BlueCross BlueShield of Tennessee Medical Policy Manual

Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)


Percutaneous electrical nerve stimulation (PENS) is an electronic stimulus generator that transmits electrical impulses of various configurations to a needle electrode that is inserted just below the skin for the purpose of pain management.

Needle electrodes are inserted either around or immediately adjacent to the nerves serving the painful area and then stimulated. PENS is generally reserved for patients who fail to get pain relief from TENS possibly due to physical barriers (e.g., scar tissue, obesity) to the conduction of electrical stimulus. PENS units, which are usually battery operated, have been used to relieve chronic intractable pain, post-surgical pain and pain associated with traumatic injuries unresponsive to other standard pain therapies. 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.

Percutaneous neuromodulation therapy (PNT) is a variant of PENS in which fine filament electrodes are temporarily placed at specific anatomic landmarks in the deep tissues near the area of the spine that is causing pain (with or without radiating lower extremity pain). Treatment regimens consist of 30-minute sessions, once or twice a week for 8 to 10 sessions.


See also:



A search of the peer-reviewed literature was performed through March 2015. The scarcity of current literature remains on the use of PENS or its effectiveness as a means of pain control.


American College of Occupational and Environmental Medicine. Occupational medicine practice and management of common health problems and functional recovery in workers. Chronic pain. Retrieved December 12, 2011 from

American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine, Anesthesiology 2010; 112 (4), 810-833.

BlueCross BlueShield Association, Medical Policy Reference Manual. (7:2014). Percutaneous electrical nerve stimulation (PENS) or percutaneous neuromodulation therapy (7.01.29). Retrieved March 10, 2015 from BlueWeb. (21 articles and/or guidelines reviewed)

Bril, V., England, J., Franklin, G., Backonja, M., Cohen, J., DelToro, D., et al. (2011). Evidence-based guideline: treatment of painful diabetic neuropathy- Report of the American Association of Neuromuscular and Electrodiagnostic Medicine, The American Academy of Neurology, and The American Academy of Physical Medicine & Rehabilitation. Muscle Nerve, 43 (6), 910-917.

Complete Guide to Medicare Coverage Issues. (2014, December). Electrical Nerve Stimulators. (NDC 160.7, p. 2-80). OptumInsight, Inc.

National Institute for Health and Care Excellence. (2013, March). Percutaneous electrical nerve stimulation for refractory neuropathic pain. Retrieved March 10, 2015 from

Weiner, D., Perera, S., Rudy, T., Glick, R., Shenoy, S., & Delitto, A. (2008) Efficacy of percutaneous electrical nerve stimulation and therapeutic exercises for older adults with chronic low back pain: A randomized control trial. Pain, 140 (2), 344-357. (Level 2 Evidence - Independent Study)




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