "TENS Safety Checklist: Pacemakers, Pregnancy and Skin" description: "A printable TENS unit safety checklist from NHS and University of Iowa Health Care pages: pacemaker, pregnancy, epilepsy, skin, pad placement, when to stop." url: https://analgesic.multisites.ai/guides/tens-safety-checklist publisher: Analgesic Healthcare phone: +1-800-749-1188 contact: https://analgesic.multisites.ai/contact --- Guide # TENS unit safety checklist: a printable list for pacemakers, pregnancy, skin and pad placement Print this list and review it with your clinician before your first TENS session. The NHS says not to use TENS with epilepsy or a pacemaker, or in pregnancy unless your doctor or midwife says so. Do not place pads on broken skin, the head, face or throat. Do not use TENS while you sleep, bathe or drive. Updated October 26, 20268 min read3 sources ## Three stop conditions The NHS says do not use TENS if you have epilepsy or a pacemaker, or if you are pregnant unless your doctor or midwife tells you to. ## Implants University of Iowa Health Care lists a pacemaker or defibrillator, a spinal cord stimulator and any implanted metallic or electronic device as reasons not to use TENS. ## Places and times No pads on broken skin or on your head, face or throat. No TENS while you sleep, bathe, shower, drive or use machinery. ## Ask first Check with a clinician before you start, and follow your clinician's and your device's instructions. Never place pads on - Broken, irritated, infected or numb skin - Your head, face, eyes or mouth - Your neck or throat - Your chest and back at the same time - Directly on your backbone Place pads safely - On clean, dry skin near the pain - On fleshy areas, not over bony sites - With a gap between them, never touching each other or metal - Only with the unit turned off, and off again before you move them Sources: [NHS](https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/), [University of Iowa Health Care](https://uihc.org/health-topics/transcutaneous-electrical-nerve-stimulator-tens). Your clinician and your device's instructions decide your exact placement. ## What is the quick safety checklist for a TENS unit? Use this list before every session, and print it if you like. Check each box. If you cannot check one, stop and ask your clinician. A [TENS unit](https://analgesic.multisites.ai/glossary/tens-unit) sends mild electrical pulses through pads on the skin to treat pain. Follow your clinician’s and your device’s instructions. This page uses two sources: the NHS TENS page (last reviewed 14 February 2025) and the University of Iowa Health Care TENS page (reviewed January 1, 2019). It does not replace your clinician’s advice. Our main [TENS unit safety guide](https://analgesic.multisites.ai/guides/tens-unit-safety) gives more detail. Done Check \[ \] A doctor or clinician has said TENS is safe for me \[ \] I do not have epilepsy or a pacemaker \[ \] I have no implanted device, or my doctor said TENS is safe \[ \] I am not pregnant, or my doctor or midwife said TENS is safe \[ \] My skin at each pad spot is clean, dry and not broken, irritated or numb \[ \] No pad goes on my head, face, throat, neck, mouth or eyes \[ \] The unit is off while I place, move or remove pads \[ \] I will turn the dial slowly, to a tingle that is not painful \[ \] I will not use TENS asleep, bathing, showering, driving or near machinery \[ \] I know the signs that mean I should stop ## Who should not use a TENS unit? Some people should not use TENS at all, and some need a clinician’s approval first. The NHS has a short list under “Do not use TENS if”. It names three cases: you have epilepsy, you have a pacemaker, or “you’re pregnant, unless your doctor or midwife tells you to”. University of Iowa Health Care has a longer list. It says “Do not use TENS if you have:” - “A cardiac pacemaker or defibrillator” - “Spinal cord stimulator” - “In-dwelling pumps or monitors” - “Any implanted metallic or electronic device” It also says to “Talk with your health care provider if you have” cancer, diabetes, cognitive impairment or epilepsy, “Or are pregnant.” Bring this list to your appointment. ### What about a pacemaker or other implant? Do not use TENS. Both sources say a pacemaker is a reason not to use TENS. University of Iowa Health Care extends this to defibrillators, spinal cord stimulators, pumps, monitors and any implanted metallic or electronic device. See the glossary entries for [cardiac pacemaker](https://analgesic.multisites.ai/glossary/cardiac-pacemaker) and [implanted medical device](https://analgesic.multisites.ai/glossary/implanted-medical-device). If you have one, ask your doctor about other ways to manage pain. ### What about pregnancy? Ask your doctor or midwife first. The NHS allows TENS in pregnancy only when “your doctor or midwife tells you to.” University of Iowa Health Care puts pregnancy on its “talk with your health care provider” list. A [contraindication](https://analgesic.multisites.ai/glossary/contraindication) is a reason not to use a treatment, and pregnancy is one the NHS names. ### What about epilepsy? The NHS says not to use TENS if you have epilepsy. University of Iowa Health Care says to talk with your health care provider if you have it. Because the two pages word it differently, treat epilepsy as a stop-and-ask item. Do not start without your clinician’s direct answer. ### What about allergies? University of Iowa Health Care says: “People who are allergic to nickel and/or adhesives may have skin irritation with TENS.” The NHS says a healthcare professional “can also tell you about alternatives if your skin is sensitive to the sticky pads.” Tell your clinician about any allergy before your first session. ## Where should I never place TENS pads? Do not place pads on skin that is not healthy, or on the head, face or throat. The two pages give these lists. Do not place pads on NHS University of Iowa Health Care Irritated, broken, infected or numb skin Yes Open wounds, rashes, swollen, red, infected or inflamed skin; skin without normal sensation Cancerous lesions, or close to them Not listed Yes Any part of your head or face Not listed (names mouth and eyes) Yes Any part of your throat Not listed Yes Your neck, mouth or eyes Yes Not listed (throat and head and face are) Chest and back at the same time Yes Not listed Both sides of the chest or trunk at the same time Not listed Yes Directly on your backbone Not listed Yes One list has items the other lacks. Follow the stricter result: if either source says not to, do not. University of Iowa Health Care also says the pads “should not touch each other or any metal object, such as a belt buckle or metal jewelry.” If you wonder about the neck, see our [neck, shoulder and headache guide](https://analgesic.multisites.ai/guides/tens-for-neck-shoulder-headache). For general placement rules, see our [pad placement guide](https://analgesic.multisites.ai/guides/tens-pad-placement-guide). ## When should I never use TENS? Do not use TENS while you sleep, bathe, shower, drive or use machinery. The NHS says: “Do not use TENS while you sleep”, “Do not use TENS in the bath or shower” and “Do not use TENS when driving or using tools or machinery”. University of Iowa Health Care lists the same four under “Do not use TENS while:”. Their reasons are simple. For sleep, University of Iowa Health Care says “It is easy for the wires to get tangled or unplugged, or the patches may come off.” For water, it says “There is a chance for electrical shock since it is an electrical device. Also, the unit is not waterproof and would be damaged.” ## What should I do to stay safe during a session? Turn the unit off whenever you touch the pads or wires. University of Iowa Health Care says: “Turn the TENS unit off before you put on, move, or take off the electrode patches.” It lists these steps for your protection: 1. Turn the unit off before you place, move or remove pads. 2. Do not share your pads with other people. 3. Only use the TENS unit on yourself as instructed. 4. Keep the unit out of the reach of children. 5. Use the TENS unit on clean, dry skin so the patches make firm contact. The NHS says: “Turn the dial slowly until you feel a tingling sensation. It should not be painful.” University of Iowa Health Care says to set the intensity to “strong but comfortable.” Never turn up the dial to the point of pain. ### What are the shock risks? You can get shocked if you do not follow the steps. University of Iowa Health Care says you can get shocked if “You reposition, or take off, the patches or if you remove the wires from the patches without first turning the unit off”, if “The unit gets wet while you are using it”, or if “You touch bare wires on a damaged cord.” Check wires for damage. Put lead wires “all the way into the connector on each patch” so no bare metal pins are exposed. ### What about other medical equipment? University of Iowa Health Care warns: “Electronic equipment, such as EKG monitors and EKG alarms, may not work the right way when TENS is in use.” Tell your care team that you use TENS before any exam or test. ## When should I stop using TENS? Stop and talk with your clinician if you notice any of these. University of Iowa Health Care says to “Stop using TENS and talk with your doctor or health care team” if you have skin irritation (redness, rash, itching), headache, dizziness or nausea. 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.” For help with sticky or slipping pads, see our [electrode pads and supplies guide](https://analgesic.multisites.ai/guides/tens-electrode-pads-supplies-guide). The glossary explains [skin irritation](https://analgesic.multisites.ai/glossary/skin-irritation). ## What should I do if the unit does not seem to work? Turn the unit off first, then check the basics. University of Iowa Health Care lists these checks if you cannot feel the current: check the power source, check that every patch is sticking to the body, and check that the wires are plugged into the patch and the unit properly. If a wire comes out of the unit or a patch, “Turn the unit off, put the wire back in, and restart the unit.” If you feel no pain relief, the same page says: “Do not use the unit for 3 to 5 days. Then try it again.” It also says to try a different setting or a new patch position, and to “Call your health care team for help if you cannot get relief.” Do not move pads onto the head, face or throat, and do not raise the intensity to the point of pain. Follow your clinician’s and your device’s instructions. ## What should I tell my care team before I start? Share your full health history, since the lists above are not complete. The NHS says: “If you want to try TENS for pain relief, it’s a good idea to check with a GP or other healthcare professional first, to make sure TENS is safe for you.” It also says: “If you’re not sure what’s causing your pain, see a healthcare professional before using a TENS machine.” Bring these items to the visit: - Your list of medicines and any implanted devices, including a pacemaker or defibrillator - Whether you are pregnant or could be - Any history of seizures - Allergies to nickel or adhesives - Any skin problems, numb areas or open wounds near where the pads would go - Your device, its manual and its pads The NHS also says: “There are some things you should not use TENS for. Read the leaflet that comes with your machine for the full list and for further information about how to use TENS.” A device leaflet may list more limits than this page does. Read it, and ask if anything is unclear. ## How often can I use a TENS unit? Your clinician decides, and no single rule applies to everyone. University of Iowa Health Care says: “Some people use their TENS only when their pain is most severe, while others use it daily.” It adds that “3 to 5 days off may be helpful.” Follow your clinician’s and your device’s instructions for how long each session lasts. ## Next step Take this checklist to your doctor or physical therapist and go through it together. Then call AHC at (800) 749-1188 or use [contact](https://analgesic.multisites.ai/contact). ## Questions people ask ### Can I use a TENS unit if I have a pacemaker? No. The NHS says do not use TENS if you have a pacemaker. University of Iowa Health Care says do not use TENS if you have a cardiac pacemaker or defibrillator, a spinal cord stimulator, or any implanted metallic or electronic device. Talk with your doctor about other options. ### Is a TENS unit safe during pregnancy? Only if your doctor or midwife tells you to. The NHS says do not use TENS if you are pregnant, unless your doctor or midwife tells you to. University of Iowa Health Care says to talk with your health care provider if you are pregnant. Do not start on your own. ### Can you use a TENS unit while sleeping? No. The NHS says do not use TENS while you sleep. University of Iowa Health Care lists sleeping among times not to use it, noting wires can tangle or unplug and patches may come off. Not wearing it to bed also lets your skin rest. ### Where should you not put TENS pads? Not on open wounds, rashes, swollen or infected skin, numb skin, or any part of your head, face or throat. Not directly on your backbone, and not on both sides of the chest or trunk at once. The NHS also says not on your neck, mouth or eyes. ### What are the side effects of a TENS unit? Skin irritation from the pads is the main one named. University of Iowa Health Care says to stop and talk with your doctor or health care team if you have skin irritation, headache, dizziness or nausea. The NHS says to remove the pads if your skin becomes itchy, irritated or red. ### Is it safe to use a TENS unit every day? Ask your clinician. University of Iowa Health Care says some people use TENS only when pain is most severe, while others use it daily, and that a break of 3 to 5 days may be helpful. Follow your clinician's and your device's instructions for how often and how long. ## Terms on this page - [Implanted medical device](https://analgesic.multisites.ai/glossary/implanted-medical-device) - [Cardiac pacemaker](https://analgesic.multisites.ai/glossary/cardiac-pacemaker) - [Contraindication](https://analgesic.multisites.ai/glossary/contraindication) - [Skin irritation](https://analgesic.multisites.ai/glossary/skin-irritation) - [TENS unit](https://analgesic.multisites.ai/glossary/tens-unit) ## Sources 1. [NHS: TENS (transcutaneous electrical nerve stimulation)](https://www.nhs.uk/conditions/transcutaneous-electrical-nerve-stimulation-tens/) 2. [University of Iowa Health Care: Transcutaneous electrical nerve stimulator (TENS)](https://uihc.org/health-topics/transcutaneous-electrical-nerve-stimulator-tens) 3. [eCFR: 21 CFR 882.5890, Transcutaneous electrical nerve stimulator for pain relief](https://www.ecfr.gov/current/title-21/chapter-I/subchapter-H/part-882/subpart-F/section-882.5890) Checked against the sources above on October 26, 2026. Coverage rules change, so check the linked page or your plan before you act. 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. ## Keep reading - [TENS unit safety: who should not use one, where pads must not go, and when to stopTENS units are not safe for everyone. The NHS says not to use TENS if you have epilepsy, have a pacemaker, or are pregnant unless your doctor or midwife tells you to. University of Iowa Health Care says not to use it with any implanted device. Never use TENS while you sleep, bathe, or drive.](https://analgesic.multisites.ai/guides/tens-unit-safety) - [TENS pad placement guide: where to put your electrode padsPut TENS electrode pads on clean, dry skin near the painful area, with a gap between them, and turn the unit off first. Never place pads on broken or numb skin, the head, face, throat, or over the spine. Your clinician can show you the exact spots for your pain.](https://analgesic.multisites.ai/guides/tens-pad-placement-guide) - [Using a TENS unit for neck, shoulder and headache pain: where the limits areThe NHS says not to use TENS on your neck, mouth or eyes. University of Iowa Health Care says not to place pads on any part of your head, face or throat. Medicare's LCD L33802 lists headache as not reasonable and necessary for TENS. Ask your clinician before any neck or shoulder trial.](https://analgesic.multisites.ai/guides/tens-for-neck-shoulder-headache) - [TENS unit electrode pads, lead wires and supplies: what you need and what Medicare saysA TENS kit has the unit, lead wires, electrode pads and a power source. Pads wear out as the adhesive fades. For covered use, Medicare's LCD L33802 sets a usual maximum of one unit of A4595 per month for 2 leads and two units for 4 leads. Lead wires, A4557, rarely need replacing more often than every 12 months.](https://analgesic.multisites.ai/guides/tens-electrode-pads-supplies-guide) - [Can you use a TENS unit while sleeping? What sources sayNo. The NHS and University of Iowa Health Care both list sleeping as a time not to use a TENS unit. Iowa gives reasons: wires can tangle or unplug, pads can come off, and skin needs a rest from the pads. If pain keeps you awake, ask your clinician about other options.](https://analgesic.multisites.ai/can-you-use-a-tens-unit-while-sleeping) - [Where not to put TENS pads: a plain-language checklistHealth sources list areas to avoid with TENS pads: broken, irritated, infected or numb skin; the head, face and throat; the eyes and mouth; and both sides of the chest or trunk at once. The lists differ a little by source. Follow your clinician's and your device's instructions.](https://analgesic.multisites.ai/where-not-to-put-tens-pads) ## Questions about your unit or a bill? Call toll free. For customer care, ask for extension 508. [Call (800) 749-1188](tel:+1-800-749-1188)[Pay invoice](https://ahcpatientservices.com/)