Beurer Magazine
Pain Relief
Heat pad or TENS for back pain: which one, and when?
Back pain is one of the most common reasons South Africans reach for a painkiller. Two options work without medicine: a heat pad and a TENS device. They work in different ways, and the research behind each is different too. Here is what the studies say, how to choose, how to use both safely, and which Beurer models do what.
Key takeaways
- For a stiff or recently strained back, heat has the better evidence. A review of the research found that a heat wrap gives a small, short term drop in pain, but it also called the evidence limited.
- TENS sends gentle pulses through pads on the skin to calm pain signals. A 2019 review could not say with confidence whether it helps long term pain. See it as something that may help you, not a proven cure.
- Keep moving rather than resting in bed. Only use a heat pad if you can feel heat normally. See a doctor if the pain is severe, spreads down your legs or comes with numbness.
In this article
Back pain: very common, and usually not serious
Back pain, especially in the lower back, is very common. It usually gets better within a few weeks.B It is common in South Africa too. A 2021 study asked 678 adults at five public hospitals in the eThekwini district of KwaZulu-Natal about their backs. Just under one in five, 18.1 percent, had chronic low back pain, meaning pain that had lasted at least 12 weeks. Sitting for most of the day, manual work, smoking and being overweight were all linked to it.A
The best thing you can do is keep moving. The UK's National Health Service advises you to stay active, carry on with your daily activities as best you can, and not stay in bed for long periods.B Heat and TENS can help you keep moving while your back recovers. They are not a reason to lie down.
What heat does for a sore back
Heat relaxes tight muscles and eases stiffness. For back pain, it has the better evidence of the two. A Cochrane review, a respected summary of the research, looked at heat and cold for low back pain. In two trials with 258 people, a heat wrap lowered pain after five days more than a dummy pill did. The authors found moderate evidence that heat wraps give a small, short term drop in pain and disability.C They were also honest about the limits, and called the evidence behind heat and cold for back pain "limited".C
So heat is worth trying for a stiff or aching back, especially in the first few days, but expect a small effect. A heat pad has one big advantage over a hot water bottle. It holds a steady temperature, so you do not have to keep refilling it. Beurer's large pads take 30 to 45 minutes to reach full warmth, so start on the highest setting and turn it down later.E
What TENS does
TENS stands for transcutaneous electrical nerve stimulation. A small device sends gentle electrical pulses through sticky pads on your skin. The pulses work on the nerves under the pads and can calm the pain signals going to the brain. Most people feel a tingling, and many find it pleasant.
The evidence is less clear than for heat. A 2019 Cochrane overview looked at all its reviews on TENS for long term pain. It found the quality of the evidence very low, so it could not say with confidence whether TENS helps or harms.D That does not mean TENS does not work. It means the research cannot yet say who it helps.
TENS does have practical advantages. The device clips onto your belt and the pads sit under your clothes, so you can walk, cook or work at a desk while it runs. The EM 56 and EM 59 show on the screen where the pads go.
Heat or TENS: how to choose
Start with heat for a fresh strain or a stiff back. Think about TENS for a back that keeps nagging you. A simple guide:
- A fresh strain, or a stiff back after gardening or a long drive: heat first, and keep moving between sessions
- A back that aches most days and holds you back: see your doctor or a physiotherapist, and ask if TENS could be part of your plan
- You want relief while you work or move around: TENS, because the device is small and the pads sit under your clothes
- You want both: the EM 59 has TENS and heat in one device, or use a heat pad first and TENS afterwards
Using heat and TENS safely
Both are safe for most adults when you follow the instructions. Beurer's heat pad pages give these warnings:E
- Do not use a heat pad if you cannot feel heat properly or cannot react if it gets too hot. This includes people with diabetes, some skin conditions or scar tissue where the pad goes, and anyone who has taken pain medicine or alcohol
- Never use it on a child under 3. Children aged 3 to 8 may only use it with an adult watching
- Do not put a hot water bottle or another heat pad on top of it
- The pads switch off on their own after about 90 minutes. If you use one for hours, turn it to the lowest setting
- Stop if your skin turns red or sore
For TENS, Beurer says not to use it if you have a pacemaker or other implanted electronic device, or if you are pregnant. Its safety notes also list epilepsy, heart rhythm problems, cancer and a fever.F Keep the pads away from the chest and heart area, the head, the throat and front of the neck, and broken or irritated skin. Start every session on the lowest strength and build up slowly.
Beurer heat pads and TENS devices for the back
For your back, choose a heat pad big enough to cover the whole lower back, or a TENS device with two channels so you can treat both sides at once.
| Model | Type | Size or pads | Settings | Extras | Price today |
|---|---|---|---|---|---|
| HK 125 XXL | Heat pad | 60 x 40 cm | 6 heat settings | Washable, switches off after about 90 minutes | R 1,349.00 |
| HK 123 XXL | Heat pad | 60 x 30 cm | 6 heat settings | Washable, made with recycled material, switches off after about 90 minutes | R 799.00 |
| HK 55 Easy Fix | Heat pad that straps on | About 59 x 30 cm | 3 heat settings | Fastens round your back or stomach, switches off after about 90 minutes | R 1,499.00 |
| EM 49 | TENS and EMS | 2 channels, 4 pads | 64 preset programmes plus 6 of your own | Runs on batteries, belt clip | R 999.00 |
| EM 56 | TENS and EMS | 2 channels, 4 pads | 22 programmes, 50 strength levels | Runs on batteries, shows where the pads go, belt clip | R 999.00 |
| EM 59 | TENS and EMS with heat | 2 channels, 4 pads | 64 preset programmes plus 6 of your own, 2 heat levels | Rechargeable, shows where the pads go | R 1,499.00 |
- For big, even heat: the HK 125 XXL is 60 by 40 cm and the HK 123 XXL is 60 by 30 cm. Both have six heat settings, and you can put them in the washing machine once you unclip the controller.
- For heat that stays in place: the HK 55 Easy Fix straps around your back or stomach, so it does not slip while you sit or move.
- For TENS on its own: the EM 49 and EM 56 both have two channels and four pads. The EM 56 has 22 programmes for areas like the back and joints, and shows where the pads go. The EM 49 has 64 preset programmes plus 6 you can set yourself.
- For TENS and heat in one: the EM 59 is rechargeable and has two heat levels. You can use TENS with heat, TENS only or heat only.
Watch the video
From the Beurer South Africa shop
Beurer Electric Heat Pad HK 125 XXL COSY Energy Efficient Heating 60x40cm. Grey
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Beurer HK 123 XXL Heat Pad Low Energy Use & Eco Friendly XXL 60x30cm - Grey
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Beurer Heating Pad HK 55 Easy Fix
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Beurer Germany EM 49 Digital TENS / EMS Unit - Pain Therapy & Muscle Stimulation
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Beurer Germany EM 56 TENS EMS Machine | 22 Programs | Pain Management & Muscle Training
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Beurer EM 59 Digital TENS/EMS Device With Heat Function - Pain Therapy & Muscle Stimulation
BeurerCommon questions about heat and TENS for back pain
Is heat or TENS better for lower back pain?
For a stiff, aching or recently strained back, heat has the stronger evidence. A review found that heat wraps gave a small, short term drop in pain. For TENS, a 2019 review could not say with confidence whether it helps long term pain. Many people start with heat and add TENS when they want relief while they move around.
How long should I use a heat pad on my back?
Beurer heat pads switch off on their own after about 90 minutes. They take 30 to 45 minutes to reach full warmth, so start on the highest setting and turn it down once it is warm. If you use the pad for hours, Beurer advises the lowest setting. Stop if your skin turns red or sore.
Can I use heat and TENS at the same time?
Yes. The Beurer EM 59 has TENS and heat in one device, and you can choose TENS with heat, TENS only or heat only. You can also use a heat pad first and TENS afterwards. Do not lay a heat pad over TENS pads.
Who should not use TENS?
Beurer says not to use TENS if you have a pacemaker or other implanted electronic device, or if you are pregnant. Its safety notes also list epilepsy, heart rhythm problems, cancer and a fever. Keep the pads away from the chest, the head, the throat and broken or irritated skin. If you have any other medical condition, ask your doctor first.
When should I see a doctor about back pain?
See your GP or clinic if the pain has not eased after a few weeks at home or stops you doing everyday things. Also go if it is worse at night or comes with weight loss you cannot explain. Go to a hospital emergency unit straight away if you have numbness, tingling or weakness in both legs, or numbness around your private parts. The same goes for problems controlling your bladder or bowel, chest pain, or pain that started after a serious accident.
Sources:
A Kahere M, Ginindza T. The prevalence and risk factors of chronic low back pain among adults in KwaZulu-Natal, South Africa: an observational cross-sectional hospital-based study. BMC Musculoskeletal Disorders 2021; 22: 955
B National Health Service (UK). Back pain, page reviewed 5 March 2026. nhs.uk
C French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006; 1: CD004750
D Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE. Transcutaneous electrical nerve stimulation (TENS) for chronic pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2019; 4: CD011890
E Beurer South Africa. HK 125 XXL heat pad, notes on heat and warning notes. beurer.co.za
F Beurer South Africa. Who should not use TENS, on the EM 56 and EM 89 product pages
This article offers general information and does not replace advice from your doctor or pharmacist.