BlueCross BlueShield of Tennessee Medical Policy Manual

Electrical Stimulation for the Treatment of Arthritis


One form of electrical stimulation is sub-sensory pulsed electrical stimulation. Pulsed electrical stimulation (e.g., BioniCare Bio-1000™) using surface electrodes has been proposed for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand to improve functional status and relieve pain related to osteoarthritis and rheumatoid arthritis unresponsive to other standard therapies. In basic research studies, sub-sensory, low-voltage, monophasic pulsed electrical stimulation has been shown to alter chondrocyte-related gene expression in vitro and to have regenerative effects in animal models of cartilage injury. Therefore, pulsed electrical stimulation is proposed to be similar to bone stimulator therapy for fracture nonunion.

This device received the U.S. Food and Drug Administration (FDA) 510(k) marketing clearances to deliver pulsed electrical stimulation for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand, after finding it to be substantially equivalent to transcutaneous electrical nerve stimulation (TENS) devices. However, these systems should not be confused with other stimulators. This system is intended to stimulate the joint tissue to improve the overall health of the joint. This type of system consists of an electronic stimulator device with electrical leads that are placed over the affected area and held in place with a lightweight, flexible wrap and Velcro fasteners. It is recommended that the device be worn for at least 6 hours per day, and patients are reported to often wear the device while sleeping.


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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.


BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2014). Electrical stimulation for the treatment of arthritis (1.01.27). Retrieved October 21, 2015 from BlueWeb. (13 articles and/or guidelines reviewed)

Harrington, J. T., Hungerford, D. S., Ford, T. L., Deveshwar, S., Mines, C. M., Sheinkop, M. B. et al. (2011). New options for treating osteoarthritis of the knee. Retrieved September 11, 2012 from

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

Zeng, C., Li, H., Yang, T., Deng, Z., Yang, Y., Zhang, Y., et al. (2015). Electrical stimulation for the 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.




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