Background: Chronic pain affects one in five people globally, frequently leading to complex polypharmacy. Transcutaneous electrical nerve stimulation (TENS) offers a non-pharmacological alternative to mitigate drug-related problems (DRPs) and reduce medication burden. This study evaluates a decade of real-world TENS utilization trends in France.

Research design and methods: We conducted a nationwide retrospective study (2014-2024) using the French National Health Data System (Open LPP). Metrics included rental and purchase volumes, associated expenditures, and the purchase-to-rental (P/R) ratio, utilized as a behavioral proxy for long-term therapeutic persistence.

Results: TENS initiations (rentals) increased 1.5-fold (91,709 to 158,947), while purchases grew 2.4-fold (17,362 to 41,784). Significant feminization was observed across all cohorts (p < 0.05). The overall P/R ratio was 22.7%. Women showed higher persistence than men (23.3% vs. 21.3%, p < 0.001). The highest persistence occurred in the 40-59 age group (25.4%), whereas the lowest was among patients under 19 (15.2%).

Conclusion: TENS utilization in France shows a strong upward trend. While long-term adoption has improved, persistence remains limited, particularly in younger populations. The P/R ratio serves as a critical marker of clinical adoption and access dynamics.