Objective: To synthesize current evidence on the efficacy, safety, and certainty of evidence regarding transcutaneous electrical nerve stimulation (TENS) in low back pain and sciatica, in order to clarify its role in multimodal management.
Methods: This was a practice-oriented narrative review. Core sources were purposively selected from PubMed/MEDLINE, Cochrane Library, PEDro, Google Scholar, and major guideline sources up to October 2025, with priority given to clinical guidelines, systematic reviews, meta-analyses, and representative randomized controlled trials. As a narrative review, this article did not follow PRISMA and was not intended to identify all available publications; certainty of evidence was referenced from published risk-of-bias and GRADE assessments.
Results: In chronic non-specific low back pain, TENS mainly showed a small short-term analgesic benefit, while its superiority over sham or usual care remained inconsistent. In acute or subacute low back pain, the available evidence was limited and of low quality. In confirmed sciatica or lumbar radiculopathy, direct evidence was scarce; TENS appeared to provide only short-term benefit and was less effective than percutaneous electrical nerve stimulation. TENS was generally safe, with mild and reversible skin irritation being the most common adverse effect.
Conclusion: TENS may be considered a selective adjunctive option in some patients with chronic low back pain, but current evidence does not support its routine use as a stand-alone treatment.