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High frequency (10 kHz) spinal cord stimulation (SCS) has proven effective for the management of chronic leg and back pain.1 In a statement issued in 2008, the Neuromodulation Therapy Access Coalition declared it to be “critical that patients with chronic, intractable pain have access to SCS because, for appropriate candidates, no other treatment options exist, and their condition is often partially or completely disabling. SCS provides a means to relieve pain, restore function, and improve the quality of life for these patients”.2 In addition, unlike alternative surgical procedures to relieve pain, SCS is reversible and preserves pain pathways.
The FDA also recognizes SCS “as an aid in the management of chronic intractable pain of the trunk or limbs,” points the document. This statement gathered support from leading pain medicine organizations, including the American Society of Interventional Pain Physicians and the American Academy of Pain Medicine. Yet, Blue Cross Blue Shield of Tennessee and Pennsylvania modified their policy earlier this month, dubbing SCS for the treatment of pain associated with conditions including multiple sclerosis, spinal cord lesions, acute peripheral nerve injuries, postherpetic neuralgia and cancer ‘investigational’.3,4
The American Society of Regional Anesthesia and Pain Medicine (ASRA) reacted to this change in policy by the leading health insurance provider in a letter5 referring to extensive clinical evidence and a randomized-controlled clinical trial (RCT), all supporting the efficacy of high-frequency SCS which showed significant improvement for 67% of patients, whereas a study looking at effectiveness of pharmacologic treatments to treat chronic pain found less than 50% of patients experienced improvements.6-8
In addition to its effectiveness, high-frequency SCS provides a much-needed alternative to opioids for the treatment of chronic pain, a key factor as opioid overuse has devastating consequences in the country. Such alternatives are also in line with CDC guidelines urging physicians to favor non-opioid treatments for chronic pain.
References
1.Russo M, Van buyten JP. 10-kHz High-Frequency SCS Therapy: A Clinical Summary. Pain Med. 2015;16(5):934-42.
2.Position Statement on Spinal Cord Stimulation. http://www.painmed.org/files/position-statement-on-spinal-cord-neurostimulation.pdf
3.Blue Cross Blue Shield of Tennessee Medical Policy Manual: http://www.bcbst.com/mpmanual/Spinal_Cord_Stimulation_for_Treatment_of_Pain.htm
4.Highmark Commercial Medical Policy in Pennsylvania: https://secure.highmark.com/ldap/medicalpolicy/wpa-highmark/Z-7-029.html
5.ASRA letter https://www.asra.com/content/documents/hf10.pdf
6.Al-kaisy A, Van buyten JP, Smet I, Palmisani S, Pang D, Smith T. Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med. 2014;15(3):347-54.
7.Kapural L, Yu C, Doust MW, et al. Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015;123(4):851-60.
8.Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60(11):1524-34.
