Clinical UM Guideline

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 Other 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

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.

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for all other indications.

TENS uses a battery-operated device that applies electrical stimulation at the site of pain by wired electrodes that are taped to the surface of the skin. TENS can also be delivered through the use of a form-fitting conductive garment (for example, a garment with conductive fibers that are separated from the individual’s skin by layers of fabric). This garment is applied when a condition exists that precludes conventional TENS electrode placement. TENS has been used to relieve pain related to musculoskeletal conditions, or pain associated with active or post-trauma injury.

PENS is similar in concept to TENS, but differs in that needle electrodes are implanted just beneath the skin instead of being taped to the surface of the skin. It is important to distinguish PENS from acupuncture with electrical stimulation. In electrical acupuncture, needle electrodes are also inserted just below the skin, but they are not necessarily inserted at the site of pain, but placed according to acupuncture meridians, a concept of Chinese medicine.

There are many published reports regarding the use of TENS and PENS for various types of conditions such as low back pain (LBP), myofascial and arthritic pain, sympathetically mediated pain, neurogenic pain, visceral pain, diabetic neuropathy and postsurgical pain. While randomized controlled trials (RCTs) have focused on both TENS and PENS, many of the currently available studies have methodological flaws that limit interpretation, including inadequate blinding, lack of reporting of drop outs, lack of reporting of stimulation variables, and lack of proper outcome measures (Johnson, 2015b). However, it is recognized that both TENS and PENS are widely accepted in the physician community as a treatment of a variety of etiologies of pain.

The American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) support the use of TENS in their revised guideline recommending that “TENS should be used as a multimodal approach to pain management for patients with chronic back pain and may be used for other pain conditions (e.g. neck and phantom limb pain)” (ASA/ASRA, 2010).

Current published studies of PENS for neuropathic pain (Raphael, 2011), overactive bladder (Casal-Beloy, 2021; de Abreu, 2021; Pierre, 2021) and TENS for gastric dysmotility with slow transit constipation (Yik, 2011), have shown limited success, but require adequately powered RCTs with generalizable population samples to demonstrate clinical efficacy.

Several trials, systematic reviews and meta-analyses have been published evaluating the use of TENS in a variety of pain-types, injuries and disorders including, but not limited to, type 2 diabetes (Lu, 2023), inguinal hernia repair (Parselenes, 2021), migraine headache (Domingues, 2021; Hokenek, 2021; Tao, 2018) spinal cord injury (Harvey, 2016), rotator cuff injuries (Desmeules, 2016; Mahure, 2017; Page, 2016), soft tissue injuries of the elbow (Dion, 2016), knee osteoarthritis (Chen, 2016; Cherian, 2016; Reichenbach, 2022; Wu 2022), xerostomia (Sivaramakrishnan, 2017), postoperative gastrointestinal recovery (Penfold, 2018) sickle cell disease (Pal, 2020), pelvic pain (Cottrell, 2019), urinary retention (Coolen, 2021) peripheral neuropathy (Ogle, 2020) and phantom stump pain (Johnson, 2015a); results revealed weak or inconclusive support for the use of TENS for these indications. Support for the use of TENS was found in systematic reviews conducted on its application in the treatment of dyspareunia, (Fernández‑Pérez, 2023); temporomandibular disorders (Busse, 2023; Fertout, 2019; Serrano-Muñoz D), in-office and post hysteroscopy (De Silva, 2020; Ghamry, 2020) chronic back pain (Jauregui, 2016), dysmenorrhea (Arik, 2022; Guy, 2023), total knee arthroplasty (Li, 2017; Yue, 2018; Zhu, 2017), multiple sclerosis (Sawant, 2015), post cardiothoracic surgery (Cardinali, 2021) and limb spasticity (Mahmood, 2019; Mills, 2016).

Peer Reviewed Publications:

1. Amer-Cuenca JJ, Badenes-Ribera L, Biviá-Roig G, et al. The dose-dependent effects of transcutaneous electrical nerve stimulation for pain relief in individuals with fibromyalgia: a systematic review and meta-analysis. Pain. 2023; 164(8):1645-1657.
2. AminiSaman J, Karimpour HA, Hemmatpour B, et al. Effect of transcutaneous electrical nerve stimulation on the pain intensity during insertion of needle in patients undergoing spinal anesthesia: A randomized controlled study. J Acupunct Meridian Stud. 2020; 13(3):83-86.
3. Arik MI, Kiloatar H, Aslan B, Icelli M. The effect of TENS for pain relief in women with primary dysmenorrhea: A systematic review and meta-analysis. Explore (NY). 2022; 18(1):108-113.
4. Báez-Suárez A, Martín-Castillo E, García-Andújar J Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials. 2018; 19(1):652.
5. Bai HY, Bai HY, Yang ZQ. Effect of transcutaneous electrical nerve stimulation therapy for the treatment of primary dysmenorrheal. Medicine (Baltimore). 2017. Available at: https://insights.ovid.com/pubmed?pmid=28885348. Accessed on March 21, 2024.
6. Cardinali A, Celini D, Chaplik M, et al. Efficacy of transcutaneous electrical nerve stimulation for postoperative pain, pulmonary function, and opioid consumption following cardiothoracic procedures: A systematic review. Neuromodulation. 2021; 24(8):1439-1450.
7. Casal-Beloy I, García-Novoa MA, García González M, et al. Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children. J Pediatr Urol. 2021; 17(5):644.e1-644.e10.
8. Chen LX, Zhou ZR, Li YL, et al. Transcutaneous electrical nerve stimulation in patients with knee osteoarthritis: evidence from randomized-controlled trials. Clin J Pain. 2016; 32(2):146-154.
9. Cherian JJ, Harrison PE, Benjamin SA, et al. Do the effects of transcutaneous electrical nerve stimulation on knee osteoarthritis pain and function last? J Knee Surg. 2016; 29(6):497-501.
10. Coolen RL, Groen J, Scheepe JR, Blok BFM. Transcutaneous electrical nerve stimulation and percutaneous tibial nerve stimulation to treat idiopathic nonobstructive urinary retention: A systematic review. Eur Urol Focus. 2021; 7(5):1184-1194.
11. Cottrell AM, Schneider MP, Goonewardene S, et al. Benefits and harms of electrical neuromodulation for chronic pelvic pain: A systematic review. Eur Urol Focus. 2020; 6(3):559-571.
12. Dalbem Paim É, Costa Batista Berbert M, Gonzales Zanella V, et al. Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region-A randomised clinical trial. J Oral Rehabil. 2019; 46(12):1142-1150.
13. de Abreu GE, de Souza LA, da Fonseca MLV, et al. Transcutaneous electrical nerve stimulation for the treatment of children and adolescents with bladder and bowel dysfunction: A randomized clinical trial. J Urol. 2021; 205(6):1785-1791.
14. DeJesus BM, Rodrigues IKL, Azevedo-Santos IF, DeSantana JM. Effect of transcutaneous electrical nerve stimulation on pain-related quantitative sensory tests in chronic musculoskeletal pain and acute experimental pain: systematic review and meta-analysis. J Pain. 2023; 24(8):1337-1382.
15. Delanois R, Sodhi N, Acuna A, et al. Use of home neuromuscular electrical stimulation in the first 6 weeks improves function and reduces pain after primary total knee arthroplasty: a matched comparison. Ann Transl Med. 2019. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829003/. Accessed on March 21, 2024.
16. De Silva PM, Mahmud A, Smith PP, Clark TJ. Analgesia for office hysteroscopy: A systematic review and meta-analysis. J Minim Invasive Gynecol. 2020; 27(5):1034-1047.
17. Desmeules F, Boudreault J, Roy J, et al. Efficacy of transcutaneous electrical nerve stimulation for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2016; 102(1):41-49.
18. de Sousa L, Gomes-Sponholz FA, Nakano AM. Transcutaneous electrical nerve stimulation for the relief of post-partum uterine contraction pain during breast-feeding: a randomized clinical trial. J Obstet Gynaecol Res. 2014; 40(5):1317-1323.
19. Domingues FS, Gayoso MV, Sikandar S, et al. Analgesic efficacy of a portable, disposable, and self-applied transcutaneous electrical nerve stimulation device during migraine attacks: A real-life randomized controlled trial. Pain Pract. 2021; 21(8):850-858.
20. Elboim-Gabyzon M, Andrawus Najjar S, Shtarker H. Effects of transcutaneous electrical nerve stimulation (TENS) on acute postoperative pain intensity and mobility after hip fracture: A double-blinded, randomized trial. Clin Interv Aging. 2019; 14:1841-1850.
21. Fernández-Pérez P, Leirós-Rodríguez R,  et al. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health. 2023; 23(1):387.
22. Fernández-Seguín LM, Heredia-Rizo AM, Díaz-Mancha JA, et al. Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: A randomized controlled trial. Medicine (Baltimore). 2019. Available at: Accessed on March 13, 2020.
23. Ferreira AP, Costa DR, Oliveira AI, et al. Short-term transcutaneous electrical nerve stimulation reduces pain and improves the masticatory muscle activity in temporomandibular disorder patients: a randomized controlled trial. J Appl Oral Sci. 2017; 25(2):112-120.
24. Garaud T, Gervais C, Szekely B, et al. Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation. Medicine (Baltimore). 2018; 97(52):e13782. 
25. Ghamry NK, Samy A, Abdelhakim AM, et al. AIM: To identify the highest-ranked pharmacological and nonpharmacological interventions for pain relief during outpatient hysteroscopy. J Obstet Gynaecol Res. 2020; 46(6):807-827.
26. Gross T, Schneider MP, Bachmann LM, et al. Transcutaneous electrical nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. Eur Urol. 2016; 69(6):1102-1111.
27. Gulacti U, Algin A, Turgut K, et al. Transcutaneous electrical nerve stimulation (TENS) for the treatment of renal colic in the ED: A randomized, double-blind, placebo-controlled trial. Am J Emerg Med. 2022; 56:127-132.
28. Guy M, Foucher C, Juhel C, et al. Transcutaneous electrical neurostimulation relieves primary dysmenorrhea: A randomized, double-blind clinical study versus placebo. Prog Urol. 2022; 32(7):487-497.
29. Harvey LA, Glinsky JV, Bowden JL. The effectiveness of 22 commonly administered physiotherapy interventions for people with spinal cord injury: a systematic review. Spinal Cord. 2016; 54(11):914-923.
30. He L, Tan K, Lin X, et al. Multicenter, randomized, double-blind, controlled trial of transcutaneous electrical nerve stimulation for pancreatic cancer related pain. Medicine (Baltimore). 2021; 100(5):e23748.
31. Hokenek NM, Erdogan MO, Hokenek UD, et al. Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial. Am J Emerg Med. 2021; 39:80-85.
32. Juarez MC, Kwatra SG. A systematic review of evidence based treatments for lichen simplex chronicus. J Dermatolog Treat. 2021; 32(7):684-692.
33. Jauregui JJ, Cherian JJ, Gwam CU, et al. A meta-analysis of transcutaneous electrical nerve stimulation for chronic low back pain. Surg Technol Int. 2016; 28:296-302.
34. Jawahar R, Oh U, Yang S, Lapane KL. Alternative approach: a systematic review of non-pharmacological non-spastic and non-trigeminal pain management in multiple sclerosis. Eur J Phys Rehabil Med. 2014; 50(5):567-577.
35. Kayman-Kose S, Arioz DT, Toktas H, et al. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014; 27(15):1572-1575.
36. Kwong PW, Ng GY, Chung RC, Ng SS. Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis. Clin Rehabil. 2018; 32(9):1203-1219.
37. Li J, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604662/. Accessed on March 21, 2024.
38. Lin S, Sun Q, Wang H, Xie G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: A systematic review and meta-analysis. J Rehabil Med. 2018; 50(1):3-7.
39. Lu JY, Ou HY, Wu CZ, et al. A randomized trial on the effect of transcutaneous electrical nerve stimulator on glycemic control in patients with type 2 diabetes. Sci Rep. 2023; 13(1):2662.
40. Mahmood A, Veluswamy SK, Hombali A, et al. Effect of transcutaneous electrical nerve stimulation on spasticity in adults with stroke: A systematic review and meta-analysis. Arch Phys Med Rehabil. 2019; 100(4):751-768.
41. Mahure SA, Rokito AS, Kwon YW. Transcutaneous electrical nerve stimulation for postoperative pain relief after arthroscopic rotator cuff repair: a prospective double-blinded randomized trial. J Shoulder Elbow Surg. 2017; 26(9):1508-1513.
42. Marcolino M, Hauck M, Stein C, et al. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil. 2020; 42(5):623-635.
43. Miller L, Mattison P, Paul L, Wood L. The effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in multiple sclerosis. Mult Scler. 2007; 13(4):527-533.
44. Oh H, Kim BH. Comparing effects of two different types of Nei-Guan acupuncture stimulation devices in reducing postoperative nausea and vomiting. J Perianesth Nurs. 2017; 32(3):177-187.
45. Ogle T, Alexander K, Miaskowski C, Yates P. Systematic review of the effectiveness of self-initiated interventions to decrease pain and sensory disturbances associated with peripheral neuropathy. J Cancer Surviv. 2020; 14(4):444-463.
46. Park J, Seo D, Choi W, Lee S. The effects of exercise with TENS on spasticity, balance, and gait in patients with chronic stroke: a randomized controlled trial. Med Sci Monit. 2014; 20:1890-1896.
47. Parselenes A, Paskauskas S, Kubiliute E, et al. Transcutaneous electric nerve stimulation reduces acute postoperative pain and analgesic use after open inguinal hernia surgery: A randomized, double-blind, placebo-controlled trial. J Pain. 2021; 22(5):533-544.
48. Penfold JA, Wells CI, Du, et al. Electrical stimulation and recovery of gastrointestinal function following surgery: a systematic review. Neuromodulation. 2019; 22(6):669-679.
49. Pierre ML, Friso B, Casarotto RA, et al. Comparison of transcutaneous electrical tibial nerve stimulation for the treatment of overactive bladder: a multi-arm randomized controlled trial with blinded assessment. Clinics (Sao Paulo). 2021; 76:e3039.
50. Plaza-Manzano G, Gómez-Chiguano GF, Cleland JA, et al. Effectiveness of percutaneous electrical nerve stimulation for musculoskeletal pain: A systematic review and meta-analysis. Eur J Pain. 2020; 24(6):1023-1044.
51. Qiu S, Bi S, Lin T, et al. Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis. Asian J Urol. 2019; 6(4):330-338.
52. Raphael JH, Raheem TA, Southall JL, et al. Randomized double-blind sham-controlled crossover study of short-term effect of percutaneous electrical nerve stimulation in neuropathic pain. Pain Med. 2011; 12(10):1515-1522.
53. Reichenbach S, Jüni P, Hincapié CA, et al. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis Cartilage. 2022; 30(3):426-435.
54. Resende L, Merriwether E, Rampazo ÉP, et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain. 2018 (4):663-678.
55. Rodriguez Lagos L, Arribas-Romano A, Fernández-Carnero J, et al. S. Effects of percutaneous and transcutaneous electrical nerve stimulation on endogenous pain mechanisms in patients with musculoskeletal pain: A systematic review and meta-analysis. Pain Med. 2023; 24(4):397-414.
56. Sarkies MN, Testa L, Carrigan A, et al. Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis. Age Ageing. 2023; 52(8):afad154.
57. Sawant A, Dadurka K, Overend T, Kremenchutzky M. Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis. Mult Scler Relat Disord. 2015;4(3):219-227.
58. Serrano-Muñoz D, Beltran-Alacreu H, Martín-Caro Álvarez D, et al. Effectiveness of different electrical stimulation modalities for pain and masticatory function in temporomandibular disorders: a systematic review and meta-analysis. J Pain. 2023; 24(6):946-956.
59. Sharififar S, Shuster JJ, Bishop MD. Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis. Ann Phys Rehabil Med. 2018; 61(5):339-344.
60. Sivaramakrishnan G, Sridharan K. Electrical nerve stimulation for xerostomia: a meta-analysis of randomized controlled trials. J Tradit Complement Med. 2017; 7(4):409-413.
61. Solak O, Turna A, Pekcolaklar A, et al. Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study. Thorac Cardiovasc Surg. 2007; 55(3):182-185.
62. Stepanović A, Kolšek M, Kersnik J, Erčulj V. Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation. Wien Klin Wochenschr. 2015; 127(9-10):369-374.
63. Tao H, Wang T, Dong X, et al. Effectiveness of transcutaneous electrical nerve stimulation for the treatment of migraine: a meta-analysis of randomized controlled trials. J Headache Pain. 2018; 19(1):42.
64. Tokuda M, Tabira K, Masuda T, et al. Effect of modulated-frequency and modulated-intensity transcutaneous electrical nerve stimulation after abdominal surgery: a randomized controlled trial. Clin J Pain. 2014; 30(7):565-570.
65. Weiner DK, Perera S, Rudy TE, et al. Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: a randomized controlled trial. Pain. 2008; 140(2):344-357.
66. Wu LC, Weng PW, Chen CH, et al. Literature review and meta-analysis of transcutaneous electrical nerve stimulation in treating chronic back pain. Reg Anesth Pain Med. 2018; 43(4):425-433.
67. Wu Y, Zhu F, Chen W, Zhang M. Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: A systematic review and meta-analysis. Clin Rehabil. 2022; 36(4):472-485.
68. Yang HL, Liu FC, Tsay PK, et al. Use of transcutaneous electrical nerve stimulation to alleviate thirst after surgery: A randomized controlled trial. J Perianesth Nurs. 2023; 38(2):291-296.
69. Yik YI, Clarke MC, Catto-Smith AG, et al. Slow-transit constipation with concurrent upper gastrointestinal dysmotility and its response to transcutaneous electrical stimulation. Pediatr Surg Int. 2011; 27(7):705-711.
70. Yue C, Zhang X, Zhu Y, et al.  Systematic review of three electrical stimulation techniques for rehabilitation after total knee arthroplasty. J Arthroplasty. 2018; 33(7):2330-2337.
71. Zhu Y, Feng Y, Peng L. Effect of transcutaneous electrical nerve stimulation for pain control after total knee arthroplasty: A systematic review and meta-analysis. J Rehabil Med. 2017; 49(9):700-704.

Government Agency, Medical Society and Other Authoritative Publications:

1. Agency for Healthcare Quality and Research (AHRQ). Noninvasive nonpharmacological treatment for chronic pain. Updated June 22, 2022. https://effectivehealthcare.ahrq.gov/products/noninvasive-nonpharm-pain-update/research. Accessed on March 21, 2024.
2. Amatya B, Young J, Khan F. Non-pharmacological interventions for chronic pain in multiple sclerosis. Cochrane Database Syst Rev. 2018; (12):CD012622.
3. American Academy of Neurology (AAN). Reaffirmed 2015. Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Neurology. 2010; 74(2):173-176.
4. American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA). Practice guidelines for chronic pain management. Anesthesiology. 2010; 112(4):810-833. 
5. Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023; 383:e076227.
6. Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations. Available at: http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. Accessed on March 21, 2024.
   • Supplies used in the delivery of transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES). NCD #160.13. Effective July 14, 1988.
   • Transcutaneous electrical nerve stimulation (TENS) for acute post-operative pain. NCD #10.2. Effective August 7, 1995.
   • Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (CLBP). NCD #160.27. Effective June 8, 2012.
7. Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147(7):478-491.
8. Gibson W, Wand BM, Meads C, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2019; (4):CD011890.
9. Gibson W, Wand BM, O'Connell NE. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults. Cochrane Database Syst Rev. 2017; (9):CD011976.
10. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement (ICSI). 2017 Available at: https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/pain/. Accessed on March 21, 2024.
11. Johnson MI, Claydon LS, Herbison GP, et al. Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults. Cochrane Database Syst Rev. 2017; (10):CD012172.
12. Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev. 2015a; (8):CD007264.
13. Johnson MI, Paley CA, Howe TE, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database Syst Rev. 2015b; (6):CD006142.
14. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008; (4):CD003008.
15. Kroeling P, Gross A, Graham N, et al. Electrotherapy for neck pain. Cochrane Database Syst Rev. 2013; (8):CD004251.
16. Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev. 2008; (3):CD003222.
17. Page MJ, Green S, Mrocki MA, et al. Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev. 2016; (6):CD012225.
18. Rutjes AWS, Nüesch E, Sterchi R, et al. Transcutaneous electrical nerve stimulation for knee osteoarthritis Cochrane Database Syst Rev. 2009; (4):CD002823.

Electrical Nerve Stimulation, Transcutaneous and Percutaneous
PENS (Percutaneous Electrical Nerve Stimulation)
Percutaneous Electrical Nerve Stimulation (PENS)
TENS (Transcutaneous Electrical Nerve Stimulation)
Transcutaneous Electrical Nerve Stimulation (TENS)

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