In a pragmatic cluster randomized clinical trial of 384 patients with fibromyalgia treated in routine outpatient physical therapy settings, adding transcutaneous electrical nerve stimulation (TENS) to physical therapy resulted in a statistically significant and clinically meaningful reduction in movement-evoked pain at 60 days compared with physical therapy alone, with benefits sustained through 6 months. Improvements were also seen in fatigue, resting pain, and disease impact, and were greater with higher TENS use. However, the invited commentary emphasized that effect sizes were modest and noted minimal improvement in the physical therapy–alone group, raising concerns about nonstandardized, non–fibromyalgia-specific therapy and the possibility of regression to the mean.