Electrical stimulation and electromagnetic therapy are technologies proposed to promote wound healing by increasing or accelerating the biological activities involved in wound healing, including migration of neutrophils and macrophages, stimulation of fibroblasts, and improved blood flow.
Electrical stimulation involves the application of electrical current through electrodes applied directly to the skin in close proximity to the target wound. The types of electrical stimulation devices can be categorized into groups based on the type of current. This includes low intensity direct current (LIDC), high voltage pulsed current (HVPC), alternating current (AC), and transcutaneous electrical nerve stimulation (TENS).
Electromagnetic therapy is a related but distinct form of treatment that involves the application of electromagnetic fields rather than direct electrical current.
Electrical stimulation using low-intensity direct current (LIDC), high-voltage pulsed current (HVPC), alternating current (AC), or transcutaneous electrical nerve stimulation (TENS) for the treatment of wounds in any setting is considered investigational.
Electromagnetic therapy for the treatment of wounds is considered investigational.
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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.
At present no electrical stimulation or electromagnetic therapy devices have received approval from the U. S. Food and Drug Administration (FDA) specifically for the treatment of wound healing. A number of devices have been cleared for marketing for other indications. Use of these devices for wound healing is an off-label indication.
American College of Physicians. (2015). Treatment of pressure ulcers: a clinical practice guideline from the American College of Physicians. Retrieved October 18, 2016 from http://annals.org.
Association for the Advancement of Wound Care. (2010). Pressure ulcer guidelines. Retrieved November 17, 2015 from http://aawconline.org.
Barnes, R., Shahin, Y., Gohil, R., & Chetter, I. (2014). Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomized controlled trials. European Journal of Clinical Investigation, 44 (4), 429-440. Abstract retrieved October 18, 2016 from PubMed database.
BlueCross BlueShield Association. Evidence Positioning System. (2:2019). Electrostimulation and electromagnetic therapy for treating wounds (2.01.57). Retrieved August 26, 2019 from https://www.evidencepositioningsystem.com/. (18 articles and/or guidelines reviewed)
Center for Medicare and Medicaid Services. CMS.gov. NCD for electrical stimulation and electromagnetic therapy for the treatment of wounds (270.1) Retrieved October 18, 2016 from https://www.cms.gov.
International Consolidated Venous Ulcer Guideline. (2015). Update of AAWC Venous Ulcer Guideline, 2005 and 2010. Retrieved August 25, 2017 from http://aawconline.org.
Khouri, C., Kotzki, S., Roustit, M., Blaise, S., Gueyffier, F., & Cracowski, J.L. (2017). Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: an effect size meta-analysis. Wound Repair and Regeneration, 25 (5), 883-891. Abstract retrieved August 27, 2019 from PubMed database.
Lala, D., Spauling, S.J., Burke, S.M., & Houghton, P.E. (2016). Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis. International Wound Journal, 13 (6), 1214-1226. Abstract retrieved August 27, 2019 from PubMed database.
Miller, C., McGuiness, W., Wilson, S., Cooper, K., Swanson, T., Rooney, D., et al. (2017). Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial. Journal of Wound Care, 26 (3), 88-98. Abstract retrieved August 25, 2017 from PubMed database.
Polak, A., Kloth, L.C., Blaszczak, E., Taradaj, J., Nawrat-Szoltysik, A., Ickowicz, T., et al. (2017). The efficacy of pressure ulcer treatment with cathodal and cathodal-anodal high-voltage monophasic pulsed current: a prospective, randomized, controlled clinical trial. Physical Therapy, 97 (8), 777-789. Abstract retrieved August 27, 2019 from PubMed database.
Thakral, G., LaFontaine, J., Najafi, B., Talal, T., Kim, P., & Lavery, L. (2013). Electrical stimulation to accelerate wound healing. Diabetic Foot & Ankle, (4) 22081. (Level 2 evidence)
ORIGINAL EFFECTIVE DATE: 4/1/2003
MOST RECENT REVIEW DATE: 10/10/2019
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