Interferential Current Stimulation - CAM 10124

Description:
Interferential current stimulation (IFS) is a type of electrical stimulation. IFS has primarily been investigated as a technique to reduce pain, and has been proposed to increase function of patients with osteoarthritis and to treat other conditions such as dyspepsia, irritable bowel syndrome and constipation.

For individuals who have musculoskeletal conditions who receive IFS, the evidence includes randomized controlled trials (RCTs) and meta-analyses. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use and treatment-related morbidity. Placebo-controlled RCTs of IFS for treating musculoskeletal pain and impaired function have mostly found that it does not significantly improve outcomes and 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. Trials 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. The evidence is insufficient to determine the effects of the technology on health outcomes. 

For individuals who have poststroke spasticity who receive IFS, the evidence includes 1 RCT. Relevant outcomes are symptoms, functional outcomes, quality of life and treatment-related morbidity. The RCT has a small sample size and very short follow-up (immediately post-treatment). The evidence is insufficient to determine the effects of the technology on health outcomes.

Background 
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.

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 the 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.

Related Policies
10109 Transcutaneous Electrical Nerve Stimulation (TENS)
20164 Biofeedback as a Treatment of Fecal Incontinence or Constipation
70129 Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)

Policy:
Interferential current stimulation is considered investigational and/ or unproven and therefore considered NOT MEDICALLY NECESSARY.

Microcurrent Stimulation devices (e.g., MENS, MET, Alpha-Stim®-100) used to decrease pain and facilitate  healing are considered investigational and/or unproven and therefore  considered NOT MEDICALLY NECESSARY. 

Policy Guidelines 
Please see the Codes table for details.

Benefit Application
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all devices approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational and, thus, these devices may be assessed only on the basis of their medical necessity.

Rationale
Evidence reviews assess the clinical evidence to determine whether the use of technology improves the net health outcome. Broadly defined, health outcomes are the 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 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 technology, 2 domains are examined: the relevance, and quality and credibility. To be relevant, studies must represent one or more intended clinical uses 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.

The question addressed in this evidence review is: Does the use of IFS improve health outcomes for those with musculoskeletal conditions?

The following PICO was used to select literature to inform this review.

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

Study Selection Criteria
Methodologically credible studies were selected using the following principles:  

  • To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs;

  • In the absence of such trials, comparative observational studies were sought, with a preference for prospective studies.

  • To assess long-term outcomes and adverse events, single-arm studies that capture longer periods of follow-up and/or larger populations were sought.

  • Studies with duplicative or overlapping populations were excluded.

Review of Evidence
Systematic 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 (OA).1 Reviewers found that IFS was significantly more effective than control interventions for pain relief (standardized mean difference, 2.06; 95% credible interval, 1.10 to 3.19) and pain intensity (standard mean difference, -0.92; 95% credible interval, -1.72 to -0.05). The validity of these conclusions is uncertain due to the limitations of the 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 the analysis of usual care comparators. A more recent systematic review and meta-analysis by Ferreira et al. (2019) evaluated non-surgical and non-pharmacological interventions for knee osteoarthritis.2, However, as it only evaluated 1 RCT on IFS, the RCT by Gundog et al. discussed below (2012), it did not add new information to the network meta-analysis by Zeng et al. (2015).

The National Institute of Health and Care Excellence (NICE) (2016) published an evidence review on non-invasive treatments for low back pain.3 This review included 4 non-US RCTs published between 1999 and 2014 that compared IFC to sham (n = 117), usual care (n = 60), or manual therapies (n=387). NICE reported that compared to sham or traction, IFC did not demonstrate a clinically important improvement in pain. No studies evaluated impact on quality of life, nor did any studies include people with sciatica. NICE concluded that evidence does not support IFC for low back pain.

Fuentes et al. (2010) published a systematic review and meta-analysis of RCTs evaluating the effectiveness of IFS for treating musculoskeletal pain.4 Twenty RCTs met the following inclusion criteria: adults diagnosed with a painful musculoskeletal condition (e.g., knee, back, joint, shoulder, or OA pain); compared IFS alone or as a co-intervention 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 pooled. 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 co-intervention 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 co-intervention nor did it control for potential placebo effects.

Randomized Controlled Trials
This section includes RCTs not included in the systematic reviews discussed above.

To evaluate IFS after arthroscopic knee surgery, Kadi et al. (2019) conducted a double blind, placebo controlled RCT in 98 individuals.5 IFS or sham treatment (pads applied with no current) was delivered for 30 minutes, twice a day for 5 days postoperatively. Although IFS significantly reduced the amount of paracetamol used by day 5, no significant difference was found between the groups with respect to pain, range of motion, or edema at days 0 through 30.

Alqualo Costa et al. (2021) conducted a placebo-controlled RCT of ICS and photobiomodulation in 168 adults with knee osteoarthritis.6 Participants were randomized to one of 4 groups: active IFS plus placebo phobiomodulation, placebo IFS plus active photobiomodulation, active IFS plus active photobiomodulation, and placebo IFS plus placebo photobiomodulation. Patients received treatments 3 times a week for 4 weeks, totaling 12 sessions. Both patients and outcome assessors were blinded to treatment allocation. The combination of active IFS plus active photobiomodulation significantly reduced pain intensity at rest and during movement compared to the IFS alone and placebo groups. Similar improvements were not shown in the group that received IFS alone. This study was limited by its small sample size and multiple statistical comparisons.

In addition to the placebo-controlled trials, several RCTs have compared IFS with another active intervention or with usual care.7,8,9,10,11,12,13 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.

Section Summary: Musculoskeletal Conditions
Placebo-controlled randomized trials of IFS for treating musculoskeletal pain and impaired function have mostly found that IFS 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.

The question addressed in this evidence review is: Does the use of IFS improve health outcomes for those with gastrointestinal disorders?

The following PICO was used to select literature to inform this review.

Population
The 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. Safety and efficacy of IFS would be evaluated at 1 month following a 4 week treatment.

Study Selection Criteria
Methodologically credible studies were selected using the following principles:  

  • To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs;

  • In the absence of such trials, comparative observational studies were sought, with a preference for prospective studies.

  • To assess long-term outcomes and adverse events, single-arm studies that capture longer periods of follow-up and/or larger populations were sought.

  • Studies with duplicative or overlapping populations were excluded.

Constipation
Review of Evidence
No large RCTs have adequately evaluated the comparative effects of using IFS to treat constipation versus the comparators of interest. Ideally, an RCT would compare IFS to another treatment of interest such as dietary changes, medication, or different types of electrical stimulation and include an IFS sham-control group to rule out a potential placebo effect.

Several sham-controlled 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.

A systematic review of neuromodulation approaches for constipation and fecal incontinence in children by Iacona et al. (2019) included 2 of the RCTs, as well as 1 prospective study, and 2 pilot studies (N=126).14 Study follow-up times ranged from 1 to 6 months. Systematic review authors reported that all of the studies reported an improvement in symptoms reported including defecation frequency, soiling episodes, and abdominal pain. This systematic review included the RCT by Kajbafzadeh et al. (2012) in Iran that randomized 30 children with intractable constipation to IFS or sham stimulation.15 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 a week 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. Overall, however, the systematic review authors concluded additional evidence including longer length of follow-up is needed to consider neuromodulation as an established therapy for the management of constipation and fecal incontinence.

Additionally, another RCT, published by Clarke et al. (2009) from Australia, and not included in the systematic review by Iacona et al. (2019), did not find a benefit of IFS.16 Thirty-three children with slow transit time constipation (mean age, 12 years) were randomized to IFS or sham treatment. They received 12, 20-minute sessions over 4 weeks; the primary outcome was health-related quality of life, 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 quality of life, as perceived by the parent group. The mean parent-reported quality of life 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 quality of life, 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).

In adults, 1 small, single-blind, sham-controlled RCT conducted in Australia was identified.17 Thirty-three women (mean age, 45 years) with functional constipation were randomized to IFS (N=17) or sham treatment (N=16). The IFS was self-delivered by the participants in their homes for 1 hour per day for 6 weeks. The participants were trained by an unblinded study coordinator in the placement of the 4 electrodes as either crossed for active IFS or uncrossed for sham IFS. The primary outcome was the number of patients with ≥ 3 spontaneous bowel movements per week. Although active IFS significantly increase the primary outcome (53% versus 12%; P = .02), there were no between-group differences on numerous other secondary outcomes, such as quality of life and the more clinically meaningful and guideline-recommended outcome of spontaneous complete bowel movement.

Irritable Bowel Disease
Review of Evidence
An RCT by Coban et al. (2012) randomized 67 adults with irritable bowel syndrome to active or placebo IFS.18 Patients with functional dyspepsia were excluded. Patients received 4, 15-minute IFS sessions over 4 weeks. Fifty-eight (87%) of 67 patients completed the trial. One month after treatment, primary outcome 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
Review of Evidence
One RCT, by Koklu et al. (2010) in Turkey, has evaluated IFS for treating dyspepsia.19 The trial randomized adults to active IFS (n=25) or sham treatment (n = 25); patients were unaware of their 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 trialists did not specify primary outcome variables; rather, 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 between groups at follow-up, 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 as a treatment option for a variety of gastrointestinal conditions, with a small number of trials completed for each condition. Trial results were 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.

The question addressed in this evidence review is: Does the use of IFS improve health outcomes for those with poststroke spasticity?

The following PICO was used to select literature to inform this review.

Population
The 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 quality of life. Effect of IFS would be assessed 1 hour after a single treatment.

Study Selection Criteria
Methodologically credible studies were selected using the following principles:  

  • To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs;

  • In the absence of such trials, comparative observational studies were sought, with a preference for prospective studies.

  • To assess long-term outcomes and adverse events, single-arm studies that capture longer periods of follow-up and/or larger populations were sought.

  • Studies with duplicative or overlapping populations were excluded.

Review of Evidence
Randomized Controlled Trials
A single-blind RCT evaluating IFS as a treatment of poststroke spasticity was published by Suh et al. (2014).20 Forty-two inpatient stroke patients with plantar flexor 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. Also, 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 Modified Ashworth Scale score was 1.55 (0.76) in the IFS group and 0.40 (0.50) in the placebo group. A major limitation of the trial was that outcomes were only measured 1 hour after the intervention and no data were available on longer-term impacts of the intervention.

Additionally, an RCT comparing IFS (n = 20) to electrical acupuncture (EAC) (n = 20) in individuals with hemiplegic shoulder pain after stroke was published by Eslamian et al. (2020).21, The interventions were added to standard care and delivered twice a week for a total of 10 sessions. The primary outcome was reduction in pain intensity at 5-weeks compared to baseline as measured using a 10 cm Visual Analogue Scale (VASs). Results were mixed across outcomes. For example, rates of clinically significant improvement of at least 13 on the Shoulder Pain and Disability Index (SPADI) questionnaire were similar between groups (75% versus 65%). However, rate of clinically significant improvement in pain intensity (defined as 1.4 points on the VAS at 5-weeks) was lower in the IFS group (35.0% versus 70.0%). Additionally, this study has several limitations, including lack of sham control group, very small sample size, short follow-up interval.

Section Summary: Poststroke Spasticity
Data from small RCT's 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 randomized controlled trials (RCTs) and meta-analyses. Relevant outcomes are symptoms, functional outcomes, quality of life, medication use, and treatment-related morbidity. Placebo-controlled randomized trial(s) 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 that the technology results in an improvement in the net health outcome.

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 that the technology results in an improvement in the net health outcome.

For individuals who have poststroke spasticity who receive IFS, the evidence includes RCTs. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatment-related morbidity. The RCTs had small sample sizes and very short follow-up (immediately posttreatment to 5 weeks). The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

The purpose of the following information is to provide reference material. Inclusion does not imply endorsement or alignment with the evidence review conclusions.

Practice Guidelines and Position Statements
Guidelines or position statements will be considered for inclusion in ‘Supplemental Information' if they were issued by, or jointly by, a U.S. professional society, an international society with U.S. representation, or National Institute for Health and Care Excellence (NICE). Priority will be given to guidelines that are informed by a systematic review, include strength of evidence ratings, and include a description of management of conflict of interest.

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 to be insufficient and, depending on the specific disorder, either did not recommend IFS or were neutral on whether to recommend it.22 For low back disorders, guidelines found the evidence on IFS to be insufficient and did not recommend it.23 For knee disorders, guidelines recommended IFS for postoperative anterior cruciate ligament reconstruction, meniscectomy, and knee chondroplasty immediately postoperatively in the elderly.24 This was a level C recommendation.

American College of Physicians and the American Pain Society
In 2009, the clinical practice guidelines from the American College of Physicians and the American Pain Society concluded that there was insufficient evidence to recommend interferential current stimulation (IFS) for the treatment of low back pain.25 An update of these guidelines by the American College of Physicians (2017) confirmed the 2009 findings that there was insufficient evidence to determine the effectiveness of interferential current stimulation (IFS) for the treatment of low back pain.26

National Institute for Health and Care Excellence
In 2016, the National Institute for Health and Care Excellence had a guideline (NG59) on assessment and management of low back pain and sciatica in people aged 16 and over.3 The guideline states “Do not offer interferential therapy for managing low back pain with or without sciatica.”

U.S. Preventive Services Task Force Recommendations
Not applicable.

Ongoing and Unpublished Clinical Trials
A search of ClinicalTrials.gov in May 2021 did not identify any ongoing or unpublished trials that would likely influence this review.

 

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. Ferreira RM, Torres RT, Duarte JA, et al. Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Acta Reumatol Port. Jul 29 2019; 44(3): 173-217. PMID 31356585
  3. National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management [NG59]. 2016; https://www.nice.org.uk/guidance/ng59. Accessed April 21, 2020.
  4. 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): 1219-38. PMID 20651012
  5. Kadi MR, Hepguler S, Atamaz FC, et al. Is interferential current effective in the management of pain, range of motion, and edema following total knee arthroplasty surgery? A randomized double-blind controlled trial. Clin Rehabil. Jun 2019; 33(6): 1027-1034. PMID 30764635
  6. Alqualo-Costa R, Rampazo EP, Thome GR, et al. Interferential current and photobiomodulation in knee osteoarthritis: A randomized, placebo-controlled, double-blind clinical trial. Clin Rehabil. Apr 26 2021: 2692155211012004. PMID 33896234
  7. 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): 663-72. PMID 26945216
  8. 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): 1639-45. PMID 24728028
  9. 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): 439-49. PMID 23035006
  10. 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): 206-16. PMID 21971895
  11. 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
  12. Albornoz-Cabello M, Perez-Marmol JM, Barrios Quinta CJ, et al. Effect of adding interferential current stimulation to exercise on outcomes in primary care patients with chronic neck pain: a randomized controlled trial. Clin Rehabil. Sep 2019; 33(9): 1458-1467. PMID 31007047
  13. Albornoz-Cabello M, Barrios-Quinta CJ, Espejo-Antunez L, et al. Immediate clinical benefits of combining therapeutic exercise and interferential therapy in adults with chronic neck pain: a randomized controlled trial. Eur J Phys Rehabil Med. Mar 24 2021. PMID 33759439
  14. Iacona R, Ramage L, Malakounides G. Current State of Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review. Eur J Pediatr Surg. Dec 2019; 29(6): 495-503. PMID 30650450
  15. 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): 453-8. PMID 22065105
  16. 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): 1268-72; discussion 1272. PMID 19524752
  17. Moore JS, Gibson PR, Burgell RE. Randomised clinical trial: transabdominal interferential electrical stimulation vs sham stimulation in women with functional constipation. Aliment Pharmacol Ther. Apr 2020; 51(8): 760-769. PMID 32128859
  18. 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
  19. 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): 961-8. PMID 20136803
  20. 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): 885-91. PMID 24607801
  21. Eslamian F, Farhoudi M, Jahanjoo F, et al. Electrical interferential current stimulation versus electrical acupuncture in management of hemiplegic shoulder pain and disability following ischemic stroke-a randomized clinical trial. Arch Physiother. 2020; 10: 2. PMID 31938571
  22. American College of Occupational and Environmental Medicine (ACOEM). Shoulder Disorders Guideline (2016). https://www.dir.ca.gov/dwc/MTUS/ACOEM_Guidelines/Shoulder-Disorders-Guideline.pdf. Accessed May 8, 2021.
  23. Hegmann KT, Travis R, Andersson GBJ, et al. Non-Invasive and Minimally Invasive Management of Low Back Disorders. J Occup Environ Med. Mar 2020; 62(3): e111-e138. PMID 31977923
  24. 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.
  25. 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 01 2009; 34(10): 1078-93. PMID 19363456
  26. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Apr 04 2017; 166(7): 514-530. PMID 28192789

Coding Section

Codes Number Description
CPT 64550 Application of surface (transcutaneous) neurostimulator (deleted eff 1/1/19)
  97014 Application of a modality to 1 or more areas; electrical stimulation (unattended)
  97032 Application of modality to one or more areas; electrical stimulation (manual), each 15 minutes (attended)
HCPCS    
  G0283 Electrical stimulation (unattended), to 1 or more areas for indication(s) other than wound care, as part of a therapy plan of care
  S8130 Interferential current stimulator, 2 channel
  S8131 Interferential current stimulator, 4 channel
ICD-10-CM   Investigational for all relevant diagnoses
  G56.40-G56.42 Causalgia of upper limb code range
  G57.70-G57.72 Causalgia of lower limb code range
  G89.0-G89.4 Pain, not elsewhere classified code range
  G90.50-G90.59 Complex regional pain syndrome I code range
  M25.50-M25.579 Pain in joint code range
  M54.00-M54.9 Dorsalgia code range
  M79.60-M79.676 Pain in limb, hand, foot, fingers and toes code range
  R52 Pain, unspecified
ICD-10-PCS   ICD-10-PCS codes are only used for inpatient services. There is no specific ICD-10-PCS code for the initiation of this therapy.
Type of Service Medicine  
Place of Service Outpatient  

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.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association. All Rights Reserved" 

History From 2013 Forward     

01/05/2022 

Annual review, no change to policy intent. Updating rationale and references. 

01/01/2021 

Annual review, no change to policy intent. Updating guidelines, coding, rationale and references. 

01/02/2020 

Annual review. Policy verbiage updated for clarity, coding updated due to code termination. 

01/16/2019 

Annual review, no change to policy intent. Updating background, regulatory status, rationale and references. 

01/25/2018 

Annual review, no change to policy intent. Updating guidelines, rationale and references. 

01/03/2017 

Annual review, no change to policy intent. Updating background, description, rationale and references. 

01/28/2016 

Annual review, no change to policy intent. Updating background and description. 

01/14/2015 

Annual review, no change to policy intent. Updated description, rationale and references. Added guidelines and coding.

01/27/2014

Annual review. Updated rationale and references. Added related policies.

 

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