BlueCross BlueShield of Tennessee Medical Policy Manual

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

DESCRIPTION

Percutaneous electrical nerve stimulation (PENS) and percutaneous neuromodulation therapy (PNT) have been evaluated for the treatment of a variety of chronic musculoskeletal or neuropathic pain conditions including low back pain, neck pain, diabetic neuropathy, chronic headache, and surface hyperalgesia. PENS is similar in concept to transcutaneous electrical nerve stimulation (TENS) but differs in that needles are inserted either around or immediately adjacent to the nerves serving the painful area and are then stimulated. PENS is also distinguished from acupuncture with electrical stimulation. In electrical acupuncture, needles are also inserted just below the skin, but the placement of needles is based on specific theories regarding energy flow throughout the human body. In PENS, the location of stimulation is determined by proximity to the pain. 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.

PNT is a variant of PENS in which fine filament electrode arrays are placed near the area causing pain. It is proposed that PNT inhibits pain transmission by creating an electrical field that hyperpolarizes C fibers, thus preventing action potential propagation along the pain pathway.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The literature for percutaneous electrical nerve stimulation (PENS) and percutaneous neuromodulation therapy (PNT) consists primarily of small controlled trials with unclear blinding and short follow-up.  The available evidence is insufficient to permit conclusions concerning the effect of this procedure on health outcomes.

SOURCES

American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy of Physical Medicine & Rehabilitation. (May, 2011; reaffirmed 2016). Evidence-based guideline: treatment of painful diabetic neuropathy. Retrieved January 24, 2018 from the National Guideline Clearinghouse (NGC: 008504).

American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. (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.Anesthesiology, 112 (4), 810-833.

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2017). Percutaneous electrical nerve stimulation and percutaneous neuromodulation therapy (7.01.29). Retrieved January 24, 2018 from BlueWeb. (19 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination: NCD for assessing patient’s suitability for electrical nerve stimulation therapy (160.7.1). Retrieved March 30, 2016 from https://www.cms.gov.

He, D.P.,Zhang, J., & Bai, Z.F. (2017). Percutaneous electrical nerve stimulation for chronic knee pain: a randomized, sham-controlled trial. Alternative Therapies in Health and Medicine, pii:AT5664. [Epub ahead of print] Abstract retrieved January 24, 2018 from PubMed database.

National Institute for Health and Care Excellence. (2013, March).Percutaneous electrical nerve stimulation for refractory neuropathic pain. Retrieved January 24, 2018 from www.nice.org.uk/guidance/ipg450.

Rossi, M., DeCarolis, G., Liberatoscioli, G., Iemma, D., Nosella, P., & Nardi, L.F. (2016). A novel mini-invasive approach to the treatment of neuropathic pain: the PENS study. Pain Physician, 19 (1), E121-E128. Abstract retrieved March 30, 2016 from PubMed database.

U.S. Food and Drug Administration. (2002, September). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K022241. Retrieved January 24, 2018 from http://www.fda.gov.

U.S. Food and Drug Administration. (2005, December). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K052289. Retrieved December 12, 2011 from http://www.fda.gov.

U.S. Food and Drug Administration. (2006, August). Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K061166. Retrieved December 12, 2011 from http://www.fda.gov.

Winifred S. Hayes, Inc. Technology Brief. (2017). Percutaneous electrical nerve stimulation for treatment of low back pain. Retrieved January 24, 2018 from www.Hayesinc.com/subscribers. (26 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  3/1980

MOST RECENT REVIEW DATE:  2/8/2018

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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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