BlueCross BlueShield of Tennessee Medical Policy Manual

Transcutaneous Electrical Nerve Stimulation (TENS)

Does not apply to BlueCare.

DESCRIPTION

Transcutaneous electrical nerve stimulation (TENS) devices are electronic stimulus generators that transmit electrical impulses of various configurations to two or more electrodes adhesed on the skin for the purpose of pain management. The electrode is placed in an area that is closest to the site of pain. TENS devices are durable medical equipment that may be applied in a variety of settings (in the patient's home, a physician's office, or in an outpatient clinic).The mechanism of action is unknown, but it is purported that the electrical pulses block the transmission of pain to nerve fibers.

TENS devices have been investigated for the relief of chronic intractable pain, acute pain, post-surgical pain and pain unresponsive to other standard pain therapies. It is also being considered for the treatment of labor pain, migraine headache prevention, and the treatment of dementia.

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

See also:

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

   Does not apply to BlueCare.

ADDITIONAL INFORMATION

Overall, evidence for the use of transcutaneous electrical nerve stimulation (TENS) from high-quality trials remains inconclusive for most indications. The available studies are inconsistent on whether TENS improves outcomes, and the overall strength of the evidence is weak for all indications. On the other hand, the best evidence exists for treatment of chronic, intractable pain, and there is strong clinical support for this indication. For indications other than chronic, intractable pain, the evidence does not permit conclusions on the efficacy of TENS. Therefore, TENS use is considered investigational for most other indications.

SOURCES

American Academy of Neurology. (January, 2015). Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Retrieved July 11, 2016 from the National Guideline Clearinghouse (NGC: 15633).

American Society of Anesthesiologists. (2010). 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. Retrieved November 2, 2012 from: http://journals.lww.com/anesthesiology/Fulltext/2010/04000/Practice_Guidelines_for_Chronic_Pain_Management_.13.aspx.

BlueCross BlueShield Association, Medical Policy Reference Manual. (11:2015). Transcutaneous electrical nerve stimulation (1.01.09). Retrieved July 11, 2016 from: BlueWeb. (76 articles and/or guidelines reviewed)

BlueCross BlueShield Association, Medical Policy Reference Manual. (2:2016). Temporomandibular joint dysfunction (2.01.21). Retrieved July 11, 2016 from: BlueWeb. (20 articles and/or guidelines reviewed)

BlueCross BlueShield of Tennessee network physicians. 2002.

California Technology Assessment Forum. (August 2014) Controversies in migraine management a technology assessment final report. Retrieved August 4, 2015 from: http://www.ctaf.org/.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Neuromuscular Electrical Stimulation (NMES) (160.12) Retrieved July 11, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=175&.

Karasuno, H., Ogihara, H., Morishita, K., Yokoi, Y., Fujiwara, T., Ogoma, Y., et al. (2016). The combined effects of transcutaneous electrical nerve stimulation (TENS) and stretching on muscle hardness and pressure pain threshold. Journal of Physical Therapy Science, 28 (4), 1124-1130.

Rai, S., Ranjan, V., Misra, D., & Panjwani, S. (2016). Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: a comparative study. European Journal of Dentistry, 10 (1), 46-53. (Level 5 evidence - Independent)

U. S. Food and Drug Administration. (2005, September). Center for Devices and Radiological Health. 510(k) Summary, K050435. Retrieved December 22, 2006 from http://www.fda.gov/cdrh/pdf5/K050435.pdf.

U. S. Food and Drug Administration. (2009, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K090889. Retrieved September 6, 2013 from http://www.accessdata.fda.gov/cdrh_docs/pdf9/K090889.pdf.

U. S. Food and Drug Administration. (2009, June). Center for Devices and Radiological Health. 510(k) Summary, K090922. Retrieved June 12, 2012 from http://www.fda.gov/cdrh/pdf5/K090922.pdf.

U. S. Food and Drug Administration. (2011, August). Center for Devices and Radiological Health. 510(k) Summary K103719. Retrieved October 11, 2013 from http://www.fda.gov/cdrh/pdf5/K103719.pdf.

Vance, C., Dailey, D., Rakel, B., and Sluka, K. (2014). Using TENS for pain control: the state of the evidence. Pain Management (2014), 4 (3), 197-209.

ORIGINAL EFFECTIVE DATE:  7/1982

MOST RECENT REVIEW DATE:  9/8/2016   

ID_BT

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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