Posts Tagged ‘t.e.n.s’

Medicare Will Stop Reimbursing Patients for TENS Unit Purchases

Sunday, July 15th, 2012

Recently, the Center for Medicare Services announced that it will no longer cover TENS unit therapy. Tens unit, which stands for transcutaneous electrical nerve stimulation, is a low-cost and low-risk therapy for alleviating pain.

The memo that was released by CMS stated “tens is not reasonable and necessary for the

TENS units

TENS Unit

treatment of chronic low back pain,”. In addition, the memo stated that tens units will only be reimbursed when the patient is part of a randomized, controlled trial looking at the effectiveness of the treatment.

The units are about the size of an iPod and patients can wear them on their belt. The units emit slight electrical impulses to go through foam pads on the skin for the purpose of providing a low risk method of relieving many types of pain. While it has been known for some time that the effectiveness of tens units has been inconclusive, the report a couple years ago from the American Academy of Neurology found the treatment not to be effective.

Interestingly, when most Arizona pain doctors and chiropractors are interviewed they say that their patients get great results from using TENS units. There are plenty of anecdotes of patients seeing excellent results from tens units, for instance at pain management Scottsdale clinics. However, CMS based its decision on formal clinical studies to draw its conclusion.

The issue with tens units are that they have not worked exceptionally well in larger studies. And unfortunately that is what CMS is looking at in this cost-saving mechanism by cutting the coverage.

Arizona pain centerWhen you consider how big of a problem opioid overdosing is these days, any type of low-cost and low risk device that can reduce the need for narcotic pain medications should be kept in place. In fact, it appears that further research studies should have been conducted prior to this decision being put forward.

An online petition while CMS was considering the move collected over 10,000 signatures asking for coverage to be continued. the decision to simply rely on research studies which may in fact have some bias and other flaws discounts significant judgment of medical providers and a considerable amount of positive patient experiences.

It is an ironic outcome against a low risk technology that has in fact shown benefit to many patients in a time of need. Reducing the need for narcotics in acute flareups of low back pain is what TENS units are very good for and now the cost for these will fall on the patient. Thankfully over the last decade the cost of TENS units for the patient has dropped a considerable amount. Most tens units can be obtained at cost of less than $100.

For a patient who wants a fast acting answer to their pain with no potential for addiction and minimal sedation, TENS units are great.

The end result is not a ban on TENS units thankfully, but a shifting of the cost of tens unit treatment for the patient. Private insurance companies for the moment will still be able to pay for tens units if it is part of a person’s coverage. If you lived in Arizona and suffer from chronic pain or acute pain such as sciatica or your “back gave out”,  Arizona Pain Specialists can help you.

These AZ pain clinics have locations all over the valley serving Phoenix, Scottsdale, Glendale, Chandler, Mesa, Tempe, Ahwatukee, Queen Creek, Surprise, Goodyear, Peoria and more.

6 Pain Management Experts Respond to CMS’ Cancelled TENS Reimbursement

Wednesday, June 27th, 2012
The Centers for Medicare and Medicaid Services last week announced that most uses of transcutaneous electrical nerve stimulation will no longer be reimbursed as treatment for chronic low back pain. In a memo released Friday, CMS officials wrote that reimbursement for TENS will be available only when patients are participating in a randomized, controlled trial to gauge the clinical effectiveness of the treatment.

Medicare previously paid for FDA-approved TENS equipment and supplies when prescribed by a physician for chronic pain and reimbursed physicians and physical therapists for evaluating patients’ suitability for the treatment.

Five pain management experts weigh in on the CMS decision.

Pamela D’Amato, MD, Pain Management Specialist, Advanced Interventional Pain Management (Clifton, N.J.): I feel that the CMS ceasing reimbursement for TENS treatment is surprising. In the climate of pain management, with the over prescription of opioid medications, it is always nice to have a non-medication and non-interventional alternative, in my arsenal of treatment options. Unfortunately, we now run the risk of the private insurance companies following the CMS’s stance. It limits the concept of a multi-modal approach to patients with chronic low back pain. A TENS unit can be beneficial for a patient, they can utilize it on their own and often with little adverse side effects.

Dale Hammer, MA, PT, MHSA, SVP Global Compliance and Government Relations, DJO Global (Vista, Calif.): We are very disappointed in the CMS decision. For over 30 years, the medical community has used TENS as a safe and effective alternative or adjunct to a pharmacological approach to pain control. It is going to be very difficult for us to tell our Medicare patients that they no longer have covered access to a technology that has helped many thousands of Medicare patients effectively and safely manage their chronic low back pain. Restricting access to this technology could necessitate greater use of potentially addictive narcotics and in some cases result in the need for surgical intervention.

An online petition collected over 10,000 patient and provider signatures asking CMS not to eliminate coverage. Nevertheless, CMS stated in their Decision Memo that “evidence from formal clinical studies is more persuasive [than patient experience] to draw confident conclusions about the impact of medical technologies.” Their approach essentially discounts many years of clinician professional judgment and patient experience. Unfortunately, we do not believe that CMS has taken into consideration the impact that this decision will have on the segment of the Medicare population with chronic low back pain.

CMS has stated that they may reconsider their decision based on favorable results from randomized clinical trials, however, aside from the fact that such studies cost millions of dollars and take years to complete, we do not believe such studies are necessary or appropriate for TENS technology. While additional evidence can help refine treatment practices for virtually any medical technology, there are very few circumstances that justify essentially revoking patient access to a technology that has been long accepted in the medical community and has no safety concerns. Given this is the approach the CMS has decided to take, however, we feel that CMS should delay any coverage restrictions for at least two years so that the Medicare population is not denied longstanding Medicare coverage during this evidence-gathering process.

Moshe Lewis MD, Chief of Department of Physical Medicine and Rehabilitation, California Pacific Medical Center (San Francisco): In a time where CMS is looking critically at treatments that can be cut due to limited benefit, TENS units will have to be covered by patients. The literature shows that while they are of benefit in a small number of patients, the majority of patients do not benefit from this intervention. Now, given modern technology TENS unit costs have decreased to the point that most people can afford to buy these independently.

Charles Chabal, MD, President of the Washington Academy of Pain Management, Pain Management Specialist, Evergreen Pain Management (Kirkland, WA): As a board certified pain management specialist who offers both interventional and pain management treatment, I believe the CMS decision to revoke coverage for TENS goes against a long history of many pain physicians’ clinical experience.

I believe there are many problems with the Cochrane review studies that influenced CMS’ decision unfortunate — and I believe misguided — decision about TENS treatments. For example, I and many of my peers and colleagues believe that the global outcomes measures used in those studies may not have targeted the appropriate intervention. In addition, I don’t believe the Cochran review studies controlled for comorbid psychosocial factor such as undiagnosed depression, poorly treated depression, sleep disorders, quality of life or anxiety. Also, as we’ve seen in my home state of Washington, the sponsoring agency of a study often picks statistical consultants who clearly have a bias towards these review methodologies. There is a growing body of literature to support the bias and limitations of these review analyses.

I would also add that many pain specialists use TENS to treat exacerbations of low back pain. The mainstay long-term treatment of LBP often includes physical exercise and medication management. However, in the real world, most patients will suffer from acute flare-ups and exacerbations within the context of their chronic condition. For these flare-ups, TENS is very useful non-drug option. Unfortunately, most Cochrane review articles make little or no mention of this common and effective use. As professional societies and government health organizations highlight the limitations and complications of pain medications such as opioids (overdose, death, falls and fractures, constipation, etc.), NSAIDS (bleeding and kidney failure) and acetaminophen (hepatic toxicity), I find it ironic that our ability to offer an effective non-drug intervention will be limited. This has the effect of limiting very safe options for both the treating physician and patient and forcing treatments that clearly have potential serious side effects and complications.

Scott Gottlieb, MD, Director of Pain Management, New York Eye and Ear Infirmary (New York City): If TENS units are not covered, it would be a huge setback for pain patients because there is not a sufficient amount of safe, effective, non-invasive treatments for pain. There is a lot of risk when prescribing pain medications (narcotics) and a TENS unit has none of the issues that narcotics are associated with. If a TENS unit has provided relief to millions of low back pain sufferers, why eliminate it?

Jeremy Scarlett, MD, Pain Management Specialist, Advanced Pain Management (Milwaukee, Wisc.): I see the recent CMS decision to halt reimbursement for TENS treatment for chronic back pain as yet another setback in the field of pain management. Any depletion in the treatment arsenal is a setback for a difficult to treat condition. Opioids, antidepressants and muscle relaxants provide some nonnarcotic benefit, but they often have side effects. Many of my patients, particularly the elderly, want a fast-acting solution for their pain that provides minimal sedation and does not affect their mental clarity or bowel function. The TENS unit is an excellent option for these patients and others who will suffer if TENS treatments are no longer covered by CMS.

In the face of the national crisis of opioid dependence, addiction and abuse, CMS is making a decision that takes away a viable alternative to the prescription of narcotics. Patients who receive TENS treatments do not run the risk of addiction or face dangerous interactions from mixing alcohol or benzodiazepines with treatments. I wish CMS would consider the direct and indirect costs both to the patient and to society of the alternatives to the therapies they no longer cover.

Take Out Tennis Elbow With TENS Therapy Units

Tuesday, June 5th, 2012

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players.

The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow–painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendon. Tendons connect muscles to bone.

Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other.

When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things, hit a tennis ball in a backhand swing in tennis, or do other similar actions.

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.

The problem is within the cells of the tendon. Doctors call this condition tendinosis. In tendinosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.

The body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.

The forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.

The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers. The forearm muscles may also feel tight and sore.

The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won’t straighten out completely.

The physical exam is often most helpful in diagnosing tennis elbow. Your doctor may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow.

When the diagnosis is not clear, your doctor may order other special tests. An MRI scan is a special imaging test that uses magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones.

The key to conservative (nonsurgical) treatment is to keep the collagen from breaking down further. The goal is to help the tendon heal.

If the problem is caused by acute inflammation, anti-inflammatory medications such as ibuprofen may give you some relief. If inflammation doesn’t go away, your doctor may inject the elbow with cortisone. Cortisone is a powerful anti-inflammatory medication.

Doctors commonly have patients with tennis elbow work with a physical or occupational therapist. At first, your therapist will give you tips how to rest your elbow and how to do your activities without putting extra strain on your elbow. Your therapist may apply tape to take some of the load off the elbow muscles and tendons. You may need to wear an elbow strap that wraps around the upper forearm in a way that relieves the pressure on the tendon attachment.

Your therapist may apply ice and electrical stimulation to ease pain and improve healing of the tendon. Electrical stimulation is often used to reduce pain and promote healing. It is a method used to relieve pain in an injured or diseased part of the body. Electrodes applied to the skin deliver low voltage intermittent stimulation to surface nerves in the skin. The transmission of pain signals is blocked and endorphins are released. Endorphins are the body’s natural pain killers.

Electrical stimulation is also known as transcutaneous electrical nerve stimulation (TENS). TENS refers to many types of electrical units that are used to relieve pain. Electrodes are placed on the skin near the injured area and attached to a stimulator by flexible wires. Electrical impulses are then produced to give relief from pain. The battery-operated unit is portable and can be used at home by the patient.

TENS is non-invasive and non-addictive. It has no side effects and can be used to treat acute or chronic pain. Persons who use pacemakers must not use any form of TENS. The electrical impulses may interfere with the pacemaker’s action.

Exercises are used to gradually stretch and strengthen the forearm muscles.

Because tendinosis is often linked to overuse, your therapist will work with you to reduce repeated strains on your elbow. When symptoms come from a particular sport or work activity, your therapist will observe your style and motion with the activity. You may be given tips about how to perform the movement so the elbow is protected. Your therapist can check your sports equipment and work tools and suggest how to alter them to keep your elbow safe.

Pain Management Tips for Lower Back Pain / Degenerative Disks

Tuesday, April 10th, 2012

Ninety percent of Americans will suffer from back pain at some point, and all but ten percent will resolve their back pain uneventfully. Out of the remaining five to ten percent whose pain becomes chronic, a significant amount have degeneration of one or multiple intervertebral discs.

First it must be understood that degenerative disk disease represents a quality of life issue. It is not a true disease in the sense of something like liver disease or cancer that may need life-saving surgery. Degenerative Disc Disease is a condition that is confined to a focal area and a person can live with it and skip surgery, although it may be debilitating.

Treatment options include:

1)Activity Modification and Weight Loss

2)Aerobic Exercise

3)Bracing

4)TENS

5)Medications

6)Physical Therapy

7)Chiropractic Treatment

8)Spinal Decompression Treatment

9)IDET

10)Interventional Pain Injections

11)Surgery - Fusion or Artificial Disc Replacement

Activity Modification is not a very exciting option. It simply means not performing painful activities. If jogging hurts the back, switch to swimming or a cross training activity that does not hurt. Weight loss may decrease the amount of pressure on the ruptured or degenerated disk, and could alleviate pain.

Aerobic exercise has been shown in studies to be very beneficial for the health of the lumbar disc.Whether it’s cycling or swimming the disc receives benefits from the activity.

Back bracing can be very helpful for pain relief. Studies have been equivocal on the benefits of bracing, however, it represents an inexpensive method of pain relief which anecdotally has been shown to provide excellent pain management relief for patients.

TENS units are a safe non-invasive drug free method of pain management that can help decrease the need for pain medication and also supplement treatment being received for pain control. A TENS unit is a device that transmits small square electrical pulses to the electrodes, which transmit this electrical pulse to the underlying soft tissues of the lumbar region.

Pain Medications include Tylenol (acetaminophen), NSAIDS, and narcotic pain medication in addition to muscle relaxers. There is a significant potential for narcotic abuse in the age group associated typically with DDD so caution should be exercised.

Physical Therapy including core stabilization and lumbar strengthening can help with pain relief for degenerative disc disease. Strengthening the paraspinal muscles around the problem disc(s) can help unload the disk and decrease pain.

Chiropractic Treatment has been shown in numerous studies to assist with back pain that is acute in nature. In conjunction with spinal decompression, the results can be quite impressive. Spinal Decompression Treatment is a revolutionary therapy which unloads the disc space and allows increased oxygen and nutrients to flow into the intervertebral disk. This can help repair an injured disc, thereby stopping back pain.

IDET stands for intervertebral discal electrothermal treatment. It was very popular for a few years then the results were shown to be less favorable than originally thought. A significant amount of insurance companies decided to stop reimbursing for it based on the questionable results so it has since fallen out of favor.

Interventional pain management injections by pain doctors can be extremely beneficial. If there is a radicular component to the DDD, epidural injections may help. If there is associated facet arthritis, facet injections can help. There is no intra-discal injection yet that has shown to assist with pain relief for DDD.

If all non-operative methods fail, as a quality of life decision surgery can electively be done. Options for surgery include spinal fusion or an artificial disc replacement. The results are between 50-70% good to excellent.Success does not necessarily mean the pain goes to zero. Usually it’s relieved by one half or so with the definition of success.

The Benefits Of Using TENS Units For Athletes

Friday, March 9th, 2012

Athletes put their bodies through incredible amounts of stress and strain, but they are usually able to recover quickly thanks to their high levels of conditioning. Sometimes, though, muscle pain and soreness will not subside. Although rest is the best solution for pain and soreness, many athletes do not have time to give their bodies a break. This is especially true in the midst of a competitive season, during which one missed day can mean the difference between winning and losing. Thankfully, TENS units for athletes are becoming more popular. These units can be used to ease the recovery from pain and soreness, plus they can help rebuild muscle tissue in the event of an injury like a pull or a tear. This keeps athletes from having to take valuable time away from their sports.

TENS stands for Transcutaneous Electrical Nerve Stimulation. The units work by sending electrical pulses into the body which prevent pain signals from reaching the brain. Additionally, TENS units can help with the body’s creation of endorphins, which can make the recovery process go more quickly. By using these units regularly when injuries or pains occur, athletes can also experience a decrease in the amount of time it takes to heal from common injuries and pains.

Because TENS units stimulate the body with small electrical shocks, they should not be used without the proper training and guidance from a physician. The machines are simply too dangerous to be used without supervision from a medical professional. Once a patient has been shown how to operate a TENS unit properly, he or she can use it as directed to help the recovery process.

One of the most appealing aspects of using TENS units for athletes is that the machines are highly portable. For this reason, the units can be used almost anywhere at any time. Athletes love this aspect since they often have very little time to devote to recovery in between workouts and jobs. In fact, an athlete could go to the gym in the morning and use his or her workday to recover by using the TENS unit. The machines are compact, quiet and effective when used properly.

Being an athlete today requires a significant commitment in terms of time and effort. When injuries happen, it can throw a training program or competitive schedule completely off track. Recovering from pain, soreness and injuries takes time, but by using TENS units for athletes, people can get back to training and playing in very little time. The machines are effective and very easy to use, plus they can be used virtually anywhere at any time. TENS units are truly revolutionary when it comes to athletic recovery.