DJO Global, Inc. has released an independent, estimated financial impact on Medicare patients who suffer from chronic low back pain (CLBP). The financial impact calculation estimates that using current standard of care procedures to treat approximately 1.5 million Medicare beneficiaries who have CLBP and seek medical intervention now costs approximately $1.3 billion annually. The company estimates that for an investment of slightly over $880 million, all of those patients can be supplied with a transcutaneous electrical nerve stimulation system (TENS) to take the place of other treatment options.
DJO Global: Independent Numbers Favor TENS System

These figures are partly based on a recently published study in volume 36, issue 12 of Orthopedics, which looked at the clinical and economic impact of TENS in patients with CLBP. The study evaluated patients who were given TENS compared with a statistically matched group without TENS for one-year prior to intervention and for one-year of follow-up. Patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging, had fewer physical therapy visits, and required less back surgery than patients receiving other treatment modalities. Furthermore, TENS is non-invasive and non-narcotic, so it does not have the risks associated with other treatment approaches.
DJO Global indicates that this news supports its Motion is Medicine initiative, an effort to help patients restore motion and improve their lives by addressing four common areas: pain, alignment, strength and stability.
“Although most payors continue to pressure doctors to utilize more conservative care options, CMS [Centers for Medicare and Medicaid Services] decided in June 2012, to remove reimbursement for TENS as a treatment for chronic lower back pain, ” said Michael Minshall, senior director of Health Economics & Reimbursement, DJO Global, in the March 10, 2014 news release. “Medicare still has to treat and pay for those suffering from CLBP and may be overspending to achieve what is arguably poorer clinical outcomes that do not always relieve pain and discomfort.”
Minshall told OTW, “Given the tightening healthcare budgets, surgeons have been thrilled to see that we are offering an effective conservative care option, namely, the MotionCARE Home Recovery Program. Those who suffer from degenerative disc disease and herniated disc now have a new option that can save them pain and possibly, a hospital stay.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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