BlueCross BlueShield of Tennessee Medical Policy Manual

Transcutaneous Electrical Nerve Stimulation (TENS)

Does not apply to BlueCare.

DESCRIPTION

Transcutaneous electrical nerve stimulation (TENS) describes the application of electrical stimulation to the surface of the skin at the site of pain. TENS has been investigated to treat chronic intractable pain, postsurgical pain, and pain associated with active or post-trauma injury unresponsive to other standard pain therapies. It has been proposed that TENS may provide pain relief through the release of endorphins in addition to potential blockade of local pain pathways. TENS may be applied in a variety of settings (home, physician’s office or outpatient clinic).

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. 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.

SOURCES 

American Academy of Neurology. (January, 2015). Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). 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. (2:2017). Temporomandibular joint dysfunction (2.01.21). Retrieved May 24, 2017 from BlueWeb. (32 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 Transcutaneous Electrical Nerve Stimulators (TENS) (280.13) Retrieved May 23, 2017 from https://www.cms.gov.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Transcutaneous Electrical Nerve Stimulation (TENS) for chronic low back pain (CLBP) (160.27).) Retrieved May 23, 2017 from https://www.cms.gov.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for Transcutaneous Electrical Nerve Stimulation (TENS) for acute post-operative pain (10.2). Retrieved May 23, 2017 from https://www.cms.gov.

Chen, L., Zhou, Z., Li, Y., Ning, G., Li, Y., Wang, X., & Feng, S. (2016). Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clinical Journal of Pain, 32 (2), 146-154. Abstract retrieved May 24, 2017 from PubMed database.

Gross, T., Schneider, M., Bachmann, L., Blok, B., Groen, J., Hoen, L., et al. (2016). Transcutaneous electrical nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. European Urology, 69 (6), 1102-1111. Abstract retrieved May 24, 2017 from PubMed database.

Jauregui, J., Cherian, J., Gwam, C., Chughtai, M., Mistry, J., Elmallah, R., et al. (2016). A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surgical Technology International, 28, 296-302. Abstract retrieved May 24, 2017 from PubMed database.

Kerai, S., Saxena, K., Taneja, B., & Sehrawat, L. (2014). Role of transcutaneous electrical nerve stimulation in post-operative analgesia. Indian Journal of Anaesthesia, 58 (4), 388-393. (Level 2 evidence)

National Comprehensive Cancer Network. (2017). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Adult cancer pain, version 2.2017. Retrieved May 23, 2017 from the National Comprehensive Cancer Network.

National Institute for Health and Care Excellence. (2011). Stable angina: management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/cg126.

National Institute for Health and Care Excellence. (2014). Osteoarthritis: care and management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/cg177.

National Institute for Health and Care Excellence. (2016). Low back pain and sciatica in over 16s: assessment and management. Retrieved May 23, 2017 from www.nice.org.uk/guidance/ng59.

Salazar, A., Stein, C., Marchese, R., Plentez, R., & Pagnussat, A. (2017). Electric stimulation for pain relief in patients with fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Pain Physician, 20, 15-25. (Level 1 evidence)

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.

U.S. Food and Drug Administration. (2009). Center for Devices and Radiological Health. 510(k) Summary, K092990. Retrieved May 23, 2017 from https://www.accessdata.fda.gov/cdrh_docs/pdf9/k092990.pdf.

Wu, Y., Tsai, W., Tu, Y., & Yu, T. (2017). Comparative effectiveness of non-operative treatments for chronic calcific tendinitis of the shoulder: a systematic review and network meta-analysis of randomized-controlled trials. Archives of Physical Medicine and Rehabilitation, 2017 Apr 8. Pii: S0003-9993(17)30226-5. [Epub ahead of print]. Abstract retrieved May 24, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  7/1982

MOST RECENT REVIEW DATE:  8/23/2017   

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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