Tricare to Exclude Controversial Back Pain Therapy from Coverage

After years of not issuing guidance on the use of transcutaneous electrical nerve stimulation (TENS) to treat lower back pain, Tricare is officially excluding the machines from coverage, effective June 1.

Tricare officials said they decided to stop letting the Tricare contractors decide whether TENS was medically necessary after studies by the American College of Physicians, along with the Defense Department and Department of Veterans Affairs, found "insufficient evidence" that the treatment is effective in treating acute, subacute and chronic lower-back pain.

"Additionally, reliable evidence in published medical literature increasingly finds that TENS for lower back pain is no more effective than sham TENS (placebo)," a Tricare official said via email Friday.

TENS is electrical stimulation to nerves, muscles and tendons to relieve pain. It can be administered in a clinic or at home with a prescribed machine. Several patients in one 2011 study experienced skin irritation, one to the point of dropping out.

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Tricare contractors Humana Military and Health Net Federal Services currently must decide whether to cover an item not specifically mentioned in the Tricare manual, like TENS was. The decision to cover is made after the contractors prove it to be safe and effective, medically necessary, and appropriate, the Tricare official said.

"Physical therapy visits, where the only treatment provided is TENS for lower back pain, are not eligible for cost sharing," the Tricare official added. "TENS therapy delivered during an otherwise covered physical therapy visit would also be ineligible for cost sharing."

The exclusion from coverage later this year will affect both TENS treatments at home or those directly provided at a clinic.

-- Dorothy Mills-Gregg can be reached at dorothy.mills-gregg@military.com. Follow her on Twitter at @DMillsGregg.

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