After a systematic review of studies, the Centers for Medicare and Medicaid Services (CMS) concluded that it would drop coverage for the use of Transcutaneous Electrical Nerve Stimulation (TENS) for chronic low back pain. In a memo sent out in June, CMS stated, ““TENS is not reasonable and necessary for the treatment of [chronic low back pain].”
Before the decision, Medicare paid for FDA-approved TENS equipment when prescribed by a physician and reimbursed physicians and physical therapists for evaluating patients’ suitability for the treatment. The TENS units are usually small, portable battery operated devices that deliver electrical currents to the skin through electrodes. While TENS treatment is widespread, its efficacy is debated due to inadequate reporting and methodology in early studies.
With CMS nixing the viability of TENS, Medicare will no longer cover most TENS treatments except for patients enrolled in new clinical studies of the treatment.
The move could not ony set a precedent for denial of coverage of non-pharmacologic pain treatments, it might also have a large impact on Workers’ Compensations and Auto Insurance markets. Read More…
There are other things that also work:
In large scientifically planned studies of individuals with back pain, the following treatments have been found to have some merit statistically, i.e. they appear to be more useful than placebo treatments. They apparently accelerate the healing process and/or diminish pain while healing occurs.
Rest, but not prolonged bed rest.
Ice, applied to areas of pain.
Heat, applied to areas of pain, muscle spasm.
NSAIDs (aspirin, Aleve, Motrin, etc.) taken as directed.
Muscle relaxing medication taken as directed.
Massage by PT, chiropractor, massage therapist.
Mobilization of joints by PT, chiropractor, or massage therapist.
Walking, slowly increasing activity.
Yoga
Instruction on lifting techniques, posture, body mechanics.
Rarely, surgery for severe stenosis, severe spodylolithesis, sequestered herniated disc fragments, intractable pain, neurological deficits, or hemorrhage into the spinal cord.
Bill Yancey, MD
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