DESCRIPTION
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. When implanted, the stimulating electrodes are connected by an insulated lead to a receiver unit that is placed under the skin. A generator connected to an antenna unit that is attached to the skin surface over the receiver unit induces stimulation. PENS units, which are usually battery operated, have been used to relieve chronic intractable pain, post-surgical pain and pain associated with active or post-trauma injury unresponsive to other standard pain therapies. The needle is placed in an area 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. PENS is generally reserved for individuals who fail to get pain relief from TENS, possibly due to physical barriers (e.g., scar tissue, obesity) to the conduction of electrical stimulus.
POLICY
Percutaneous electrical nerve stimulation (PENS), for the management of acute postoperative and chronic intractable pain, is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Percutaneous electrical nerve stimulation (PENS), for the management of pain related to unstable angina pectoris or during pregnancy, is considered investigational.
Percutaneous electrical nerve stimulation (PENS), 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:
MEDICAL APPROPRIATENESS
PENS for the management of chronic intractable pain and acute postoperative pain is considered medically appropriate with ALL of the following:
The use of TENS produced incomplete relief
ANY ONE of the following criteria:
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 PENS unit for pain control
Pain requiring placement of PENS 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.
SOURCES
Ahmed, H. E., White, P. E., Craig, W. F., Hamza, M. A., Ghoname, E. A., & Gajraj, N. M. (2000). Use of percutaneous electrical nerve stimulation (PENS) in short-term management of headache. Headache. 40 (4), 311-315.
American Society of Anesthesiologist Task Force. (1997). Practice guidelines for chronic pain management. Anesthesiology, 86 (4), 995-1004.
BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2003). Temporomandibular joint dysfunction (2.01.21). Retrieved December 18, 2006 from BlueWeb.
BlueCross BlueShield Association, Medical Policy Reference Manual. (3:2006). Percutaneous electrical nerve stimulation (PENS) or percutaneous neuromodulation therapy (7.01.29). Retrieved December 18, 2006 from BlueWeb.
BlueCross BlueShield of Tennessee network physicians. 2002.
Complete Guide to Medicare Coverage Issues. (2006, February). Assessing patients suitability for electrical nerve stimulation therapy (NDC 160.7.1, p. 2-69 - 2-70).
Ghoname, E. S., Craig, W. F., White, P. F., Ahmed, H. E., Hamza, M. A., Gajraj, N. M., et al. (1999). The effect of stimulus frequency on the analgesic response to percutaneous electrical nerve stimulation in patients with chronic low back pain. Anesthesia and Analgesia, 88 (4), 841-846.
Hamza, M. A., Ghoname, E. A., White, P. F., Craig, W. F., Ahmed, H. E., Gajraj, N. M., et al. (1999). Effect of the duration of electrical stimulation on the analgesic response in patients with low back pain. Anesthesiology, 91 (6), 1622-1627.
Hamza, M., A, White, P., F., Craig, W. F., Ghoname, E. A., Ahmed, H. E., Proctor, T. J., et al. (2000). Percutaneous electrical nerve stimulation: A novel analgesic therapy for diabetic neuropathic pain. Diabetes Care, 23 (3),365-370.
Schwartz, R.G., Electric sympathetic block: Current theoretical concepts and clinical results. (1998). Journal of Back and Musculoskeletal Rehabilitation, 10, 31-46.
TheTechnology Evaluation Center. (1997, January). Transcutaneous or percutaneous electrical nerve stimulation in the treatment of chronic and postoperative pain. (Vol. 1, No. 21). Chicago: BlueCross BlueShield Association.
White, P. F., Li, S., & Chiu, J. W. (2001). Electroanalgesia: Its role in acute and chronic pain management. Anesthesia and Analgesia, 92 (2), 505-513.
ORIGINAL EFFECTIVE DATE: 3/1980
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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