Background: Over 1.2 million women undergo Cesarean delivery each year in the United States, accounting for approximately 30% of deliveries. In the United States, women are prescribed opioids for pain management in both the inpatient stay and upon discharge home following Cesarean delivery. Non-pharmacological therapy for postsurgical incision pain, such as Transcutaneous Electrical Nerve Stimulation (TENS), may be effective to reduce the quantity of opioids provided to new mothers after birth to manage postoperative pain after Cesarean delivery. Little is known about the use and effectiveness of TENS in inpatient postpartum care. The purpose of this review was to explore the use and effectiveness of TENS to decrease pain and opioid consumption after Cesarean delivery during the inpatient hospital stay. Methods: A systematic review was initially attempted, but the literature was scarce and heterogeneous. A scoping review was therefore pursued to better understand the research landscape of TENS for the reduction of pain and opioid consumption after Cesarean delivery. A literature search was conducted in 2018 and updated in 2022 using PubMed and CINAHL databases. Search terms included: “TENS,” “transcutaneous electrical nerve stimulation,” “electrical stimulation,” “Cesarean,” “analgesia,” “incisional pain,” “postpartum,” and “opioids.” Peer-reviewed studies published between 2010 and 2022, in English, with female human subjects were included. Studies investigating the effects of TENS on incisional pain in postpartum individuals after Cesarean delivery were included. Exclusion criteria were animal studies, those not in English, qualitative studies, and nonintervention studies. Results: Nine studies were identified that utilized TENS to reduce pain in women with acute Cesarean incisional pain during the first 72 hours after surgery. Studies that compared TENS plus usual care to usual care alone found statistically significant reductions in pain. Electrode placement consisted of 2 or 4 electrodes placed within 5 cm of the incision. High frequency TENS (>75 Hz) was more effective to reduce pain than low frequency TENS. TENS was provided for 2 to 4 days either continuously or at 30-minute intervals. Two of the 9 studies utilized TENS and measured opioid consumption and reported conflicting findings. Discussion: TENS can be used to complement the usual care provided in the postpartum inpatient hospital stay and has been shown to reduce pain within the first 72 hours using a high-frequency (>75 Hz) setting for 30-minute intervals. Physical therapists are an underutilized resource within the United States’ postpartum health care model. Factors such as the opioid epidemic in the United States, prevalence of Cesarean delivery, and the routine prescription of opioid medications in usual care contribute to the critical need for scalable non-pharmacological therapies like TENS to reduce acute postsurgical pain and promote patient mobility.
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Simonds et al. (2025) studied this question.