Pending Policies - Medicine


Interferential Current Stimulation

Number:MED201.041

Effective Date:08-15-2018

Coverage:

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Interferential current stimulation is considered experimental, investigational and/or unproven.

Description:

Interferential current stimulation (IFS) is a type of electrical stimulation that has been investigated as a technique to reduce pain, improve function and range of motion, and treat gastrointestinal disorders. The technique has been proposed to increase function in patients with osteoarthritis and to treat other conditions such as constipation, irritable bowel syndrome, dyspepsia, and spasticity.

Background

IFS uses paired electrodes of 2 independent circuits carrying high-frequency and medium-frequency alternating currents. The superficial electrodes are aligned on the skin around the affected area. It is believed that IFS permeates the tissues more effectively and, with less unwanted stimulation of cutaneous nerves, is more comfortable than transcutaneous electrical nerve stimulation. There are no standardized protocols for the use of IFS; IFS may vary by frequency of stimulation, the pulse duration, treatment time, and electrode-placement technique.

Regulatory Status

A number of IFS devices have been cleared for marketing by the U.S. Food and Drug Administration through the 510(k) process, including the Medstar™ 100 (MedNet Services) and the RS-4i® (RS Medical). IFS may be included in multimodal electrotherapy devices such as transcutaneous electrical nerve stimulation and functional electrostimulation.

Rationale:

This medical policy was created in June 2014 and has been updated regularly with searches of the MEDLINE database. The most recent literature update was performed through April 9, 2018.

Medical policies assess the clinical evidence to determine whether the use of a technology improves the net health outcome. Broadly defined, health outcomes are length of life, quality of life, and ability to function, including benefits and harms. Every clinical condition has specific outcomes that are important to patients and to managing the course of that condition. Validated outcome measures are necessary to ascertain whether a condition improves or worsens; and whether the magnitude of that change is clinically significant. The net health outcome is a balance of benefits and harms.

To assess whether the evidence is sufficient to draw conclusions about the net health outcome of a technology, 2 domains are examined: the relevance and the quality and credibility. To be relevant, studies must represent one or more intended clinical use of the technology in the intended population and compare an effective and appropriate alternative at a comparable intensity. For some conditions, the alternative will be supportive care or surveillance. The quality and credibility of the evidence depend on study design and conduct, minimizing bias and confounding that can generate incorrect findings. The randomized controlled trial (RCT) is preferred to assess efficacy; however, in some circumstances, nonrandomized studies may be adequate. RCTs are rarely large enough or long enough to capture less common adverse events and long-term effects. Other types of studies can be used for these purposes and to assess generalizability to broader clinical populations and settings of clinical practice.

Musculoskeletal Conditions

RCTs with placebo control are extremely important to assess treatments of painful conditions, due to the expected placebo effect, the subjective nature of pain assessment in general, and the variable natural history of pain that often responds to conservative care. Therefore, to establish whether an intervention for pain is effective, a placebo comparison is needed.

Clinical Context and Therapy Purpose

The purpose of using interferential current stimulation (IFS) in patients who have musculoskeletal conditions is to provide a treatment option that is an alternative to or an improvement on existing therapies.

Does use of IFS improve health outcomes for those with musculoskeletal conditions?

The following PICOTS were used to select literature for this policy:

Patients

The relevant population of interest is individuals with musculoskeletal conditions.

Interventions

The therapy being considered is IFS.

Comparators

The following therapies are currently being used: physical therapy, medication, and other types of electrical stimulation.

Outcomes

The specific outcomes of interest are pain control, increased functional capacity, and improved quality of life.

Timing

IFS would be used as adjunctive treatment with observed effects to be expected within 6 months.

Setting

IFS treatment can be provided by physical therapists, physiatrists, and other neuromuscular specialists in the outpatient setting.

Systemic Reviews

A network meta-analysis by Zeng et al. (2015) identified 27 RCTs on 5 types of electrical stimulation therapies used to treat pain in patients with knee osteoarthritis. (1) Reviewers found that IFS was significantly more effective than control interventions for pain relief (standardized mean difference [SMD], 2.06; 95% credible interval [CrI], 1.10 to 3.19) and pain intensity (SMD = -0.92; 95% CrI, -1.72 to -0.05). The validity of these conclusions is uncertain due to the limitations of network meta-analysis, which used indirect comparisons to make conclusions. A further limitation is that the findings of placebo-controlled studies were not reported separately; rather, they were pooled in analysis of usual care comparators.

Fuentes et al. (2010) published a systematic review and meta-analysis of RCTs evaluating the effectiveness of IFS for treating musculoskeletal pain. (2) Twenty RCTs met the following inclusion criteria: adults diagnosed with a painful musculoskeletal condition (e.g., knee, back, joint, shoulder, or osteoarthritic pain); compared IFS alone or as a cointervention with placebo, no treatment, or an alternative intervention; and assessed pain using a numeric rating scale. Fourteen of the trials reported data that could be included in a pooled analysis. IFS as a stand-alone intervention was not found to be more effective than placebo or an alternative intervention at reducing pain. For example, a pooled analysis of 2 studies comparing IFS alone with placebo did not find a statistically significant difference in pain intensity at discharge; the pooled mean difference (MD) was 1.17 (95% confidence interval [CI], -1.70 to 4.05). Also, a pooled analysis of 2 studies comparing IFS alone with an alternative intervention (e.g., traction or massage) did not find a significant difference in pain intensity at discharge; the pooled MD was -0.16 (95% CI, -0.62 to 0.31). Moreover, in a pooled analysis of 5 studies comparing IFS as a cointervention with a placebo, there was a nonsignificant finding in pain intensity at discharge (MD=1.60; 95% CI, -0.13 to 3.34; p=0.07). The meta-analysis found IFS plus another intervention to be superior to a control group (e.g., no treatment) for pain intensity at day 1 and 4 weeks; a pooled analysis of 3 studies found an MD of 2.45 (95% CI, 1.69 to 3.22; p<0.001). However, that analysis did not distinguish the specific effects of IFS from the cointervention nor did it control for potential placebo effects.

Randomized Controlled Trials

Two placebo-controlled randomized trials were included in the Fuentes meta-analysis, one of which (Defrin et al. 2005) was also included in the Zeng meta-analysis. The trial by Defrin included 62 patients with osteoarthritic knee pain. (3) Patients were randomized to 1 of 6 groups 4 active treatment groups and 2 control groups, sham and nontreated). Acute pre- vs posttreatment reductions in pain were found for all active groups but neither control group. Stimulation resulted in a modest pretreatment elevation of pain threshold over this 4-week trial. Taylor et al. (1987) randomized 40 patients with temporomandibular joint syndrome or myofascial pain syndrome to active or placebo IFS. (4) Principal outcomes were pain assessed by a questionnaire and range of motion. There were no statistically significant differences in the outcomes between groups.

Two other RCTs, both published in 2012, were included in the Zeng meta-analysis. One found significantly better outcomes with IFS vs placebo while the other did not find significant differences between active and sham interventions. Atamaz et al. (2012) compared IFS, transcutaneous electrical nerve stimulation, shortwave diathermy, and sham interventions for treating knee osteoarthritis. (5) A total of 203 patients were randomized to 1 of 6 groups, 3 with active treatment and 3 with sham treatment. The primary outcome was knee pain as assessed on a visual analog scale (VAS; range, 0-100). Other outcomes included range of motion, time to walk 15 meters, paracetamol intake, the Nottingham Health Profile (NHP) score, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score. At the 1-, 3-, and 6-month follow-ups, there was no statistically significant difference across the 6 groups in the VAS pain score, NHP pain score, or WOMAC pain score. Moreover, WOMAC function score, time to walk 15 meters, and NHP physical mobility score did not differ significantly among groups at any of the follow-up assessments. At the 1-month follow-up, paracetamol intake was significantly lower in the IFS group than in the transcutaneous electrical nerve stimulation (TENS) group.

Gundog et al. (2012) randomized 60 patients with knee osteoarthritis to 1 of 4 groups: 3 IFS groups at frequencies of 40 Hz, 100 Hz, and 180 Hz, and sham IFS. (6) The primary outcome was pain intensity assessed by the WOMAC. Mean WOMAC scores 1 month after treatment were 7.2 in the 40-Hz group, 6.7 in the 100-Hz group, 7.8 in the 180-Hz group, and 16.1 in the sham IFS group (p<0.05 vs active treatment groups). Secondary outcomes (e.g., VAS score) also showed significantly higher benefit in the active treatment groups compared with the sham IFS group. The number of patients assigned to each group and patient follow-up rates were not reported.

In addition to the placebo-controlled trials, several RCTs have compared IFS with another active intervention or with usual care. (7-11) However, studies with active comparators, as well as those with usual care control groups may be subject to the placebo effect. Receiving an older or known, rather than a novel, intervention, may elicit a placebo response. Recent literature research offered lack of long term data and size with anecdotal evidence, not supported by data. (22-30)

Section Summary: Musculoskeletal Conditions

Placebo-controlled randomized trials of IFS for treating musculoskeletal pain and impaired function have mostly found that it does not significantly improve outcomes. A meta-analysis limited to placebo-controlled trials also did not find a significant benefit of IFS for treating pain and function. RCTs with usual care or active treatment comparisons may be subject to the placebo effect.

Gastrointestinal Disorders

Clinical Context and Therapy Purpose

The purpose of using IFS in patients who have gastrointestinal disorders (e.g., constipation, irritable bowel syndrome, and dyspepsia) is to provide a treatment option that is an alternative to or an improvement on existing therapies.

Does use of IFS improve health outcomes for those with gastrointestinal disorders?

The following PICOTS were used to select literature for this policy:

Patients

The relevant population of interest is individuals with a gastrointestinal disorder such as constipation, irritable bowel syndrome, or dyspepsia.

Interventions

The therapy being considered is IFS.

Comparators

The following therapies are currently being used: dietary changes, medication, and other types of electrical stimulation.

Outcomes

The specific outcomes of interest are pain control, increased functional capacity, and improved quality of life.

Timing

Safety and efficacy of IFS would be evaluated at one month following a 4-week treatment.

Setting

IFS treatment can be provided by gastroenterologists in the outpatient setting.

Constipation

Several RCTs evaluating IFS for treating children with constipation and/or other lower gastrointestinal symptoms were identified. The RCTs had small sample sizes and did not consistently find a benefit of IFS. For example, Kajbafzadeh et al. (2012) in Iran randomized 30 children with intractable constipation to receive IFS or sham stimulation. (12) Children ranged in age from 3 to 12 years old and had failed 6 months of conventional therapy (e.g., dietary changes, laxatives). Patients received 15 IFS sessions (20 minutes long), 3 times a week for 5 weeks. Over 6 months, the mean frequency of defecation increased from 2.5 times a week to 4.7 times a week in the treatment group and from 2.8 times per a to 2.9 times a week in the control group. The mean pain during defecation score decreased from 0.35 to 0.20 in the treatment group and from 0.29 to 0.22 in the control group. The authors reported a statistically significant between-group difference in constipation symptoms.

Another RCT, published by Clarke et al. (2009) was conducted in Australia. (13) Thirty-three children with slow transit time constipation (mean age, 12 years) were randomized to IFS or sham treatment. They received a dozen 20-minute sessions over 4 weeks; the primary outcome was health-related quality of life (QOL), and the main assessment instrument used was the Pediatric Quality of Life Inventory. The authors only reported within-group changes; they did not compare the treatment and control groups. There was no statistically significant change in QOL, as perceived by the parent group. The mean parent-reported QOL scores changed from 70.3 to 70.1 in the active treatment group and from 69.8 to 70.2 in the control group. There was also no significant difference in QOL, as perceived by the child after sham treatment. The Pediatric Quality of Life Inventory score, as perceived by the child, did increase significantly in the active treatment group (mean, 72.9 pretreatment vs 81.1 posttreatment, p=0.005).

Irritable Bowel Disease

An RCT by Coban et al. (2012) randomized 67 adults with irritable bowel syndrome to active or placebo IFS. (14) Patients with functional dyspepsia were excluded. Patients received four 15-minute IFS sessions over 4 weeks. Fifty-eight (87%) of 67 patients completed the study. One month after treatment, primary outcomes measures did not differ significantly between treatment and control groups. For example, for abdominal discomfort, the response rate (i.e., >50% improvement) was 68% in the treatment group and 44% in the control group. For bloating and discomfort, the response rate was 48% in the treatment group and 46% in the placebo group. Using a VAS, 72% of the treatment group and 69% of the control group reported improvement in abdominal discomfort.

Dyspepsia

We identified 1 RCT, by Koklu et al. (2010) in Turkey, that evaluated IFS for treating dyspepsia. (15) The trial randomized patients to active IFS (n=25) or sham treatment (n=25); patients were unaware of treatment allocation. Patients received 12 treatment sessions over 4 weeks; each session lasted 15 minutes. Forty-four (88%) of 50 randomized patients completed the therapy session and follow-up questionnaires at 2 and 4 weeks. The authors did not specify primary outcome variables; they measured the frequency of 10 gastrointestinal symptoms. In an intention-to-treat analysis at 4 weeks, IFS was superior to placebo for the symptoms of early satiation and heartburn, but not for the other 8 symptoms. For example, before treatment, 16 (64%) of 25 patients in each group reported experiencing heartburn. At 4 weeks, 9 (36%) patients in the treatment group and 13 (52%) patients in the sham group reported heartburn (p=0.02). Among symptoms that did not differ at follow-up between groups, 24 (96%) of 25 patients in each group reported epigastric discomfort before treatment. In the intention-to-treat analysis, 5 (20%) of 25 patients in the treatment group and 6 (24%) of 25 patients in the placebo group reported epigastric discomfort.

Section Summary: Gastrointestinal Disorders

IFS has been tested for a variety of gastrointestinal conditions, with a small number of trials completed for each condition. Trial results are mixed, with some reporting benefit and others not. This body of evidence is inconclusive on whether IFS is an efficacious treatment for gastrointestinal conditions.

POSTSTROKE SPASTICITY

Clinical Context and Therapy Purpose

The purpose of using IFS in patients who have poststroke spasticity is to provide a treatment option that is an alternative to or an improvement on existing therapies.

Does use of IFS improve health outcomes for those with poststroke spasticity?

The following PICOTS were used to select literature for this policy:

Patients

The relevant population of interest is individuals with poststroke spasticity.

Interventions

The therapy being considered is IFS.

Comparators

The following therapy is currently being used: standard stroke rehabilitation.

Outcomes

The specific outcomes of interest are improved function and QOL.

Timing

Effect of IFS would be assessed one hour after a single treatment.

Setting

IFS treatment can be provided by physical therapists and physiatrists.

Randomized Controlled Trials

A single-blind RCT evaluating IFS as a treatment of chronic stroke was published by Suh et al. (2014). (16) Forty-two inpatient stroke patients with plantarflexor spasticity were randomized to a single 60-minute session with IFS or placebo IFS treatment following 30 minutes of standard rehabilitation. In the placebo treatment, electrodes were attached; however, the current was not applied. Outcomes were measured immediately before and 1 hour after the intervention. The primary outcomes were gastrocnemius spasticity (measured on a 0 to 5 Modified Ashworth Scale) and 2 balance-related measures: the Functional Reach Test and the Berg Balance Scale. In addition, gait speed was measured using a 10-meter walk test, and gait function was assessed with the Timed Up & Go Test. The IFS group performed significantly better than the placebo group on all outcomes (p<0.05 for each comparison). For example, the mean (standard deviation) difference in the Modified Ashworth Scale was 1.55 (0.76) in the IFS group and 0.40 (0.50) in the placebo group. A major limitation of the study was that outcomes were only measured 1 hour after the intervention and no data were available on longer term impacts of the intervention.

Section Summary: Poststroke Spasticity

Data from a small RCT with very short follow-up provides insufficient evidence on the impact of IFS on health outcomes in patients with post-stroke spasticity.

Summary of Evidence

For individuals who have musculoskeletal conditions who receive IFS, the evidence includes RCTs and meta-analyses. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use, and treatment-related morbidity. Placebo-controlled randomized trial have found that IFS, when used to treat musculoskeletal pain and impaired function(s), does not significantly improve outcomes; additionally, a meta-analysis of placebo-controlled trials did not find a significant benefit of IFS for decreasing pain or improving function. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have gastrointestinal disorders who receive IFS, the evidence includes RCTs. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use, and treatment-related morbidity. IFS has been tested for a variety of gastrointestinal conditions, with a small number of trials completed for each condition. The results of the trials are mixed, with some reporting benefit and others not. This body of evidence is inconclusive on whether IFS is an efficacious treatment for gastrointestinal conditions. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have post-stroke spasticity who receive IFS, the evidence includes an RCT. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatment-related morbidity. The RCT had a small sample size and very short follow-up (immediately posttreatment). The evidence is insufficient to determine the effects of the technology on health outcomes

Practice Guidelines and Position Statements

American College of Physicians and the American Pain Society

Clinical practice guidelines from the American College of Physicians and the American Pain Society, published in 2009, concluded that there was insufficient evidence to recommend interferential current stimulation (IFS) for the treatment of low back pain. (17)

American College of Occupational and Environmental Medicine

The American College of Occupational and Environmental Medicine published several relevant guidelines. For shoulder disorders, guidelines found the evidence on IFS is insufficient and, depending on the specific disorder, either did not recommend IFS or were neutral on whether to recommend it. (18) For low back disorders, guidelines found the evidence on IFS is insufficient and the intervention is not recommended. The sole exception was that IFS could be considered as an option on a limited basis for acute low back pain with or without radicular pain. (19) For knee disorders, the guidelines recommended IFS for postoperative anterior cruciate ligament reconstruction, meniscectomy, and knee chondroplasty immediately postoperatively in the elderly. This was a level C recommendation. (20)

Ongoing and Unpublished Clinical Trials

Some currently unpublished trials that might influence this review are listed in Table 1.

Table 1. Summary of Key Trials

NCT No.

Trial Name

Planned Enrollment

Completion Date

Ongoing

NCT02381665

Efficacy of Interferential Therapy in Chronic Constipation (CON-COUR) (CON-COUR)

200

Mar 2019

Table Key: NCT: national clinical trial.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

There are no specific CPT codes describing interferential current stimulation. The following CPT codes might be used: 64550, 97014.

The following HCPCS code might also be used: G0283, S8130.

CODING:

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

64550, 97014, 97032, 97139

HCPCS Codes

E1399, G0283, S8130, S8131

ICD-9 Diagnosis Codes

Refer to the ICD-9-CM manual

ICD-9 Procedure Codes

Refer to the ICD-9-CM manual

ICD-10 Diagnosis Codes

Refer to the ICD-10-CM manual

ICD-10 Procedure Codes

Refer to the ICD-10-CM manual


Medicare Coverage:

The information contained in this section is for informational purposes only. HCSC makes no representation as to the accuracy of this information. It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does not have a national Medicare coverage position. Coverage may be subject to local carrier discretion.

A national coverage position for Medicare may have been developed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

1. Zeng C, Li H, Yang T, et al. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage. Feb 2015; 23(2):189-202. PMID 25497083

2. Fuentes JP, Armijo Olivo S, Magee DJ, et al. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys Ther. Sep 2010; 90(9):1219-1238. PMID 20651012

3. Defrin R, Ariel E, Peretz C. Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain. May 2005; 115(1-2):152-160. PMID 15836978

4. Taylor K, Newton RA, Personius WJ, et al. Effects of interferential current stimulation for treatment of subjects with recurrent jaw pain. Phys Ther. Mar 1987; 67(3):346-350. PMID 3493493

5. Atamaz FC, Durmaz B, Baydar M, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. Arch Phys Med Rehabil. May 2012; 93(5):748-756. PMID 22459699

6. Gundog M, Atamaz F, Kanyilmaz S, et al. Interferential current therapy in patients with knee osteoarthritis: comparison of the effectiveness of different amplitude-modulated frequencies. Am J Phys Med Rehabil. Feb 2012; 91(2):107-113. PMID 22019968

7. Koca I, Boyaci A, Tutoglu A, et al. Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study. Rheumatol Int. Dec 2014; 34(12):1639-1645. PMID 24728028

8. Lara-Palomo IC, Aguilar-Ferrandiz ME, Mataran-Penarrocha GA, et al. Short-term effects of interferential current electro-massage in adults with chronic non-specific low back pain: a randomized controlled trial. Clin Rehabil. May 2013; 27(5):439-449. PMID 23035006

9. Facci LM, Nowotny JP, Tormem F, et al. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Med J. 2011; 129(4):206-216. PMID 21971895

10. Albornoz-Cabello M, Maya-Martin J, Dominguez-Maldonado G, et al. Effect of interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized controlled trial. Clin Rehabil. Feb 2017; 31(2):242-249. PMID 26975312

11. Dissanayaka TD, Pallegama RW, Suraweera HJ, et al. Comparison of the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy on the upper trapezius in myofascial pain syndrome: a randomized controlled study. Am J Phys Med Rehabil. Sep 2016; 95(9):663-672. PMID 26945216

12. Kajbafzadeh AM, Sharifi-Rad L, Nejat F, et al. Transcutaneous interferential electrical stimulation for management of neurogenic bowel dysfunction in children with myelomeningocele. Int J Colorectal Dis. Apr 2012; 27(4):453-458. PMID 22065105

13. Clarke MC, Chase JW, Gibb S, et al. Improvement of quality of life in children with slow transit constipation after treatment with transcutaneous electrical stimulation. J Pediatr Surg. Jun 2009; 44(6):1268-1272; discussion 1272. PMID 19524752

14. Coban S, Akbal E, Koklu S, et al. Clinical trial: transcutaneous interferential electrical stimulation in individuals with irritable bowel syndrome - a prospective double-blind randomized study. Digestion. 2012; 86(2):86-93. PMID 22846190

15. Koklu S, Koklu G, Ozguclu E, et al. Clinical trial: interferential electric stimulation in functional dyspepsia patients - a prospective randomized study. Aliment Pharmacol Ther. May 2010; 31(9):961-968. PMID 20136803

16. Suh HR, Han HC, Cho HY. Immediate therapeutic effect of interferential current therapy on spasticity, balance, and gait function in chronic stroke patients: a randomized control trial. Clin Rehabil. Sep 2014; 28(9):885-891. PMID 24607801

17. Chou R, Atlas SJ, Stanos SP, et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). May 1 2009;34(10):1078-1093. PMID 19363456

18. American College of Occupational and Environmental Medicine (ACOEM). Shoulder disorders. In: Hegmann KT, ed. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village, IL: ACOEM; 2011:1-297.

19. American College of Occupational and Environmental Medicine (ACOEM). Low Back Disorders. In: Hegmann KT, ed. Occupational medicine practice guidelines: evaluation and management of common health problems and functional recovery in workers. Westminster, CO: Reed Group; 2016:1-844.

20. American College of Occupational and Environmental Medicine (ACOEM). Knee Disorders. In: Hegmann KT, ed. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village, IL: ACOEM; 2011:1-503.

Additional Literature:

21. Fuentes JP, Armijo O, Magee DJ, et al. Effectiveness of interferential current therapy in a management of musculoskeletal pain: a systematic review and meta-analysis. Phys Thera. 2010 Sept; 90(9);1219-38. PMID 20651012

22. Albornoz-Cabello M, Maya-Martin J, Dominguez-Maldonado G, et al. Effect and interferential current therapy on pain perception and disability level in subjects with chronic low back pain: a randomized study. Clin Rehabil. 2017 Feb; 31(2):242-249 PMID 26975312

23. Dissanayaka TD, Pallegama RW, Suraweera HJ, et al. Comparison of the effectiveness of transcutaneous electrical nerve stimulation and interferential therapy on the upper trapezius in myofascial pain syndrome: a randomized controlled study. Am J Phys Rehabil. 2016Sept; 95(9); 663-72. PMID 26945216.

24. Lara-PalomoIC, Aguilar-Ferrandiz ME, Mataran-Penarrocha GA, et al. Short-term effects of interferential current electromassage in adults with chronic nonspecific low back pain; a randomized controlled trial. Clin Rehabil. 2013 May; 27(5):439-49. PMID 23035006.

25. Facci LM, Nowotny JP, Tormem F, et al. Effects of transcutaneous electric nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain; randomized clinical trial. Sao Paulo Med J. 2011; 129(4)206-16. PMID 21971895

26. Bjordal KM, Johnson MI, Ljunggreen AE, et al. Transcutaneous electrical nerve stimulation (TENS) can reduce postperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain; European Jour of Pain. 2003: 7(2);181-188. PMID 12600800

27. Stevens-Lapsley JE1, Balter JE, Wolfe P, Eckhoff DG, et al. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012 Feb; 92(2):210-26. PMID 22095207

28. Li J1, Song Y. Transcutaneous electrical nerve stimulation for postoperative pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Sep; 96(37):e8036. PMID 28906393

29. Almeida CC, Silva VZ, Júnior GC, ET AL. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Braz J Phys Ther. 2018 Feb 2; S1413-3555(17): 30283-6. PMID: 29426587

30. Interferential Stimulation for Treatment of Pain. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (June 2018) Durable Medical Equipment 1.01.24.

Policy History:

DateReason
8/15/2018 Document updated with literature review. Coverage unchanged. Added references 17, 22-30.
10/15/2017 Reviewed. No changes.
11/1/2016 Document updated with literature review. Coverage unchanged.
4/15/2015 Reviewed. No changes.
6/1/2014 New medical document. Coverage is unchanged: Interferential current stimulation is considered experimental, investigational and/or unproven. This topic was previously addressed on MED201.026 Surface Electrical Stimulation.

Archived Document(s):

Title:Effective Date:End Date:
Interferential Current Stimulation10-15-201708-14-2018
Interferential Current Stimulation11-01-201610-14-2017
Interferential Current Stimulation04-15-201510-31-2016
Interferential Current Stimulation06-01-201404-14-2015
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