Project Sync / Status Update Summary Podcast Episode Overview The host discussed Transcutaneous Electrical Nerve Stimulation (TENS) as a recurring pain board topic and reviewed mechanisms, efficacy, and clinical considerations. Emphasis that TENS appears on pain boards annually and is a foundational topic from early podcast episodes. Board Prep and NRAP Community at PainExam.com or NRAPpain.org ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship Educational Offerings and Events Training and Courses: Monthly ultrasound courses in New York and upcoming courses in Detroit covering ultrasound-guided regional anesthesia and chronic pain. Ultrasound Guided Acute and Chronic Pain course in November near Hollywood/Fort Lauderdale with venue pending confirmation. Multiple instructors to offer diverse perspectives; registration via the CME calendar at nrappain.org. Conferences and Teaching: New York–New Jersey Pain Conference in November (hosted by Soudir Duwan). ISPN conference in London next week, with ultrasound teaching participation by the host. Community and Coaching: Private coaching and shadowing opportunities available; contact via newsletter replies. Access to the NRAP community forum upon signup at nrappain.org for discussions on neuromodulation, regional anesthesia, and pain. TENS: Mechanisms and Parameters Device and Parameters: TENS delivers adjustable pulse frequency and intensity; configurations include low (50–100+ Hz), and mixed frequencies. Mechanisms of Analgesia: Activation of large-diameter, non-noxious A-beta afferent fibers in the periphery, driving descending inhibitory pathways and reducing hyperalgesia. Board-relevant point: selective activation of A-beta fibers is frequently tested. Central effects: Reduces central excitability and nociceptive dorsal horn neuron activity in uninjured and injured models. Frequency-dependent opioid receptor mediation: High-frequency analgesia blocked by delta receptor antagonists. Low-frequency analgesia blocked by mu re