One of the leading advocates of transcutaneous electrical nerve stimulation (TENS) for chronic pain says he is “shocked and saddened” by a federal agency’s ruling that Medicare should no longer cover TENS for lower back pain.
“It’s a sad situation. Many patients that can’t use TENS are going to take more medications, have more procedures, more surgeries done. And there’s just minimal risk for this particular product,” said Joseph Shurman, MD, Chairman of Pain Management at Scripps Memorial Hospital in La Jolla, California. “It’s used around the country in most every pain clinic. It is very shocking.”
The Centers for Medicare and Medicaid Services (CMS) began its review of TENS after the American Academy of Neurology found the treatment was ineffective. “The review concluded that there was conflicting evidence for the use of TENS in the treatment of chronic low back pain and that TENS should be deemed ineffective for this purpose,” a CMS memo said. CMS also cited other reviews that failed to find clear support for TENS efficacy.
TENS units are small, battery operated devices that apply an electrical current to the skin for pain relief. Medicare currently pays for TENS equipment and supplies when prescribed by a doctor for chronic pain, and reimburses physicians and physical therapists for the treatment. Under the proposed ruling, Medicare will continue to reimburse for TENS when it’s prescribed for chronic pain other than lower back pain, such as cancer pain or post-operative pain. Reimbursement for TENS treatment of low back pain would only be available if a patient is participating in a randomized, controlled trial of TENS’ effectiveness.
“There’s no question it’d be nice to have a gigantic study. It’s just this is not big pharma that has billions of dollars,” said Dr. Shurman, who is a consultant to the TENS industry. “I was hoping that at least Medicare would continue coverage and allow a study to be done, but not to stop coverage. The product has been around for 35 years and there are multiple positive studies and analysis favoring the use of TENS. It’s going to be terrible, for the companies and for the patients. It’s sad.”
Shurman is also worried that private insurers may drop coverage of TENS, in light of the CMS ruling. “Frequently private insurance companies follow what Medicare does, that’s the problem,” Shurman told American News Report.
CMS is accepting public comments on the proposed decision until April 12, after which it will issue a final ruling.