A powerful California Congressman has injected himself into the debate over a non-narcotic pain relief treatment that has been used for over three decades to treat chronic pain.
Rep. Darrell Issa, Chairman of the House Committee on Oversight and Government Reform, wants to know why the Centers for Medicare and Medicaid Services (CMS) plans to discontinue long-standing Medicare coverage for transcutaneous electrical nerve stimulation (TENS) for patients with chronic low back pain.
TENS involves the delivery of an electric current to the skin through surface electrodes, primarily for the purpose of pain relief. Chronic low back pain is generally considered low back pain that has persisted for at least three months.
Congressman Issa, in a letter dated May 3, wrote that “TENS has long been recognized by CMS as an effective treatment for Medicare beneficiaries with low back pain and its costs have long been covered by Medicare when prescribed by physicians.” Issa asked the CMS to provide him with information explaining the rationale behind its decision.
CMS will issue a final ruling on TENS coverage for chronic low back pain on June 11. CMS’s proposal is to provide TENS coverage only to those Medicare patients who are enrolled in a prospective clinical study with a randomized controlled design. Industry officials have been pointing out that clinical studies enroll only limited patients and are generally restricted to specific geographic regions.
The American News Report first reported on the matter March 15. The proposed CMS decision memo can be read here. A website petition has been signed by nearly 8,000 patients and clinicians protesting the decision.
This debate comes at an interesting time. The chronic pain world is already reeling from reports of possible over prescription of pain medication as well as the pharmaceutical industry’s influence on various non-profit pain organizations.
One pain physician noted that if TENS coverage is dropped, the options available to treat the elderly greatly diminish. “In my practice, a TENS unit is a first line therapy. It is a conservative approach that allows the patient to have control over their pain,” said Dr. Matthew Kaplan of All Saints Hospital in Racine,Wisconsin.”
Physical therapists also use TENS in their practice to treat chronic pain patients. Dana Dailey has been a physical therapist for 24 years and is currently pursuing her doctorate in physical therapy at the University of Iowa.
“TENS has been a safe and affordable treatment with minimal side effects. It allows for self-management of pain in conjunction with medication, exercise and other treatments,” said Dailey. “I use TENS in both acute and chronic conditions to decrease pain and increase function.”
If the CMS decision stands, other private insurers may eventually stop covering TENS as well.