Cochrane review concludes SCS is ineffective for chronic low back pain

[Agast]

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014789.pub2/full

“Authors' conclusions
Data in this review do not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.”

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[DrMDAware]

Thanks for posting. Not surprising given incidence and prevalence of LBP is so high and causes are multifactorial. I tell patients I do not use SCS for LBP and usually only offer it to those with leg pain greater than back pain with a neuropathic component.

I would much rather see weight loss, stretching/yoga, smoking cessation for chronic LBP.

 

[lobelsteve]

CLBP is not a diagnosis. It is a symptom.
Preaching to choir.

 

[SpineandWine]

Blue cross blue shield + any two symptoms

 

[Agast]

CLBP is not a diagnosis. It is a symptom.
Preaching to choir.

I can’t log in to read the study to see which studies they reviewed, but they mention it doesn’t work for back or leg pain, so it sounds like they were looking at radicular symptoms as well

 

[Dr. Ice]

Stim is overrated and overdone

 

[epidural man]

Stim is overrated and overdone

Not in my practice. I don’t think I do it enough.

 

[epidural man]

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014789.pub2/full

“Authors' conclusions
Data in this review do not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.”

Then the authors should quit sending their patients to us.

I love how these FP and IM types (and sometimes surgeons) always do these studies and meta-analysis that show what we do doesn’t work - yet when they have a complaining back pain patient, they punt them our direction.

If they don’t think what we do is helpful, why don’t they do what they think is helpful and leave us alone?

But they won’t. They will continue to send the non-specific back pain complainer to us because they lack the skill and insight to do anything else.

Seems monumentally hypocritical to me.

 

[Greenbayslacker]

If they don’t think what we do is helpful, why don’t they do what they think is helpful and leave us alone?

Probably just want you to write opioids and stop messing around with the needles.

 

[epidural man]

Probably just want you to write opioids and stop messing around with the needles.

They have the same ability to write opioids as I do.

They work (or don’t work) just as effective when they write the script.

Their studies on opioids and back pain say the same thing as their studies on SCS and back pain.

 

[SpineandWine]

All these trials have issues.
-According to SPORTS trial, discectomy doesn’t help
-Mint trial- MBNB and RFA don’t help.

Just some academic trying to increase amount of signatures associated with their email

 

[Ducttape]

Then the authors should quit sending their patients to us.

I love how these FP and IM types (and sometimes surgeons) always do these studies and meta-analysis that show what we do doesn’t work - yet when they have a complaining back pain patient, they punt them our direction.

If they don’t think what we do is helpful, why don’t they do what they think is helpful and leave us alone?

But they won’t. They will continue to send the non-specific back pain complainer to us because they lack the skill and insight to do anything else.

Seems monumentally hypocritical to me.

no, they hope we do quality care based on the best evidence, not based on pre$umed be$t financial evidence.

they hope you will discuss injections that do have some evidence - RFA, ESI for acute radic, SIJ, PT, HEP, non-opioid med management, CBT/EAAT/pain psychology, and referral to surgeon when indicated and be the ones to break the bad news that chronic pain is not going to go away.

that way, they can focus on what they were trained to do - manage chronic medical conditions such as hypertension, diabetes, GERD, health maintenance (flu vaccine, etc), mild depression, asthma, COPD, obesity...

 

[drusso]

no, they hope we do quality care based on the best evidence, not based on pre$umed be$t financial evidence.

they hope you will discuss injections that do have some evidence - RFA, ESI for acute radic, SIJ, PT, HEP, non-opioid med management, CBT/EAAT/pain psychology, and referral to surgeon when indicated and be the ones to break the bad news that chronic pain is not going to go away.

that way, they can focus on what they were trained to do - manage chronic medical conditions such as hypertension, diabetes, GERD, health maintenance (flu vaccine, etc), mild depression, asthma, COPD, obesity...

Bull-****e. Follow the money. It's not an accident that they publish this crap. Remember getting paid to NOT do thing is the same kind of financial COI as getting paid to do things.

Big Data: The Danger in Knowing Less and Less about More and More | The Lund Report

If policymakers want clearer direction about how to prioritize limited resources, then they can stop paying for meta-analysis.

www.thelundreport.org

 

[Ducttape]

um... the point is that some pain docs do procedures entirely due to financial benefits with little respect to patient improvement. PCPs send patients to us with the hope that we are not using this paradigm.



i admit i dont know what Bul-****e means.

 

[MitchLevi]

Axial LBP with no Hx of back surgery in a pt with stenosis and facet disease is not an indication for SCS.

I'm dealing with this as we speak. A local POS pain group was bought out by PE, the founder of the clinic was fired and now it's an even worse POS and there are SCS patients being sent out looking for implanters and trialers. Of course, the rep sends two to me.

I meet one, a 73 yo guy who is extremely healthy (takes Lisinopril) with mod to severe L3-5 spinal stenosis from an MRI over two years ago with golf ball facets and classic axial low back pain. Huge facets at L5-S1 with facet edema (which the radiologists DIDN'T include by the way). He had "injections," no clue what type or when...

He has never seen an MD at that clinic, and has been managed by PAs the entire time. Never once seen the MD except for getting "injections." I will tell you 99% of PAs will NOT look at that images on the CD, and if they do they're not gonna pick up subtleties like clinically significant facet edema. There's also no way a PA will pick that up and mention it if the radiologist didn't say it.

What is clearly apparent to me is the fact small pain groups live and die on stimulators and a few other things...Monthly opiate visits at 214 and urine to go along with it.

They hoard patients bc the electricity bill needs to be paid, employees need paychecks, etc.

Surgery is indicated for symptomatic stenosis in extremely healthy 73 yo gentleman, not spinal cord stimulation.

"I don't want surgery, but I was told surgery won't treat this and the stim-uh-lader will let me live out the rest of my days without pain."

Here's an amazing back and forth - I texted the rep basically telling him I won't accept these patients anymore and that I don't see any way a stimulator will help this guy and the rep replies to me, "I wouldn't over promise long term relief for arthritis pain but the axial back pain we should get good relief with."

That is a direct quote from my text messages. If yall ever think your rep knows anything at all about back pain or how best to treat your patients, read that quote again.

I'm getting a new MRI and will offer him an ablation or an ESI, if he declines or it fails I will offer a referral to one of our spine surgeons. If he declines that he can go find someone else to do it.

I am blocking all referrals from that practice.

They once sent me an implant pt who did a 12 hour trial that failed. She was a smoker on immunosuppression with a BMI around 16. Didn't even trial for 24 hours.

In the next 5 years it will become more and more restrictive to put a stimulator in a patient.

IMO, the only reason to do it is CRPS, FBSS with persistent radic, FBSS with axial pain or some other neuropathic process.

Preoperative axial back pain is a BS stimulation target, and anyone who does it and tries to tell me they get good results is either blind or FoS.

The other thing...Your avg pain doctor would probably make more money stacking ESI/RFA patients instead of putting in stimulators. At least, that's true of implants.

 

[Ducttape]

over the years, i have seen least 10 patients from a spine and pain group with implants for axial back pain with "radiculopathy" and essentially normal CT scans and negative EMGs. (no MRI because of SCS)

 

[MitchLevi]

over the years, i have seen least 10 patients from a spine and pain group with implants for axial back pain with "radiculopathy" and essentially normal CT scans and negative EMGs. (no MRI because of SCS)

Pay those bills bro!

Porsche ain't gonna buy itself.

"Sir...You will hurt indefinitely on one level or another. You're lit up with arthritis and there's no fixing this."

WTF can't anyone say that!?!? It isn't your fault that pt got older.

 

[Asclepius186]

Axial LBP with no Hx of back surgery in a pt with stenosis and facet disease is not an indication for SCS.

I'm dealing with this as we speak. A local POS pain group was bought out by PE, the founder of the clinic was fired and now it's an even worse POS and there are SCS patients being sent out looking for implanters and trialers. Of course, the rep sends two to me.

I meet one, a 73 yo guy who is extremely healthy (takes Lisinopril) with mod to severe L3-5 spinal stenosis from an MRI over two years ago with golf ball facets and classic axial low back pain. Huge facets at L5-S1 with facet edema (which the radiologists DIDN'T include by the way). He had "injections," no clue what type or when...

He has never seen an MD at that clinic, and has been managed by PAs the entire time. Never once seen the MD except for getting "injections." I will tell you 99% of PAs will NOT look at that images on the CD, and if they do they're not gonna pick up subtleties like clinically significant facet edema. There's also no way a PA will pick that up and mention it if the radiologist didn't say it.

What is clearly apparent to me is the fact small pain groups live and die on stimulators and a few other things...Monthly opiate visits at 214 and urine to go along with it.

They hoard patients bc the electricity bill needs to be paid, employees need paychecks, etc.

Surgery is indicated for symptomatic stenosis in extremely healthy 73 yo gentleman, not spinal cord stimulation.

"I don't want surgery, but I was told surgery won't treat this and the stim-uh-lader will let me live out the rest of my days without pain."

Here's an amazing back and forth - I texted the rep basically telling him I won't accept these patients anymore and that I don't see any way a stimulator will help this guy and the rep replies to me, "I wouldn't over promise long term relief for arthritis pain but the axial back pain we should get good relief with."

That is a direct quote from my text messages. If yall ever think your rep knows anything at all about back pain or how best to treat your patients, read that quote again.

I'm getting a new MRI and will offer him an ablation or an ESI, if he declines or it fails I will offer a referral to one of our spine surgeons. If he declines that he can go find someone else to do it.

I am blocking all referrals from that practice.

They once sent me an implant pt who did a 12 hour trial that failed. She was a smoker on immunosuppression with a BMI around 16. Didn't even trial for 24 hours.

In the next 5 years it will become more and more restrictive to put a stimulator in a patient.

IMO, the only reason to do it is CRPS, FBSS with persistent radic, FBSS with axial pain or some other neuropathic process.

Preoperative axial back pain is a BS stimulation target, and anyone who does it and tries to tell me they get good results is either blind or FoS.

The other thing...Your avg pain doctor would probably make more money stacking ESI/RFA patients instead of putting in stimulators. At least, that's true of implants.

I always wonder how referring docs don’t see through these kind of groups. Like how do they keep getting patients?

 

[MitchLevi]

I always wonder how referring docs don’t see through these kind of groups. Like how do they keep getting patients?

I'm not so sure they suck up referrals TBH, at least not in my area.

This is why these pts are smothered with opiates, shots and stimulators. You have to grind them into dust bc you're not receiving 100 new referrals per month.

Especially when PE groups buy them out, send 2 new pain doctors in and rename the practice. These docs initially try to do a good job but they're under oppressive contracts and they're fighting for their lives.

 

[Ferrismonk]

Um, Nevro is now on-label for "Non-surgical refractory low back pain"...

I also have great chronic non-radicular low back pain results with Boston and their FAST programming.

I think the idea of Post-lami and radicular neuropathic pain only is an antiquated idea. There is no doubt tons of stims are placed inappropriately due to financial reasons, and I'm not saying everyone needs a stim, but modern stims absolutely work for low back pain.

 

[gaspasser127]

Beware of the next indication for SCS that these companies will be pushing:


“Non surgical low back pain”

 

[MitchLevi]

Um, Nevro is now on-label for "Non-surgical refractory low back pain"...

I also have great chronic non-radicular low back pain results with Boston and their FAST programming.

I think the idea of Post-lami and radicular neuropathic pain only is an antiquated idea. There is no doubt tons of stims are placed inappropriately due to financial reasons, and I'm not saying everyone needs a stim, but modern stims absolutely work for low back pain.

Funny you mention Nevro dude.

I pulled a Nevro implant out this AM and you may be surprised to find out it's a Nevro rep pushing these pts to me.

"On label" means jack S to me in 2023 if we're talking pain technology, especially if the conversation involves spinal cord stimulation, and even more so if you're talking Nevro.

 

[Dr. Ice]

um... the point is that some pain docs do procedures entirely due to financial benefits with little respect to patient improvement. PCPs send patients to us with the hope that we are not using this paradigm.



i admit i dont know what Bul-****e means.

****e but he was hoping they wouldn’t take out the bull in front of it

 

[Dr. Ice]

But they did it to me too

 

[DrMDAware]

Funny you mention Nevro dude.

I pulled a Nevro implant out this AM and you may be surprised to find out it's a Nevro rep pushing these pts to me.

"On label" means jack S to me in 2023 if we're talking pain technology, especially if the conversation involves spinal cord stimulation, and even more so if you're talking Nevro.

Please enlighten me why you’re not a huge Nevro fan. I don’t have a dog in the fight. Just looking to learn more.

 

[DrMDAware]

Um, Nevro is now on-label for "Non-surgical refractory low back pain"...

I also have great chronic non-radicular low back pain results with Boston and their FAST programming.

I think the idea of Post-lami and radicular neuropathic pain only is an antiquated idea. There is no doubt tons of stims are placed inappropriately due to financial reasons, and I'm not saying everyone needs a stim, but modern stims absolutely work for low back pain.

Thanks for sharing. When do you consider the use of SCS for CLBP then? A big broad generalized question I admit. Just looking for your gestalt and a prototypical patient

 

[Tboned]

I’ll tell you my algorithm

I do a bunch of injections that don’t work
Then I look at the patients MRI and see the multifidi are atrophied or sometimes they’re not but they’ll at least look dysfunctional, hard to describe but I’ve been doing this type of MRI review for awhile now so I can tell.
Then I bend the patient over the exam table and push on their back and make those little atrophied/dysfunctional buggers scream…I call it the prone instability test…it’s legit. At this point I have triple, maybe quadruple confirmed my diagnosis of chronic low back pain. Next I implant Reactiv8 cuz it’s the only way to wake up those sleepy muscles (and obviously I did that prone instability test which is a sure fire diagnostic physical exam maneuver). I tell my younger patients we need to get those muscle “woke” and this is the best way to do that, but sometimes this implantable device is a bridge to PT (someone said that on SDN so I make sure patients know up front).

Shoot, maybe this was the wrong thread…I’ll cross post in the multifidiverse thread

Purple font

 

[MitchLevi]

Please enlighten me why you’re not a huge Nevro fan. I don’t have a dog in the fight. Just looking to learn more.

It has underperformed in my hands. I did a Nevro trial 3 days ago; I removed a Nevro implant yesterday. I still use Nevro, but it simply doesn't perform in my hands like SENZA said it would. Additionally, now that they're rolling out this AI programming thing, you will all be paying more for implants in your ASC. I've already received an email from them about it.

 

[lobelsteve]

It has underperformed in my hands. I did a Nevro trial 3 days ago; I removed a Nevro implant yesterday. I still use Nevro, but it simply doesn't perform in my hands like SENZA said it would. Additionally, now that they're rolling out this AI programming thing, you will all be paying more for implants in your ASC. I've already received an email from them about it.

View attachment 367508

Over half my implants are from outside docs. Have maintained success at that 9/10 patients mark.
Yesterday had 2 patients from different docs in pre-op next to each other. Long term friends and neither knew their friend was getting an implant with me that day. Small world. What are the chances.

 

[deleted131481]

Um, Nevro is now on-label for "Non-surgical refractory low back pain"...

I also have great chronic non-radicular low back pain results with Boston and their FAST programming.

I think the idea of Post-lami and radicular neuropathic pain only is an antiquated idea. There is no doubt tons of stims are placed inappropriately due to financial reasons, and I'm not saying everyone needs a stim, but modern stims absolutely work for low back pain.

What kind of non-radicular lower back pain? Facets, SI, stenosis, disc, msk?

They did a wonderful job marketing it for chronic non-radicular lower back pain, but that's not a diagnosis.

 

[MitchLevi]

What kind of non-radicular lower back pain? Facets, SI, stenosis, disc, msk?

They did a wonderful job marketing it for chronic non-radicular lower back pain, but that's not a diagnosis.

This is exactly what bothers me about this entire charade. What is "low back pain" exactly, and why would SCS reliably treat it?

This is the same situation as DRG stimulation for post TKA pain, which is virtually always mechanical in nature. I work in a large ortho group and we're doing huge numbers of knees. I've seen a great deal of post TKA pain and not once have I seen one with anything close to resembling CRPS. I think Abbott teaches it as causalgia in their DRG by the way. Not quite sure why they call it that or if they still do. Last I checked, the American Civil War was a long time ago and that term isn't currently used.

...I just checked the Abbott website. They're using CRPS on the site.

Geriatric spine pain is largely mechanical in my corner of the world, and generally responds favorably to RFA.

Over half my implants are from outside docs. Have maintained success at that 9/10 patients mark.
Yesterday had 2 patients from different docs in pre-op next to each other. Long term friends and neither knew their friend was getting an implant with me that day. Small world. What are the chances.

Like I said, I use Nevro. I am happy to hear you're finding success in 90% of your implants. Did you get that number from the charts Nevro emails you, or did you get that number from your own data collecting after speaking to your patients?

I get those charts they email but it just doesn't seem to align with the human beings sitting in front of me on a random clinic visit on Tuesday.

BTW - Yesterday 810 AM I saw a FBSS with radic pt with a Nevro implant who is doing great with his buttock and leg pain, modestly beneficial with his back pain and zero relief of his DPN with A1C < 9.

He's a success story, but his success is directly countered by the Nevro implant I removed yesterday at 7AM (before clinic). A woman with classic FBSS and chronic radic with mild LBP.

I definitely wouldn't claim 9/10 pts are significantly improved, and I'm extremely restrictive in who I implant.

I should add, if they're going to start charging more money for implants bc of their new AI programming I'm probably going to just stop using them TBH.

 

[SC Tian]

It has underperformed in my hands. I did a Nevro trial 3 days ago; I removed a Nevro implant yesterday. I still use Nevro, but it simply doesn't perform in my hands like SENZA said it would. Additionally, now that they're rolling out this AI programming thing, you will all be paying more for implants in your ASC. I've already received an email from them about it.

View attachment 367508

Similar observation, keep reprogramming, lower efficacy after two years if not exaggerating, how much more they will charge you for iq battery, they notify me 1k more, total 19,600, is that closer to yours? Thanks.

 

[MitchLevi]

Similar observation, keep reprogramming, lower efficacy after two years if not exaggerating, how much more they will charge you for iq battery, they notify me 1k more, total 19,600, is that closer to yours? Thanks.

Haven't been given any quotes yet. Just an email notifying us the cost will increase and they want to come out and discuss it with our ASC director.

They haven't altered their prices in 4 years, so I get the need to increase it, but I'm not going to entertain this if the cost is substantially higher.

 

[SC Tian]

Haven't been given any quotes yet. Just an email notifying us the cost will increase and they want to come out and discuss it with our ASC director.

They haven't altered their prices in 4 years, so I get the need to increase it, but I'm not going to entertain this if the cost is substantially higher.

How much is current price if this is not secret, I negotiate the price with them personally. just some of my direct observations, the Medtronic dtm
or near future closed loop may have more or equivalent benefits for back pain.

 

[MitchLevi]

How much is current price if this is not secret, I negotiate the price with them personally. just some of my direct observations, the Medtronic dtm
or near future closed loop may have more or equivalent benefits for back pain.

Off top of my head I don't know. Have to go back through my emails to find that. Between Abbott, BSc and Nevro, BSc is by far the least expensive.

 

[SpineandWine]

So I’ve mostly had experience with Medtronic and Boston- are you guys implying Nevro is worse?

I am talking about good candidate selection - FBSS, hardware intact, thought to be scar tissue and neuropathic component of leg pain- will Nevro do worse than other companies? Reason I ask is in this new job, they’re going with Nevro secondary to pricing which I’m not privy to. I can push back and ask for medtronic, but don’t wNt to make waves especially if it’s a comparable company

 

[MitchLevi]

So I’ve mostly had experience with Medtronic and Boston- are you guys implying Nevro is worse?

I am talking about good candidate selection - FBSS, hardware intact, thought to be scar tissue and neuropathic component of leg pain- will Nevro do worse than other companies? Reason I ask is in this new job, they’re going with Nevro secondary to pricing which I’m not privy to. I can push back and ask for medtronic, but don’t wNt to make waves especially if it’s a comparable company

My experience is my own. I use Abbott, BSc and Nevro.

I've had wins with every system.

Each of those three systems is probably equally efficacious, but I do not believe for a moment Nevro will reliably treat routine low back pain, and I feel similarly about it treating diabetic PN.

I think it's laughable when ppl say they use Nevro in more axial cases and another system if it's more radicular.

Nevro holds no ownership over low back coverage.

Abbott has a new battery that is very tiny, and you supposedly charge it 5-6x per year. It is quite small, which means faster implant times and potentially lower infxn risk given the pocket is smaller.

BTW - I'm not pushing Abbott. They lied to me a few yrs ago when a rep tried to tell me they have a brand new battery with extended lifespan and it turned out to be a simple programming change where it only stimulates for x seconds every x minutes.

These companies are all out for profit (can't blame them - they have to make money) and their marketing is clever and preys on the inability for most doctors to do nothing.

I let ppl hurt all the time.

Just bc a pt says he/she doesn't want back surgery should not mean they now get to do stimulator trials, most of which will work for the 1st 2 months and then it won't help any longer. You'll pull a lot of those devices out 12 months later after it's been turned off for 6 months.

I'm explanting another device this coming Friday. FBSS with radic. He's lost weight and his IPG is hurting him.

 

[lobelsteve]

My experience is my own. I use Abbott, BSc and Nevro.

I've had wins with every system.

Each of those three systems is probably equally efficacious, but I do not believe for a moment Nevro will reliably treat routine low back pain, and I feel similarly about it treating diabetic PN.

I think it's laughable when ppl say they use Nevro in more axial cases and another system if it's more radicular.

Nevro holds no ownership over low back coverage.

Abbott has a new battery that is very tiny, and you supposedly charge it 5-6x per year. It is quite small, which means faster implant times and potentially lower infxn risk given the pocket is smaller.

BTW - I'm not pushing Abbott. They lied to me a few yrs ago when a rep tried to tell me they have a brand new battery with extended lifespan and it turned out to be a simple programming change where it only stimulates for x seconds every x minutes.

These companies are all out for profit (can't blame them - they have to make money) and their marketing is clever and preys on the inability for most doctors to do nothing.

I let ppl hurt all the time.

Just bc a pt says he/she doesn't want back surgery should not mean they now get to do stimulator trials, most of which will work for the 1st 2 months and then it won't help any longer. You'll pull a lot of those devices out 12 months later after it's been turned off for 6 months.

I'm explanting another device this coming Friday. FBSS with radic. He's lost weight and his IPG is hurting him.

Who was putting in those stims out that way. Mark?

 

[MitchLevi]

Who was putting in those stims out that way. Mark?

He's pills for shots in 2023.

I have 2 ppl he sees who want me to trial them, but his PA told them they'll be fired if I do it.

They will be fired if I do their trial.

No COVID vaccine? You are fired.

I'm not against stim. I'm a believer in the tech for certain pts, but I want this thing available in 2026 and 2031, and the more indications for stim the worse the outcomes will be and harder this will be for all of us.

 

[bedrock]

He's pills for shots in 2023.

I have 2 ppl he sees who want me to trial them, but his PA told them they'll be fired if I do it.

They will be fired if I do their trial.

No COVID vaccine? You are fired.

I'm not against stim. I'm a believer in the tech for certain pts, but I want this thing available in 2026 and 2031, and the more indications for stim the worse the outcomes will be and harder this will be for all of us.

Agree. Stim can be very helpful for the right patient but overuse by greedy docs will result in losing that option for many.

 

[DrMDAware]

My experience is my own. I use Abbott, BSc and Nevro.

I've had wins with every system.

Each of those three systems is probably equally efficacious, but I do not believe for a moment Nevro will reliably treat routine low back pain, and I feel similarly about it treating diabetic PN.

I think it's laughable when ppl say they use Nevro in more axial cases and another system if it's more radicular.

Nevro holds no ownership over low back coverage.

Abbott has a new battery that is very tiny, and you supposedly charge it 5-6x per year. It is quite small, which means faster implant times and potentially lower infxn risk given the pocket is smaller.

BTW - I'm not pushing Abbott. They lied to me a few yrs ago when a rep tried to tell me they have a brand new battery with extended lifespan and it turned out to be a simple programming change where it only stimulates for x seconds every x minutes.

These companies are all out for profit (can't blame them - they have to make money) and their marketing is clever and preys on the inability for most doctors to do nothing.

I let ppl hurt all the time.

Just bc a pt says he/she doesn't want back surgery should not mean they now get to do stimulator trials, most of which will work for the 1st 2 months and then it won't help any longer. You'll pull a lot of those devices out 12 months later after it's been turned off for 6 months.

I'm explanting another device this coming Friday. FBSS with radic. He's lost weight and his IPG is hurting him.

I’m only partially kidding but I say we become KOLs about removing implants. Make best practices. Post on LinkedIn. Have webinars for fellows. Establish a society. Create a new ICD10. Might make a nice penny cleaning up other peoples messes.

 

[MitchLevi]

I’m only partially kidding but I say we become KOLs about removing implants. Make best practices. Post on LinkedIn. Have webinars for fellows. Establish a society. Create a new ICD10. Might make a nice penny cleaning up other peoples messes.

I've always have wanted a nice automatic watch.

I love Farer, Christopher Ward and many other microbrands.

I won't do the shoes though. Pointy shoes ain't gonna happen.

 

[callmeanesthesia]

I've always have wanted a nice automatic watch.

I love Farer, Christopher Ward and many other microbrands.

I won't do the shoes though. Pointy shoes ain't gonna happen.

New Balance will be our official shoes.

 

[clubdeac]

Then the authors should quit sending their patients to us.

I love how these FP and IM types (and sometimes surgeons) always do these studies and meta-analysis that show what we do doesn’t work - yet when they have a complaining back pain patient, they punt them our direction.

If they don’t think what we do is helpful, why don’t they do what they think is helpful and leave us alone?

But they won’t. They will continue to send the non-specific back pain complainer to us because they lack the skill and insight to do anything else.

Seems monumentally hypocritical to me.

I agree however I think the ones writing these worthless Cochrane reviews probably sit in the ivory towers and no longer take part in any meaningful clinical patient care

 

[Tboned]

I’m only partially kidding but I say we become KOLs about removing implants. Make best practices. Post on LinkedIn. Have webinars for fellows. Establish a society. Create a new ICD10. Might make a nice penny cleaning up other peoples messes.

Nobody posts failures on LinkedIn…could be onto something my friend. Would definitely change the perspective. All the younger docs like myself see is KOL posting about sucessful SCS, reactiv8 (which works as long as you screen with the prone instability test) , this that and the other, but what we need to see is real life and learn from those who have been in the trenches, not eating scallops

 

[lobelsteve]

New Balance will be our official shoes.

1080s

 

[lobelsteve]

Nobody posts failures on LinkedIn…could be onto something my friend. Would definitely change the perspective. All the younger docs like myself see is KOL posting about sucessful SCS, reactiv8 (which works as long as you screen with the prone instability test) , this that and the other, but what we need to see is real life and learn from those who have been in the trenches, not eating scallops

They post failure. Look at the SIJ thread. Just didn’t know it was a failure.

 

[MitchLevi]

They post failure. Look at the SIJ thread. Just didn’t know it was a failure.

That was a train wreck.

A cautionary tale.

I couldn't look away.

What makes it the most uncomfortable is the dude who posted it is probably a pain doc simply trying his best to solve the pain equation sitting in the chair across from him on a Wed AM at 930. He got a little confident where he shouldn't have and got stomped to death.

 

[nopain1234]

Nevro high frequency stim is for the purpose of a moving to perm. Once perm is in, high frequency resumes leading to rapid habituation and eventual explantation.

 

[gaspasser127]

That was a train wreck.

A cautionary tale.

I couldn't look away.

What makes it the most uncomfortable is the dude who posted it is probably a pain doc simply trying his best to solve the pain equation sitting in the chair across from him on a Wed AM at 930. He got a little confident where he shouldn't have and got stomped to death.

Which post is this?