Molly Ayala
Electrical nerve stimulation is a method used to treat pain through electrodes placed on or just beneath the skin that send small electrical impulses to underlying sensory nerve fibers to modify pain perception. It is theorized that electrical stimulation of nerve fibers blocks pain signals from reaching the brain. Electrical stimulation is also thought to reduce inflammation and swelling and to relax muscle fibers by releasing endorphins in the brain, which act as analgesics. Medicare benefits for services that fall under Part A or Part B services do not typically provide coverage for e-stim therapy as a stand-alone procedure. However, Medicare does cover some electrical nerve stimulation procedures, such as electrical stimulation for nausea, vomiting, and motion sickness, and electrical stimulation for headaches.
| Characteristics | Values |
|---|---|
| What is Percutaneous Electrical Nerve Stimulation (PENS)? | A method used to treat pain through electrodes placed on or just beneath the skin that send small electrical impulses to underlying sensory nerve fibers to modify pain perception. |
| How does it work? | It is theorized that electrical stimulation of the nerve fibers, applied near the segment of the spinal cord, blocks pain signals from reaching the brain. |
| What is it used for? | PENS is used to treat chronic neuropathic pain, axial neck and back pain, diabetic neuropathy, and opioid withdrawal. |
| What are the benefits? | PENS can help reduce inflammation and swelling, and relax muscle fibers by releasing endorphins in the brain, which act like analgesics. |
| Is it covered by Medicare? | Medicare benefits for services that fall under Part A or Part B services do not typically provide coverage for e-stim therapy as a stand-alone procedure. However, Medicare Administrative Contractors (MACs) can provide more information on coverage. |
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What You'll Learn
Medicare coverage for e-stim therapy
E-stim therapy, or electrical stimulation, is a method used to treat pain through electrodes placed on or just beneath the skin. The electrodes send small electrical impulses to underlying sensory nerve fibers to modify pain perception. It is thought that electrical stimulation of nerve fibers blocks pain signals from reaching the brain. Electrical stimulation is also thought to reduce inflammation and swelling and to relax muscle fibers by releasing endorphins in the brain, which act as analgesics.
For example, Medicare may cover functional electrical stimulation (FES) for patients with certain types of paralysis or spinal cord injuries. FES can help these patients regain limited use of their muscles. Additionally, Medicare may cover transcutaneous electrical nerve stimulation (TENS) for the treatment of certain types of pain, such as diabetic neuropathy, occipital neuralgia, and musculoskeletal pain. TENS is one of the most common forms of e-stim therapy and uses strategically placed electrodes to send signals that disrupt the brain's response to pain.
To determine if Medicare will cover a specific type of e-stim therapy, it is best to contact the Medicare Administrative Contractor (MAC) or refer to the Medicare Coverage Database, which can be found on the CMS website. These sources will provide the most up-to-date and accurate information regarding Medicare coverage for e-stim therapy.
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Peripheral nerve stimulation
Percutaneous electrical nerve stimulation (PENS) is a therapy used to treat chronic neuropathic pain. It is a minimally invasive technique that delivers electrical stimulation directly to peripheral nerves through fine needles. This method induces analgesic effects and helps normalize central pain processing, offering relief for chronic peripheral neuropathic pain. PENS therapy avoids the risks of surgery and is ideal for patients seeking non-drug treatments for pain management. It has also been found to have fewer side effects and complications compared to long-term medication use.
PENS therapy is a promising treatment option for patients with chronic intractable neuropathic pain who often struggle to find relief from conventional treatments like medication therapy or exercise. The therapy involves delivering electrical currents to nerve fibres responsible for pain, directly impacting the source of the neurological issue. The peripheral nervous system is a network of nerves that runs throughout the head, neck, and body, carrying messages to and from the central nervous system (the brain and spinal cord).
PENS therapy can be particularly useful for patients experiencing hyperalgesia (increased sensitivity to pain) and allodynia (pain from non-painful stimuli). It can also be used to target specific pain areas, such as single peripheral nerves or their smaller nerve branches. During treatment, fine probes are placed subcutaneously at the predetermined pain site, with ultrasound sometimes being used to ensure accurate placement. A combination of low and high-frequency electrical currents stimulates the release of natural pain-relieving chemicals like encephalin, β-endorphin, endomorphin, and dynorphin.
The effectiveness of PENS for musculoskeletal pain has been evaluated in several studies. For example, a 2020 systematic review and meta-analysis published in the European Journal of Pain examined the effectiveness of PENS for musculoskeletal pain. The study found that PENS was effective in reducing pain and improving physical function in patients with musculoskeletal pain conditions. Another study published in the journal Pain Physician in 2021 evaluated the effectiveness of PENS in patients with myofascial neck pain. The study found that PENS with high-frequency electrical stimulation was more effective in reducing neck pain and improving neck mobility when compared to PENS with low-frequency electrical stimulation.
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Transcutaneous electrical nerve stimulation
TENS is often used to treat muscle pain or spasms, and related conditions, as well as mobility issues. It is also used to treat bladder and bowel dysfunction in children and adolescents, and to relieve spinal pain. TENS is also used in conjunction with acupuncture in some cases.
Functional electrical stimulation (FES) is another form of e-stim, which targets paralysed muscles to help patients regain limited use of those muscles, often after a back injury, stroke, or other neurological injuries. Medicare benefits under Part A or Part B services do not typically provide coverage for e-stim therapy as a stand-alone procedure. However, TENS treatment may be considered medically necessary if it significantly alleviates pain and a physician documents the patient's likely therapeutic benefit from continuous use.
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Treatment for chronic neuropathic pain
Over-the-Counter (OTC) Pain Relievers
These include medications like acetaminophen, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve or Motrin. However, unlike most other types of pain, neuropathic pain does not usually respond well to common painkillers.
Anticonvulsant and Antidepressant Drugs
These medications are often the first line of treatment for neuropathic pain. While the exact mechanism of their effectiveness is not fully understood, it is believed that they interfere with pain signals in the body. Antidepressants can be particularly useful in providing relief from neuropathic pain as anxiety and depression can worsen the condition.
Electrical Stimulation
Electrical stimulation is a method used to treat pain through electrodes placed on or just beneath the skin that send small electrical impulses to underlying sensory nerve fibers to modify pain perception. It is theorized that electrical stimulation blocks pain signals from reaching the brain and may also reduce inflammation and swelling. One example of electrical stimulation is Transcutaneous Electrical Nerve Stimulation (TENS), which can be followed by Percutaneous Electrical Nerve Stimulation (PENS) if incomplete relief is achieved. These treatments are consistent with Medicare DME MAC guidelines.
Topical Treatments
Topical treatments such as lidocaine or capsaicin can be applied directly to the affected areas in the form of creams, ointments, or patches. Capsaicin, in particular, is thought to work by stopping the nerves from sending pain messages to the brain. However, it may cause side effects such as skin irritation and a burning or itching sensation in the treated area, and it might also affect heart rate and blood pressure.
Nerve Blocks
Nerve blocks are injections provided by a healthcare provider close to the affected nerve or group of nerves. These injections can offer temporary pain relief for neuropathic pain.
Physical Therapy
Physical therapy can help relieve soreness, stiffness, and discomfort resulting from neuropathic pain. It encourages the body to produce more natural pain-relieving chemicals and may include various types of massage and exercise.
Surgery
In some cases, surgery may be an option to release, repair, or remove certain nerves to reduce or eliminate neuropathic pain.
Psychological Counseling
In addition to medical treatments, psychological counseling can be beneficial for individuals experiencing neuropathic pain. Addressing emotional, social, and mental well-being can improve overall quality of life.
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Electrical stimulation for nausea and vomiting
Electrical stimulation is a method used to treat pain through electrodes placed on or just beneath the skin that send small electrical impulses to underlying sensory nerve fibers to modify pain perception. It is also used to treat nausea and vomiting. Transcutaneous electrical acupoint stimulation, also known as acustimulation, has been proposed as a method of treating severe nausea and vomiting that do not respond to other conservative treatments. A watch-like device is placed on the wrist and provides very mild electrical impulses to stimulate the median nerve, which is an acupuncture point thought to be effective for treating nausea and vomiting. Examples of devices used for this treatment include the PrimaBella and ReliefBand. The ReliefBand is a non-invasive and drug-free prescription treatment for nausea and vomiting due to pregnancy, chemotherapy, or post-operative reasons. It is also available over the counter for motion sickness.
Medicare Coverage Database and Aetna do not cover over-the-counter disposable ReliefBand devices because they do not meet their definition of durable medical equipment. However, the clinical policies are consistent with Medicare DME MAC guidelines. Aetna's Medical Clinical Policy Bulletins also include CPB 0676 - Electrical Stimulation for Nausea, Vomiting, and Motion Sickness (PrimaBella and ReliefBand) and Other Selected Indications.
Lee and Done (1999) evaluated the effectiveness of non-pharmacologic techniques to prevent post-operative nausea and vomiting by systematic review. These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Habib and colleagues (2006) examined whether transcutaneous acupoint electrical stimulation with the ReliefBand can prevent nausea and vomiting during surgery. They found that the combination group had a significantly higher complete response rate than the acustimulation group (73% versus 40%). In addition, fewer patients in the combination group experienced subsequent emetic events (8 compared to 18 in the acustimulation group).
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Frequently asked questions
PENS is a method of treating pain by placing electrodes on or just beneath the skin to send small electrical impulses to underlying sensory nerve fibers to modify pain perception.
Medicare benefits for services that fall under Part A or Part B services do not typically provide coverage for e-stim therapy as a stand-alone procedure. However, Medicare covers Peripheral Nerve Stimulation (PNS) in certain cases.
PNS is a form of electrical stimulation that targets nerves in the body to improve their function, reduce pain, or both.
You can contact the Medicare Administrative Contractor (MAC) who published the document. The contractor information can be found at the top of the document in the Contractor Information section.
PENS is theorized to block pain signals from reaching the brain, reduce inflammation and swelling, and relax muscle fibers by releasing endorphins in the brain, which act like analgesics.
