BlueCross BlueShield of Tennessee Medical Policy Manual

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

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.

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.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

A search of the peer-reviewed literature was performed through November 2011. There is a scarcity of current literature on the use of PENS or its effectiveness as a means of pain control.

SOURCES

American College of Occupational and Environmental Medicine. Occupational medicine practice and management of common health problemsand functional recovery in workers. Chronic pain. Retrieved December 12, 2011 from http://www.guideline.gov.

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. (8:2011). Percutaneous electrical nerve stimulation (PENS) or percutaneous neuromodulation therapy (7.01.29). Retrieved November 9, 2011 from BlueWeb. (18 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.

Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, T., Shekelle, P., et al. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from The American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147 (7), 478 - 491.

Complete Guide to Medicare Coverage Issues. (2011, November). Assessing patients suitability for electrical nerve stimulation therapy (NDC 160.7.1, p. 2-79 - 2-90). Ingenix.

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. (Level 4 Evidence - Independent Study)

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.

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)

ORIGINAL EFFECTIVE DATE:  3/1980

MOST RECENT REVIEW DATE:  4/13/2012

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