IEICE Electronics Express, Vol.6, No.

22, 1587–1594

Design and implementation

of wireless transcutaneous
electrical nerve stimulator
(TENS) for smart phone
Hee Joon Park1 , Sang Hyo Woo2 , Zia Mohy Ud Din3 ,
Myoung Nam Kim3 , and Jin Ho Cho2a,b)
1
Dept. of Medical Informatics, School of Medicine, Keimyung University Univer-
sity, taegu, 702–701, South Korea
2
School of Electrical Engineering and Computer Science, Kyungpook National Uni-
versity, pookgu, taegu, 702–701, South Korea
3
Dept. of Medical & Biological Eng., School of medicine, Kyungpook National Uni-
versity, pookgu, taegu, 702–701, South Korea
a) wgundan@kornet.net
b) jhcho@knu.ac.kr

Abstract: The aim of this study is to design and implement a

wireless transcutaneous electrical nerve stimulator (TENS) that is con-
trolled by a smart phone. The proposed TENS can be attached to the
human arm with the help of an arm band for providing electrical stim-
uli via a disposable electrode. These stimuli help suppress pain and
increase skin temperature, and the electrical parameters of the stimuli
are controlled with the help of a smart phone. For implementing a
small (21 × 20 mm) and electrically safe TENS, a modified boost con-
verter, which continuously monitors the peak current output to ensure
the electrical safety, is used. Simple in vivo experiments are conducted
to identify the pain control ability and skin temperature increment in
the human arm.
Keywords: transcutaneous electrical nerve stimulator (TENS), smart
phone, electrical safety, low power, ubiquitous
Classification: Electronic instrumentation and control

References

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c IEICE 2009
DOI: 10.1587/elex.6.1587
retinal prosthetic device,” IEEE J. Solid-State Circuits., vol. 40, no. 3,
Received September 30, 2009 pp. 763–771, March 2005.
Accepted October 09, 2009
Published November 25, 2009

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c IEICE 2009
DOI: 10.1587/elex.6.1587
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009
IEICE Electronics Express, Vol.6, No.22, 1587–1594
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[13] [Online] http://www.nordicsemi.com, available at July 2009
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1 Introduction
Recently, the smart phone performance has improved dramatically, and there
are numerous challenges exist to integrate various circuits into the smart
phone. However, the phone cost and design complexity would increase with
the integration of special circuits. Therefore, it is essential to implement the
special circuits as external devices that can be wirelessly controlled by using
a smart phone. When the external devices are controlled by the smart phone,
the devices do not require independent displays and eventually it could reduce
its size. A further advantage is that the smart phone can be a base station
of the external devices and it could maximize utility of the smart phone.
There are many external systems that can be combined with the smart
phone, and a transcutaneous electrical nerve stimulator (TENS) is one good
example. The TENS can improve suppressing pain [1], and it is widely used
in commercial market. One drawback of previous TENS products was that
the patients had to carry large size of the external device because of the
independent display. Therefore, it is need to develop a small size TENS
which is controlled by a smart phone and it makes the patients free from
caring previous large TENS.
In order to design small, low power, and safe TENS, designing the stim-
ulator is important part of all. Many researchers have developed small and
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c IEICE 2009
DOI: 10.1587/elex.6.1587
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009
IEICE Electronics Express, Vol.6, No.22, 1587–1594
low power stimulators for various applications. Generally, a current mirror
circuit was used for an implantable nerve stimulator [2, 3, 4, 5], and it was
simple, reliable, and small enough to be inserted into the nerve. The problem
with this technique is that it only works with low impedance because output
voltage is limited by input voltage. Dry human finger and body skin can
have an high impedance as 1 MΩ [6, 7], and human tissues are excited when
current intensity and duration time are above the strength and duration (SD)
curve that is a graph relating the current intensity to the duration time it
must flow to be active the nerve [8]. On the basis of the SD curve, high
voltage stimulator is required to active the nerve from the transdermal due
to high impedance.
Reilly et al. proposed a unipolar high voltage (> 300 V) capacitive dis-
charger and analysis the characteristic of the SD curve [8]. This research is
useful to design the defibrillator that requires high voltage over the 300 volt-
age. On the other hand, the high voltage could cause electroporation which
could cause damage to the cell [7]. The electroporation is widely used in the
genetic modification field, and it can insert some substance into a cell that
changes a piece of coding deoxyribonucleic acid (DNA). Therefore, output
voltage over than 300 V must be avoided for the electrical safety.
Woodward et al. proposed an opto-isolated circuit to protect the human
body from the ground loop problem [9]. One drawback of this technique is
that the output power was fixed and it was difficult to implement high volt-
age output. Therefore, it is not a suitable technique for the transcutaneous
stimulator which has to be attached to the epidermis.
The aim of this study was to design and implement a wireless tran-
scutaneous electrical nerve stimulator (TENS) that was controlled by the
smart phone. The stimulator was designed to generate high voltage that
can stimulate the nerve through the high impedance epidermis. The TENS
was designed to monitor extreme current flow for electrical safety, and it can
automatically limit the maximum output power to the patient.
2 Methods
2.1 Benefits of the TENS and electrical safety
There are Aβ, Aδ , C fibers that transmit pain signals to the brain, where the
Aδ fiber contributes to transmission of acute pain and the C fiber transmits
slow and dull pain. Fig. 1 illustrates that the electrical stimulus from the
TENS can excite the Aβ fiber and cause blocks the other pain signals from
the spinal cord. Such phenomenon is well observed when rubbing the skin,
and it can suppress overall pain.
Therefore, the TENS have to stimulate only the Aβ fiber and this can
be achieved by controlling a period of the electrical stimulus, because of
chronaxie [10]. The chronaxie is minimal electrical stimulus duration time
for the nerve excitation in the SD curve, and the chronaxie of the Aβ fiber
(0.20 ms) is shorter than the Aδ , C fibers (0.45 ms). Therefore the duration
of the proposed stimulator was fixed as 0.25 ms that is slight longer than the
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Fig. 1. Illustration of benefits of the TENS.

choronaxie of the Aβ fiber. On the basis of the SD curve, Aδ , C fibers can

be active even though duration of the stimulator was fixed as 0.25 ms when
output current intensity is higher than the SD curve. Therefore, patient has
to adjust the output intensity as comfortable level. The duration time deter-
mines a fundamental frequency of the proposed stimulator as 2 MHz, and the
electrical safety of this frequency had to be considered. There are electrical
safety regulations from the International Commission on Non-Ionizing Radia-
tion Protection (ICNIRP) and they limit maximum current density as f /100
(mA/m2 RMS) from 0.1 ∼ 10 MHz range [11]. The proposed stimulator used
25 cm2 large electrodes, and it was assumed that the current density from
the electrode was uniform. Therefore, the proposed stimulator was designed
to limit 3 mA current that is thousand times less than the regulation. When
the peek current exceeds the threshold, the system will automatically turns
off the stimulus output.
Another consideration in regard to electrical stimulus is the polarity of
the stimulus. Lilly reported that bipolar stimuli are safer than the unipolar
stimuli and the proposed stimulator was designed to output bipolar stimuli
by using an H-bridge circuit [12].

2.2 Stimulator and Radio Frequency (RF) system design

Fig. 2 (a) illustrates a wireless TENS which was attached to an arm and it
was controlled by the smart phone. Fig. 2 (b) is a schematic of the proposed
stimulator, and it consists of a boost converter, level detector, current mon-
itor, and H-bridge. The boost converter boosts input voltage and stores it
in the tank capacitor, which is placed next to the diode. The voltage level
of the tank capacitor is monitored by a schmitt trigger, and it alarms the
controller when the voltage level is lower than the target voltage. The size
of the tank capacitor was decided by the maximum output power, and it is

c IEICE 2009
DOI: 10.1587/elex.6.1587
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009

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described as
1
CV 2 < V IT = Im 2 (Rskin + 2Rpad )T (1)
2
2Im 2 (Rskin + 2Rpad )
C< (2)
V2
Where V , I, T are voltage, current and turn on time, Rskin , Rpad are the
resistance values of the skin and pad, and Im is the maximum current allowed
for electrical safety. The current monitor identifies the peek current, and
automatically shuts down the output when the output current is more than
the threshold. Further, the H-bridge is used to generate the bipolar signal.
To communicate between the proposed stimulator and the smart phone,
a Bluetooth is the most widely used technique in the industry. However, it
requires high power consumption for communication and a pairing process

Fig. 2. Illustrations. (a) Concept of the proposed sys-

tem. (b) Schematic. (c) Circuit. (d) TENS as
 IEICE 2009
c
band type. (e) Smart phone interface program.
DOI: 10.1587/elex.6.1587
Received September 30, 2009 (f) Example waveform of stimuli output.
Accepted October 09, 2009
Published November 25, 2009

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c IEICE 2009
DOI: 10.1587/elex.6.1587
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009
IEICE Electronics Express, Vol.6, No.22, 1587–1594
is required. Therefore, a 2.4 GHz gaussian frequency shift keying (GFSK)
transceiver was used to design the RF system [13]. The transceiver used an
industrial, scientific and medical (ISM) band which could be used without
government permission, and the size of the antenna is small enough to make
a small system.
To implement a low power receiver, the receiver was periodically turned
on for 1 ms every 1 s, and the average power consumption of the receiver was
reduced as 0.118 mW. The transmitter was implemented as a dongle type,
and it can be connected to the smart phone (SCH-M480, Samsung) by using
a 20 pin connector socket. When the user changed the stimuli pattern, the
RF transmitter transmitted the parameter data until an acknowledgment
signal was received. Fig. 2 (c) shows the implementation of the TENS and
RF receiver, fig. 2 (d) shows the implemented case, fig. 2 (e) shows a smart
phone application program for controlling the TENS. A LabVIEW mobile
program was used to program and send command to the receiver. Fig. 2 (f)
shows an example of the bipolar stimulus output from the TENS module.
3 Experiment
To verify reduction of pain ability and increasing skin temperature, simple in
vivo experiments were conducted. Informed written consent was obtained for
each volunteer and the experiment protocol was checked by a rehabilitation
doctor from kyungpook national university hospital. Fifteen male volunteers
(age: 28 ± 4.2 years) who rarely exercised were made to perform 50 push-
ups so that they experienced pain in their arms. After pain was occurred,
the TENS electrodes (No:862.2050, TenzPad) were attached to the arm of
each volunteer as illustrated in Fig. 3 (a). Seven volunteers were randomly
selected for the control group and did not apply the electrical stimulus. The
electrical stimulus parameters were set as 35∼45 V, 0.25 ms, and 40 Hz. The
intensity (voltage) was controlled by the volunteers depending on their com-
fort feeling, and applied the electrical stimulus for 14 minutes while measuring
the skin temperature increment by using a thermal camera (Thermal CAM
P20, FLIR). The environmental temperature was controlled as 23◦ C, and the
emissivity parameter was set at 0.96, which is the emissivity of the skin.
Fig. 3 (b-c) shows a few of the recorded from thermal images; it show the
skin temperature was incased from 30.5◦ C to 30.9◦ C after 14 minutes of the
TENS stimulation. Fig. 3 (d) shows the summarized results of the skin tem-
perature difference after the TENS stimulation; the case group shows that
an average increment of 0.29 ± 0.19◦ C was observed from the skin temper-
ature. Further, the results of the Mann-Whitney rank sum test revealed a
significant difference in the skin temperatures between the case and control
groups (P < 0.002).
In order measure the pain reduction ability, simple surveys were used
to determine the extent of the pain reduction ability. Since the pain is a
subjective experience, it is hard to measure by quantitative method, and the
survey is widely used in the clinical experiment for the pain measurement.
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Fig. 3. Experiments. (a) Placement of the electrode. (b)

Thermal image before the TENS. (c) Thermal im-
age after the TENS. (d) Summarized skin temper-
ature difference. (e) Result of pain reduction.

Therefore, the volunteer was asked whether the pain in their arm increase or
decrease after using the TENS. As shown in figure 3 (e), a 22% decrease in
the pain was observed in the case group, and there was a significant difference
in the degree of pain reduction between the case and control group (t-test, P
= 0.027).

4 Conclusion
In this paper, a wireless transcutaneous electrical nerve stimulator was im-
plemented and simple in vivo experiments were conducted. The proposed
stimulator was wirelessly controlled by a smart phone, and the implemented
system was small enough to attach to an arm. The proposed stimulator
showed pain reduction and skin temperature increment. However, the pro-
posed stimulator used a GFSK transceiver that was not integrated in the

c IEICE 2009
DOI: 10.1587/elex.6.1587
smart phone and an additional dongle was required for communication. New
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009

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Bluetooth protocol 3.0 was released in April 2009 and it included a low power
mode which is necessary for the handheld applications [14]. When the new
Bluetooth protocol is widely used in the smart phones, it could become pos-
sible to interconnect many handheld devices with the smart phone. In this
way, the smart phone could become a control hub for all external devices,
and subsequently minimize the size of the external devices.

Acknowledgments
This work was supported by grand no. 10031779 from the Strategic Technol-
ogy Development Program of Ministry of Knowledge Economy. Also, this
work was supported by the Grant of the Korean Ministry of Education, Sci-
ence and Technology The Regional Core Research Program.


c IEICE 2009
DOI: 10.1587/elex.6.1587
Received September 30, 2009
Accepted October 09, 2009
Published November 25, 2009

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