BlueCross BlueShield of Tennessee Medical Policy Manual

Electrical Stimulation for the Treatment of Arthritis

DESCRIPTION

Pulsed electrical and electromagnetic stimulation devices are being investigated as a means to improve functional status and relieve pain related to forms of arthritis unresponsive to standard therapies. Electrical stimulation is provided by electronic devices that noninvasively deliver a subsensory low-voltage, monophasic electrical field to the target site via treatment coils placed over the skin.

Pulsed electrical stimulation devices (e.g., BioniCare Bio-1000™) using surface electrodes have been proposed for the treatment of osteoarthritis of the knee and rheumatoid arthritis of the hand to improve functional status and relieve pain. 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.

Pulsed electrical stimulation is proposed to be similar to bone stimulator therapy for fracture nonunion. While there is some evidence of improved function there is no evidence of reduced pain. Clinical studies conclusions are limited by methodologic shortcomings and inconsistency of trial results.

POLICY

See also: 

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

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.

SOURCES 

American Academy of Orthopaedic Surgeons (2013, May) Treatment of osteoarthritis of the knee; evidence based guideline. Retrieved September 22, 2016 from: http://www.aaos.org/guidelines.

BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2014). Electrical stimulation for the treatment of arthritis (1.01.27). Retrieved September 22, 2016 from BlueWeb. (14 articles and/or guidelines reviewed)

Nelson, F., Zvirbulis, R., and Pilla, A., (2013, August) 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):2169-73. Abstract retrieved September 22, 2016 from PubMed database.

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 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.

ORIGINAL EFFECTIVE DATE:  3/14/2013

MOST RECENT REVIEW DATE:  11/10/2016

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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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