ASRA Urges Reconsideration of High Frequency Spinal Cord Stimulation Coverage Denial

Jun 17, 2016

Recent studies have shown significant therapeutic value from the use of high-frequency - 10,000 (HF-10) spinal cord stimulation (SCS) for patients experiencing chronic back and leg pain. However, Blue Cross Blue Shield in at least two states considers the therapy to be experimental and investigational, taking away yet another avenue of potential relief for thousands of patients in pain.

ASRA leadership has written letters to both the Blue Cross Blue Shield of Tennessee and Highmark Blue Cross Blue Shield of Pennsylvania to raise critical concerns about the classification decision, citing evidence that not only does HF-10 demonstrate clinical effectiveness, but the therapy is a welcomed nonopioid option for patients.

“...This modality is precisely the sort of treatment that the CDC Guideline recommends in light of the opioid crisis in America.” 

With the current opioid epidemic in the United States, along with the Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain, physicians are urged to find nonopioid therapies for patients experiencing chronic pain. One such therapy is HF-10, which has been found to provide significant improvement in 67% of patients, according to a randomized clinical trial (RCT) published in 2015.[1]   By comparison, studies of patients receiving pharmacologic therapy have demonstrated less than 50% have significant improvement.[2]

The Kapural study was used to support the Food and Drug Administration's original approval of HF-10, and, as one of the largest-ever RCTs of SCS interventional pain therapy, the work recently received the highest quality score in a systematic review and methodological assessment of SCS therapies by Grider et al.[3]

As more evidence pours in showing the toll that opioids are taking on our society, including a recent study suggesting they may even increase the risk of heart attack,[4] finding alternative therapies is critical to helping patients with chronic pain. ASRA will continue to monitor the situation and advocate coverage of any and all evidence-based treatments for the very complex and individualized condition of chronic pain.


  1. Kapural L, Yu C, Doust MW, et al. Novel 10-kHz high-frequency therapy (HF10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain: The SENZA-RCT randomized controlled trial. Anesthesiology 2015; 123: 851-60.
  2. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Arch Neurol 2003; 60: 1524-34.
  3. Grider JS, Manchikanti L, Carayannopoulos A, et al. Effectiveness of spinal cord stimulation in chronic spinal pain: A systematic review. Pain Physician 2016; 19: E33-54.
  4. Ray WA, Chung CP, Murray KT, Hall K, Stein M. Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. JAMA 2016; 315:2415-23. doi: 10.1001/jama.2016.7789