Electrical and electromagnetic stimulation are being investigated to improve functional status and relieve pain related to osteoarthritis and rheumatoid arthritis that are unresponsive to standard therapies. Noninvasive electrical stimulators (e.g., BioniCare Bio-1000™ stimulator, OrthoCor™ Active Knee System) generate a weak electrical current within the target site using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields. In capacitive coupling, small skin pads/electrodes are placed on either side of the knee or wrist. Electrical stimulation is provided by an electronic device that noninvasively delivers a sub-sensory low-voltage, monophasic electrical field to the target site of pain. Pulsed electromagnetic fields (e.g., aMP™ Orthopedics) are delivered via treatment coils placed over the skin. Combined magnetic fields deliver a time-varying field by superimposing that field onto an additional static magnetic field.It is proposed that pulsed electrical stimulation treats the underlying cause of arthritis by stimulating the joint tissue and improving the overall health of the joint to provide a slow-acting, but longer-lasting improvement in symptoms. Pulsed electrical stimulation is proposed to be similar to bone stimulator therapy for fracture nonunion.
Electrical or electromagnetic stimulation for the treatment of osteoarthritis or rheumatoid arthritis is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
No studies were found for the use of electrical stimulation for rheumatoid arthritis and only a few, small trials were found pertaining to the use of electrical stimulation for treating knee osteoarthritis. There is a lack of evidence showing improved health outcomes with the use of electrical stimulation in comparison to other available treatments for the treatment of arthritis. Therefore this technology remains investigational.
American Academy of Orthopaedic Surgeons (2013). Treatment of osteoarthritis of the knee; evidence based guideline, 2nd ed. Retrieved September 22, 2016 from: http://www.aaos.org/guidelines.
American College of Rheumatology. (2016). 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Retrieved August 9, 2017 from www.arthritisrheum.org.
Bagnato, G.L., Miceli, G., Marino, N., Sciortino, D. & Bagnato, G.F. (2016). Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Rheumatology, 55, 755-762. (Level 2 evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2018). Electrical stimulation for the treatment of arthritis (1.01.27). Retrieved August 6, 2018 from BlueWeb. (17 articles and/or guidelines reviewed)
CGS Administrators, LLC. (2017, January). Local Coverage Determination (LCD): Transcutaneous electrical joint stimulation devices (TEJSD). L34821). Retrieved August 9, 2017 from www.cms.gov.
National Institute for Health and Care Excellence. (2014). Osteoarthritis: care and management. Retrieved August 9, 2017 from www.nice.org.uk/guidance/cg177.
Negm, A., Lorbergs, A., & Macintyre, N.J. (2013). Efficacy of low frequency pulsed subsensory threshold electrical stimulation vs placebo on pain and physical function in people with knee osteoarthritis: systematic review with meta-analysis. Osteoarthritis Cartilage, 21 (9), 1281-1289. Abstract retrieved August 9, 2017 from PubMed database.
Nelson, F., Zvirbulis, R., and Pilla, A. (2013). Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study. Rheumatology International, 33 (8), 2169-2173. Abstract retrieved September 22, 2016 from PubMed database.
U. S. Food and Drug Administration. (2008, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K07541. Retrieved August 9, 2017 from http://www.accessdata.fda.gov.
U. S. Food and Drug Administration. (2008, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K073386. Retrieved September 10, 2012 from http://www.accessdata.fda.gov.
Zeng, C., Li, H., Yang, T., Deng, Z., Yang, Y., Zhang, Y., et al. (2015). Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage, 23 (2), 189 - 202. Abstract retrieved October 21, 2015 from the PubMed database.
ORIGINAL EFFECTIVE DATE: 3/14/2013
MOST RECENT REVIEW DATE: 9/13/2018
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