What Should Clinicians Do When a Patient Reports Discomfort During NMES?

Neuromuscular electrical stimulation (NMES) is used in rehabilitation to produce controlled muscle contractions through electrical impulses delivered using surface electrodes. Although an NMES muscle stimulator can support muscle activation and rehabilitation exercises, patients may sometimes experience discomfort during a session. Clinicians should take these reports seriously and respond appropriately rather than assuming that discomfort is a normal part of treatment.

Patient comfort is an important consideration in electrotherapy. An uncomfortable experience may affect a patient's confidence, willingness to continue treatment and ability to participate in rehabilitation. Understanding the possible causes of discomfort helps healthcare professionals make informed decisions about treatment adjustments, patient safety and ongoing clinical assessment.

Understanding Patient Discomfort During NMES Treatment

NMES delivers electrical impulses through electrodes placed on the skin. These impulses stimulate the nerves supplying a targeted muscle, producing a contraction that may support muscle re-education and rehabilitation.

Patients can experience different sensations during stimulation. Some may describe a tingling feeling, pulling sensation or noticeable muscle contraction. Others may report sharp discomfort, excessive tightness, burning or pain. The type and intensity of the sensation can vary depending on the treatment area, electrode application, stimulation settings and individual tolerance.

Patient discomfort during NMES treatment should be considered a signal that the clinician needs to assess the situation. It does not automatically mean that the treatment is unsuitable, but it should never be ignored or dismissed.

The clinician's priority is to establish what the patient is experiencing, identify possible contributing factors and decide whether stimulation should continue, be modified or be stopped.

How Does NMES Work and Why Can Discomfort Occur?

NMES uses electrical pulses to activate motor nerves and produce muscle contractions. The stimulation is delivered through electrodes connected to a device, with settings selected according to the treatment objective and clinical assessment.

Discomfort may occur for several reasons.

1. Stimulation intensity may be unsuitable

If the intensity is higher than the patient can comfortably tolerate, the resulting sensation or muscle contraction may become unpleasant. The appropriate level depends on the individual, treatment area and clinical purpose.

2. Electrode placement may need reviewing

Electrodes that are not positioned appropriately may produce an uneven or uncomfortable sensation. Placement should be checked against the relevant clinical guidance and the intended muscle target.

3. Skin contact may be inconsistent

Poor electrode contact, dried adhesive surfaces, damaged electrodes or uneven skin contact can affect how stimulation is delivered. This may contribute to an unpleasant sensation.

4. The muscle may be experiencing fatigue

Repeated stimulation can place demands on the targeted muscle. If the patient reports increasing discomfort or fatigue during a session, the clinician should reassess the treatment rather than continuing automatically.

5. Individual sensitivity may differ

Patients do not all respond to electrical stimulation in the same way. Previous treatment experiences, skin sensitivity, the condition being treated and individual tolerance may influence how stimulation feels.

What Should Clinicians Do When Discomfort Is Reported?

When a patient reports discomfort, the clinician should follow a structured approach. The immediate response should focus on safety, communication and assessment.

1. Pause or stop stimulation

The first step is to respond promptly. If the patient reports pain, burning or another concerning sensation, stimulation should be paused or stopped while the clinician assesses the situation.

Patients should not be encouraged to tolerate significant discomfort simply to complete a planned session. Continuing without understanding the cause may increase distress and reduce confidence in the treatment process.

2. Ask the patient to describe the sensation

The clinician should ask clear questions to understand what the patient is experiencing.

Useful questions include:

• Where exactly is the discomfort?

• Does it feel like tingling, pulling, burning or pain?

• Did it begin immediately or develop during the session?

• Does it occur throughout stimulation or only during muscle contraction?

• Has the sensation changed since treatment began?

This information can help distinguish an expected stimulation sensation from a problem that requires further investigation.

3. Check the skin and electrode contact

The clinician should inspect the treatment area and check the electrodes, lead wires and connections. Look for skin irritation, redness, damaged electrode surfaces or uneven contact.

If the skin appears injured or the patient reports a burning sensation, stimulation should not be restarted until the issue has been appropriately assessed. Any decision to resume treatment should follow clinical judgement and relevant device instructions.

4. Review the stimulation settings

The clinician should review the selected intensity and other relevant parameters, including pulse characteristics, frequency and treatment duration. These settings should be considered in relation to the patient's needs and treatment objective.

Patient discomfort during NMES treatment may indicate that the current settings or application need reassessment. Adjustments should be made by a qualified professional rather than left to the patient to experiment with independently.

5. Reassess whether treatment should continue

After reviewing the patient, skin condition, electrodes and device settings, the clinician should decide whether treatment can safely resume. If the cause remains unclear, discomfort continues or concerning symptoms are present, the session should be discontinued and further clinical assessment arranged.

Key Clinical Considerations When Managing Discomfort

Maintaining patient communication

Patients should feel comfortable reporting changes in sensation. Clinicians can explain what sensations may normally occur during NMES and make it clear that pain or unusual discomfort should be reported immediately.

Clear communication helps patients participate actively in their rehabilitation and reduces the likelihood of them silently tolerating an unpleasant experience.

Distinguishing muscle contraction from pain

NMES is intended to produce muscle activation, so patients may notice a pulling or contracting sensation. However, a strong contraction should not automatically be considered appropriate if it causes pain or distress.

Clinicians should evaluate the quality of the contraction alongside the patient's feedback.

Recognising possible skin reactions

Skin irritation may be associated with electrode materials, adhesive sensitivity, poor contact or repeated application. If a reaction is suspected, the clinician should assess the skin and follow appropriate guidance before considering further stimulation.

Considering clinical suitability

NMES is not appropriate for every patient or treatment situation. Medical history, relevant contraindications, skin condition, sensation and the intended treatment area should be considered before stimulation is started or resumed.

Documenting the response

Recording the patient's symptoms, treatment settings, electrode placement, clinical observations and actions taken can support continuity of care. Documentation is particularly useful when reviewing repeated discomfort across multiple sessions.

How Can Healthcare Professionals Use This Approach in Practice?

Different rehabilitation professionals may encounter discomfort during NMES for different reasons. A consistent assessment process helps them respond appropriately.

Physiotherapists can monitor muscle contractions during rehabilitation exercises and ask patients to report unusual sensations. They can also review electrode placement and treatment parameters when discomfort occurs.

Rehabilitation clinicians can compare patient feedback with the treatment objective, muscle response and progress across sessions. This helps determine whether the current approach remains appropriate.

Pelvic health specialists should consider the patient's comfort, treatment area, electrode or probe application and individual clinical requirements when using stimulation for pelvic floor rehabilitation. Any discomfort should prompt a review of the application and treatment suitability.

Hospitals and rehabilitation centres can establish consistent procedures for responding to discomfort. Staff training, clear documentation and appropriate equipment checks can help maintain a structured approach to electrotherapy.

For supervised home rehabilitation, patients should receive clear instructions about recognising discomfort, stopping stimulation when necessary and contacting their healthcare professional. They should not independently increase intensity or change treatment settings beyond the guidance provided.

Choosing the Right NMES Solution

Selecting an appropriate device involves more than considering its available stimulation settings. Clinicians should evaluate whether the equipment supports the intended rehabilitation application and allows treatment to be delivered in a controlled manner.

Important considerations include:

• Adjustable stimulation: The device should allow clinicians to select appropriate settings based on clinical requirements and patient tolerance.

• Clear controls: Easy-to-understand controls can help healthcare professionals manage sessions and make necessary adjustments.

• Suitable output configuration: The number of channels and available stimulation options should match the intended treatment application.

• Compatible accessories: Electrodes and lead wires should be suitable for the device and used according to manufacturer instructions.

• Patient monitoring: Clinicians should be able to observe muscle responses and obtain feedback throughout treatment.

• Professional guidance: Device instructions and clinical protocols should support safe and appropriate application.

Patient discomfort during NMES treatment should also be considered when evaluating whether a device and treatment approach are suitable for an individual. Equipment functionality cannot replace clinical assessment, but appropriate controls and reliable accessories can support structured treatment delivery.

Why Professional Rehabilitation Devices Matter

Professional rehabilitation devices provide healthcare practitioners with tools for delivering structured electrotherapy according to clinical requirements. Their usefulness depends on appropriate device selection, correct application and professional supervision.

Verity Medical is associated with the development and supply of professional NeuroTrac rehabilitation devices. Its range includes equipment for applications such as NMES/STIM, TENS and EMG biofeedback.

For muscle rehabilitation, relevant NeuroTrac stimulation devices can support controlled electrical stimulation when selected for an appropriate clinical purpose. EMG biofeedback equipment, including devices in the MyoPlus range, can also help clinicians assess and display muscle electrical activity. This provides a different form of feedback from NMES, although the technologies may be considered together in suitable rehabilitation programmes.

Professional equipment should be used as part of an individualised treatment plan. Device features alone cannot determine whether a particular stimulation setting is appropriate or whether a patient should continue treatment when discomfort occurs.

Practical Considerations for Effective NMES Therapy

A careful approach before, during and after stimulation can help clinicians manage patient comfort.

Before treatment, healthcare professionals should review relevant clinical information, explain the procedure and inspect the skin. They should also check electrode condition, lead connections and device settings.

During treatment, clinicians should:

• Observe the muscle response and patient tolerance.

• Ask about changes in sensation.

• Avoid assuming that stronger contractions are always better.

• Pause stimulation when discomfort is reported.

• Reassess electrode contact and treatment settings when appropriate.

• Stop treatment if symptoms remain concerning.

After treatment, the clinician should check the patient's response, inspect the skin where appropriate and document any problems. If discomfort occurs repeatedly, the treatment plan should be reviewed rather than simply repeating the same approach.

Conclusion

When a patient reports discomfort during NMES, clinicians should respond promptly, pause or stop stimulation when necessary and investigate the possible cause. Reviewing patient feedback, electrode placement, skin condition, device settings and clinical suitability helps healthcare professionals make informed decisions about continuing or modifying treatment.

Professional NMES equipment can support structured muscle rehabilitation, but patient comfort and clinical judgement must remain central to every session. A careful, patient-focused approach helps ensure that electrotherapy is delivered appropriately and that any concerns are addressed before treatment continues.