Member does not have any untreated existing substance use disorder(s) (per American Society of Addiction Medicine (ASAM) guidelines), and.Member has undergone careful screening, evaluation and diagnosis by a multidisciplinary team prior to implantation (Note: screening must include psychological as well as physical evaluations) and.The member must meet all of the following criteria:.Last resort treatment of moderate to severe (5 or more on a 10-point VAS scale) chronic neuropathic pain of certain origins (i.e., lumbosacral arachnoiditis, phantom limb/stump pain, peripheral neuropathy (including diabetic peripheral neuropathy), post-herpetic neuralgia, intercostal neuralgia, cauda equina injury, incomplete spinal cord injury, or plexopathy) that has been present for 12 or more months and.Inoperable chronic ischemic limb pain secondary to peripheral vascular disease or.Complex regional pain syndrome (CRPS) (also known as reflex sympathetic dystrophy ) Note: For clinical diagnostic criteria, see Appendix for the Budapest Criteria for Complex Regional Pain Syndrome or.Failed back surgery syndrome (FBSS) with low back pain and significant radicular pain or.This Clinical Policy Bulletin addresses spinal cord stimulation.Īetna considers the following interventions medically necessary:Ī trial of percutaneous dorsal column stimulation to predict whether a dorsal column stimulator will induce significant pain relief in members with chronic pain due to any of the following indications (1 through 4) when the criteria (5) listed below are met: “The potential ease of access and implantation of stimulators in the spinal cord compared to the brain suggests that this is a very exciting area for future exploration.”Ĭo-authors include: Rahul Chaturvedi and Rajiv Reddy, UC San Diego Takashi Agari, Tokyo Metropolitan Neurological Hospital Hirokazu Iwamuro, Juntendo University, Tokyo and Ayano Matsui, National Center Hospital of Neurology and Psychiatry, Tokyo.Number: 0194 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References “We are seeing growing data on novel uses of spinal cord stimulation and specific waveforms on applications outside of chronic pain management, specifically Parkinson’s disease,” said Chakravarthy, pain management specialist at UC San Diego Health. The authors said the findings suggest SCS may have therapeutic benefit for patients with Parkinson’s in terms of treatment for pain and motor symptoms, though they noted further studies are needed to determine whether improved motor function is due to neurological changes caused by SCS or simply decreased pain. TUG assesses physical balance and stability, both standing and in motion. Seventy-three percent of patients showed improvement in the 10-meter walk, a test that measures walking speed to assess functional mobility and gait, with an average improvement of 12 percent.Īnd 64 percent of patients experienced improvements in the Timed Up and Go (TUG) test, which measures how long it takes a person to rise from a chair, walk three meters, turn around, walk back to the chair and sit down. Researchers implanted percutaneous (through the skin) electrodes near the patients’ spines, who then chose one of three types of electrical stimulation: continuous, on-off bursts or continuous bursts of varying intensity.įollowing continuous programmed treatment post-implantation, the researchers said all patients reported significant improvement, based on the Visual Analogue Scale, a measurement of pain intensity, with a mean reduction of 59 percent across all patients and stimulation modes. Seven patients had received only drug treatments previously. Eight had undergone earlier DBS, a non-invasive, pain therapy in which electrical currents are used to stimulate specific parts of the brain. All of the patients were experiencing pain not alleviated by previous treatments. The mean age of the patients was 74, with an average disease duration of 17 years. Writing in the Septemissue of Bioelectronic Medicine, first author Krishnan Chakravarthy, MD, PhD, assistant professor of anesthesiology at University of California San Diego School of Medicine, and colleagues recruited 15 patients with Parkinson’s disease, a neurodegenerative disorder that is commonly characterized by physical symptoms, such as tremors and progressive difficulty walking and talking, and non-motor symptoms, such as pain and mental or behavioral changes. A team of researchers in the United States and Japan reports that spinal cord stimulation (SCS) measurably decreased pain and reduced motor symptoms of Parkinson’s disease, both as a singular therapy and as a “salvage therapy” after deep brain stimulation (DBS) therapies were ineffective.
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