This document addresses transcutaneous electrical nerve stimulation (TENS) and percutaneous electrical nerve stimulation (PENS). 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 of the nerve fibers, applied near the segment of the spinal cord, blocks pain signals from reaching the brain. Electrical stimulation is also theorized to reduce inflammation and swelling, and to relax muscle fibers by releasing endorphins in the brain, which act like analgesics. The use of acupuncture with electrical stimulation is not addressed in this document.

Note: Transcutaneous electrical modulation pain reprocessing ([TEMPR], e.g. Scrambler Therapy) using multichannel TENS devices are addressed by DME.00011 Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices.

Note: Please see the following related document(s) for additional information:

• CG-ANC-03 Acupuncture
• CG-DME-03 Neuromuscular Stimulation in the Treatment of Muscle Atrophy
• CG-SURG-09 Temporomandibular Disorders

Clinical Indications

Medically Necessary:

1. TENS and PENS units are considered medically necessary when prescribed as a treatment for pain for those who have not responded to other modalities, in the following situations:
   1. Pain related to musculoskeletal conditions; or
   2. Pain associated with active or post trauma injury. 
2. A TENS garment, when prescribed, is considered medically necessary when:
   1. There is a large area or many sites to be stimulated such that use of conventional electrodes, adhesive tapes and lead wires is not feasible; or
   2. The areas or sites to be stimulated are inaccessible with the use of conventional electrodes, adhesive tapes and lead wires; or
   3. There is a documented medical condition such as skin problems that preclude the application of conventional electrodes, adhesive tapes and lead wires.

Not Medically Necessary:

Use of TENS and PENS is considered not medically necessary when the above criteria are not met and for all other indications.