Transcutaneous Electrical Nerve Stimulation (TENS)
DESCRIPTION
Transcutaneous electrical nerve stimulation (TENS) is an electronic stimulus generator that transmits electrical impulses of various configurations to electrodes on the skin for the purpose of pain management. TENS units, which are usually battery operated, have been used to relieve chronic intractable pain, post-surgical pain and pain associated with active or post-traumatic injury unresponsive to other standard pain therapies. The electrode is placed in an area that is closest to the site of pain. The mechanism of action is unknown, but it is purported that the electrical pulses block the transmission of pain to nerve fibers or may stimulate the release of endorphins or serotonin.
Electrical Nerve Block, a form of TENS, is the use of transdermally applied electricity to obtain sympathetic neuron blockade in individuals experiencing regional chronic pain. The key difference between electrical nerve block and TENS is the electrode size, shape, configuration, placement, and time used to achieve sympathetic neuron blockade.
POLICY
Transcutaneous electrical nerve stimulation (TENS), for the management of chronic intractable pain and acute post-operative pain, is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Transcutaneous electrical nerve stimulation (TENS), for the management of pain related to unstable angina pectoris or during pregnancy, is considered investigational.
Transcutaneous electrical nerve stimulation (TENS) for the management of pain, when there is an implantable electrical device such as a pacemaker or defibrillator or a convulsive disorder of the head and neck is considered investigational.
See also:
Interferential Current Stimulation for the Treatment of Pain
Transcutaneous Electrical Nerve Stimulation for the Treatment of Nausea and Vomiting
MEDICAL APPROPRIATENESS
TENS for the management of chronic intractable pain and acute post-operative pain is considered medically appropriate if ALL of the following criteria are met:
ANY ONE of the following:
Pain is ineffectively controlled due to diminished effectiveness of medications
Pain is ineffectively controlled with medications due to side effects
History of substance abuse
Significant pain from postoperative or acute conditions limits the ability to perform exercise programs/physical therapy treatment
Unresponsive to conservative measures (e.g., repositioning, heat/ice, etc.)
ABSENCE of ALL of the following:
Radiculopathies or peripheral neuropathies
Inability either mentally or physically to understand new procedures and the use of the TENS unit for pain control
Pain requiring placement of TENS over the eyes or anterior neck
Note: Individuals must receive a one-month trial period to permit the physician to study the effects and benefits. Trial periods of more than one month should be justified by documentation and submitted for review.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Scientific evidence is inadequate to validate the application of transcutaneous electrical nerve stimulation or provide comparisons to other treatments for conditions other than those listed as medically necessary.
SOURCES
BlueCross BlueShield Association, Medical Policy Reference Manual. (1:2003). Temporomandibular joint dysfunction (2.01.21). Retrieved December 21, 2006 from BlueWeb.
BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2005). Transcutaneous Electrical Nerve Stimulator (TENS) (1.01.09). Retrieved December 21, 2006 from BlueWeb.
BlueCross BlueShield of Tennessee network physicians. 2002.
Brosseau, L., Milne, S., Robinson, V., Marchand, S., Shea, B., et al. (2002). Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain. Spine, 27 (6), 596-603.
Chiu, J. H., Chen, W. S., Chen, C. H., Jiang, J. K., Tang, G. J., et al. (1999). Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy. Diseases of the Colon and Rectum, 42 (2), 180-185.
Complete Guide to Medicare Coverage Issues [Computer software]. (2006, November). Transcutaneous electrical nerve stimulation (TENS). (NCD 10.2, p. 2-1, NCD 160.7.1, p. 2-69). St. Anthony Publishing.
Deyo, R. A., Walsh, N. E., Martin, D. C., Schoenfeld, L. S., & Ramamurthhy, S. (1990). A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. The New England Journal of Medicine, 322 (23), 1627-1634.
Labrecque, M., Nouwen, A., Bergeron, M., & Rancourt, J. F. (1999). A randomized controlled trial of nonpharmacologic approaches for relief of low back pain during labor. The Journal of Family Practice, 48 (4), 259-263.
Langley, G. B., Sheppeard, H., Johnson, M., & Wigley, R. D. (1984). The analgesic effects of transcutaneous electrical nerve stimulation and placebo in chronic pain patients. Rheumatology International, 4 (3), 119-123.
Lewis, B., Lewis, D., & Cumming, G. (1994). The comparative analgesic efficacy of transcutaneous electrical nerve stimulation and non-steroidal anti-inflammatory drug for painful osteoarthritis. British Journal of Rheumatology, 33 (5), 455-460.
Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002823. DOI: 10.1002/14651858.CD002823.
Price CIM, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001698. DOI: 10.1002/14651858.CD001698.
Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002123. DOI: 10.1002/14651858.CD002123.
Schwartz, R.G. (1998). Electric sympathetic block: Current theoretical concepts and clinical results. Journal of Back and Musculoskeletal Rehabilitation, 10, 31-46.
The Technology Evaluation Center. (1997, January). Transcutaneous or percutaneous electrical nerve stimulation in the treatment of chronic and postoperative pain (Vol. 11, No. 21). Chicago: BlueCross Blue Shield Association.
U. S. Food and Drug Administration. (2005, September). Center for Devices and Radiological Health. 510(k) Summary. Retrieved December 22, 2006 from http://www.fda.gov/cdrh/pdf5/K050435.pdf.
ORIGINAL EFFECTIVE DATE: 7/1982
MOST RECENT REVIEW DATE: 5/1/2008
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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