TENS Holds Hope for Reducing Cost of Care

Transcutaneous electrical nerve stimulation (TENS) has been in use since 63. No, that’s not a typo—electrical stimulation for the purpose of pain management can in fact be traced back to the year 63 A.D. According to a 1985 paper published in the American Journal of Sports Medicine, Scribonius Largus, the court physician to Roman Emperor Claudius, recorded that patients in pain could find relief by standing on electrical fish at the seashore.

TENS is a technique by which electrical pulses are delivered to the nervous system in order to block pain signals from reaching the brain. The first version of a wearable device for the delivery of TENS was patented in the United States in 1974. Only recently, however, has the focus turned to how TENS can save the healthcare industry money. In December, a study comparing patients suffering from chronic back pain who were treated with TENS with similar patients who did not received TENS was published in the journal Orthopedics. According to the study, patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging (31 vs. 46 events per 100 patients), had fewer physical therapy visits (94 vs. 107), and required less back surgery (7.5 vs. 9.2 surgeries) than patients receiving other treatment modalities. Total annual costs for chronic low back pain patients without neurological involvement were lower in TENS patients ($17,957 vs. $17,986 for non-TENS), even when the cost of the device was taken into account.

At the recent annual meeting of the American Association of Orthopaedic Surgeons, Senior Director of Health Economics & Reimbursement at DJO Global Michael E. Minshall, M.P.H., presented an analysis of the data from the December study. TENS systems have the potential to save the U.S. healthcare system “almost half a billion dollars,” he claimed. Orthopedic company DJO Global, of course, has a stake in increasing the use of TENS among patients with chronic pain, as a 2007 deal made it the owner of the Empi brand of TENS products.

The Empi wearable TENS lower back wrap. Image courtesy of DJO Global Inc.

“What’s even more important than the TENS technology in isolation is the way in which the technology fits within the motion care program,” President of DJO Global Recovery Sciences Sharon Wolfington told ODT. “What I’ve learned in healthcare is that no one thing is the magic bullet. You really have to have it as part of an integrated care model, especially with conservative care of management being so important for bundled payments in accountable care organizations.”

DJO’s Motion is Medicine initiative has become the Vista, Calif.-based company’s core mission. It propagates habitual activity to allow patients to “take control of their healthcare.” Wolfington said that TENS fits right in with DJO’s Motion is Medicine program, as it ameliorates chronic pain so that patients can stay active. DJO’s TENS products run the gamut from entire clinical suites that can be set up like spas, to wearable devices patients can strap on their back, knee, or any other area with chronic pain.

“‘Conservative care management’ is a new buzz phrase,” Wolfington said. “‘Medical home’ is a new buzz phrase. Our motion care program is built to answer to the need for conservative care management and the medical home. This entire motion care program for spine is a home treatment for degenerative disc disease. When a patient presents with chronic pain, they will soon be able to get a duffel bag of modalities that they can take home and cut the amount of physical therapy visits in half. They will be able to get pain relief and get moving. Once you get moving, you’re not going experience what we call the downward spiral. When people experience chronic pain, chronic pain stops you from moving, lack of motion turns to obesity, obesity turns into depression, diabetes, etc. That’s where TENS ties to Motion is Medicine.”

Healthcare reform, as Wolfington sees it, was built around the triple aims of improving the overall health of communities; having excellent patient satisfaction because of high quality care; and controlling costs.

“All three of those aims seem daunting but they are possible,” Wolfington said. “The motion care program is built to support those three things. Improving the overall health of communities is to keep people moving. That’s the tagline of motion is medicine. If DJO can play a role in maintaining patients and people in motion, we couild decrease the cost of per capita care. That’s the vision.”