K Number
K032928
Device Name
MEDIPHYSICS PAIN TREATMENT SYSTEM, MODEL 1
Date Cleared
2003-12-19

(88 days)

Product Code
Regulation Number
882.5890
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The MediPhysics Pain Treatment System, Model 1, is intended for temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain.
Device Description
The McdiPhysics Pain Treatment System, Model 1, consists of a control console, two Treatment Probes (electrodes), and a Security Cartridge. The system operates on 115V wall current. Treatment, intended to take place under the supervision of a physician in a medical setting, consists of applying very low current to painful tissue and associated trigger points with the Treatment Probes.
More Information

Not Found

No
The description focuses on electrical stimulation and does not mention any AI/ML components or functionalities.

Yes
The device is intended for "temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain," which are therapeutic applications. It also lists several TENS devices as predicates, which are therapeutic.

No
The document states that the device is intended for "temporary symptomatic relief of chronic intractable pain" and "as an adjunctive treatment" for pain. It describes applying electrical current for treatment, not for diagnosis.

No

The device description explicitly lists hardware components: a control console, two Treatment Probes (electrodes), and a Security Cartridge. It also mentions operating on 115V wall current and applying current to tissue, indicating a physical device delivering electrical stimulation.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is for "temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain." This describes a therapeutic treatment applied directly to the patient's body, not a test performed on a sample taken from the body.
  • Device Description: The device consists of a control console, treatment probes (electrodes), and a security cartridge. It applies "very low current to painful tissue and associated trigger points." This is consistent with a device that delivers energy or stimulation to the body for therapeutic purposes.
  • Lack of IVD Characteristics: There is no mention of analyzing biological samples (blood, urine, tissue, etc.) or providing diagnostic information based on such analysis.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device does not fit that description.

N/A

Intended Use / Indications for Use

The MediPhysics Pain Treatment System, Model 1, is intended for temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain.

Product codes (comma separated list FDA assigned to the subject device)

GZJ

Device Description

The McdiPhysics Pain Treatment System, Model 1, consists of a control console, two Treatment Probes (electrodes), and a Security Cartridge. The system operates on 115V wall current. Treatment, intended to take place under the supervision of a physician in a medical setting, consists of applying very low current to painful tissue and associated trigger points with the Treatment Probes.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

painful tissue and associated trigger points

Indicated Patient Age Range

Not Found

Intended User / Care Setting

supervision of a physician in a medical setting

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

The MediPhysics Pain Treatment System, Model 1, has been systematically tested and test results demonstrate that it fulfills design and performance specifications.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K894127, K970203, K883911, K895473, K020020, K020803

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 882.5890 Transcutaneous electrical nerve stimulator for pain relief.

(a)
Identification. A transcutaneous electrical nerve stimulator for pain relief is a device used to apply an electrical current to electrodes on a patient's skin to treat pain.(b)
Classification. Class II (performance standards).

0

K032928

510(k) Summary MediPhysics Pain Treatment System, Model 1

1. SPONSOR

MediPhysics Pain Centers of America 13 Orchard Road, Unit 108 Lake Forest, California 92630

Contact Person: James Rogers Telephone: (949) 215-0145, extension 10

Date Prepared: November 24, 2003

2. DEVICE NAME

Proprietary Name:MediPhysics Pain Treatment System, Model 1
Common/Usual Name:Electro-Magnetic Device for the Treatment of Pain
Classification Name:Class II; 21CFR 882.5890; Product Code GZJ

3. PREDICATE DEVICES

  • Therapeutic Devices Inc. TENS (K894127) .
  • . Empi Epix VT TENS (K970203)
  • Electro-Acuscope 85 (K883911) .
  • Medical Devices Matrix 1 TENS model 4700s (K895473) .
  • . Well Life Health Care Mini TENS WL-2403 (K020020)
  • CEFAR Primo (K020803) .

DEVICE DESCRIPTION 4.

The McdiPhysics Pain Treatment System, Model 1, consists of a control console, two Treatment Probes (electrodes), and a Security Cartridge. The system operates on 115V wall current. Treatment, intended to take place under the supervision of a physician in a medical setting, consists of applying very low current to painful tissue and associated trigger points with the Treatment Probes.

1

5. INTENDED USE

The MediPhysics Pain Treatment System, Model 1, is intended for temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain.

TECHNOLOGICAL CHARACTERISTICS AND SUBSTANTIAL EQUIVALENCE 6.

MediPhysics has determined that the MediPhysics Pain Treatment System, Model 1, is substantially equivalent to the cited predicate devices based on intended use, indications for use, design characteristics, and technological characteristics and that the differences between the MediPhysics Pain Treatment System, Model 1, and cited predicate devices are minor and raise no new issues of safety or effectiveness.

7. PERFORMANCE TESTING

The MediPhysics Pain Treatment System, Model 1, has been systematically tested and test results demonstrate that it fulfills design and performance specifications.

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized eagle with three stripes forming its wing, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" encircles the eagle. The text is arranged in a circular fashion around the eagle, with "DEPARTMENT OF HEALTH & HUMAN SERVICES" at the bottom and "USA" at the top.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

DEC 1 9 2003

Mr. Morten Simon Christensen Representing MediPhysics Pain Centers of America Underwriters Laboratories, Inc. 1655 Scott Boulevard Santa Clara, California 95050-4169

Re: K032928

Device Name: MediPhysics Pain Treatment System, Model 1 Regulation Number: 21 CFR 882.5890 Regulation Names: TENS Device for Pain Relief Regulatory Class: Class 2 Product Codes: GZJ Dated: December 2, 2003 Received: December 4, 2003

Dear Mr. Christensen:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if

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Page 2 - Mr. Morten Simon Christensen

applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4648. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97), You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours.

h. Mark N. Millman

Celia M. Witten, M.D., Ph.D. Director Division of General, Restorative, and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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510(k) Number (if known): K032928

Device Name: MediPhysics Pain Treatment System, Model 1

Indications for Use: The MediPhysics Pain Treatment System, Model 1, is intended for temporary symptomatic relief of chronic intractable pain, and as an adjunctive treatment in the management of post-surgical and post-traumatic acute pain.

Image /page/4/Picture/3 description: The image shows the words "PRESCRIPTION USE" in all capital letters. There is a large "X" next to the words. The words and the "X" are written in black ink.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NECESSARY)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Mark N Milhusan

IVISION (o General, Restorative and Neurological

Prescription Use X (Per 21 CFR 801.109)

OR

Over-The-Counter Use _________________________________________________________________________________________________________________________________________________________

(Optional Format 1-2-96)

MediPhysics Pain Centers of America, Traditional 510(k) MediPhysics Pain Treatment System, Model MPTS1 November 24, 2003 Page 1