SCS companies

[ManUnited]

I have heard from a few physicians that at least one of the SCS companies has been involved in cases in which stimulators were placed by CRNAs.

Do any of these companies have a genral policy against this?

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[Aether2000]

CRNAs have zero training in chronic pain interventional procedures during their training programs. All they have learned is simply by experimenting on their patients or by going to little weekend courses that are supposed to teach what physicians with years of experience and training have acquired. CRNAs simply should not be permitted to do interventional pain procedures and hospitals that permit them to do so are either blind or care more about $$$ than patient care and safety issues. Most SCS companies have adopted policies that are consistent with the ISIS, ASIPP, AAPMR, AMA, and most recently NASS, that interventional pain procedures are the practice of MEDICINE, not nursing.

 

[sweetalkr]

Algos,

I am guessing you haven't spent time on the anesthesiology SDN forum recently. I just finished my residency, so i have.

ManUnited is a NEW member with a controversial post. I am 100% certain he/ probably she is a CRNA trying to stir it up .

Just ignore any further posts by them. Just a heads up. You contribute a lot to this forum, don't pay attention to her

 

[SleepIsGood]

I dnt know who ManUnited is.

HOwever, suppossing what she says is correct. Whatever SCS or other interventional pain company or person who teaches/instructs CRNAs should be called out in this forum. I then recommend others avoiding their product and using their competition.

IF we all stay united in this regard, we can maintain the best quality of care be provided to our patients.

 

[sweetalkr]

I asked Medtronics rep today while we were discussing a pt we are doing a stim trial on. I wear my heart on my sleeve, so when I asked, she said "if they are trained. was this CRNA trained?"

i had a look between disgust and horror. so she soon replied "well they can't train, so no. we would not distribute SCS to them"

which means, if they can legally do it, they will distribute them. but does anyone know if an insurance company will reimburse them?

 

[painchas]

Had a frank discussion with SJM today in this regard. Indicated to me that they have no interest in training nurses with whatever training in the placement of SCS. Strongly behind pain MDs only, not even that comfortable training radiology in this method. Strongly in our court. Go SJM

 

[Aether2000]

Thanks for the info!

 

[PMR 4 MSK]

All docs who implant should put financial pressure on the companies who make SCS or any other implants, to not use their company if they find they are supplying or training non-physicians (non-MD and non-DO) to use their products.

Tell the reps and tell the district managers.

 

[clubdeac]

SMJ all the way baby. Although I have been known to like the BS reps

 

[SleepIsGood]

So...does it look like MEdtronic is the only company that caters to CRNAS?

 

[sweetalkr]

i googled it. what do yall think

http://www.mindbodyhealthnow.com/index2.php?option=com_content&do_pdf=1&id=303

 

[ultm8frisbee]

i googled it. what do yall think

http://www.mindbodyhealthnow.com/index2.php?option=com_content&do_pdf=1&id=303

Holy fu$k that is ridiculous, this CRNA has claimed to put in 600 stims! It's people like this that will eventually ruin this promising modality for future patients. There is no way that someone form a CRNA background can know when a stim is or isn't appropriate. Horrible.

 

[hyperalgesia]

I think this "Alpha stim" is completely external and not a spinal cord stimulator. I don't think any CRNA in his right mind would try to do real SCS.

 

[Jcm800]

I think this "Alpha stim" is completely external and not a spinal cord stimulator. I don't think any CRNA in his right mind would try to do real SCS.

1) alpha stim is like tens.
alpha SCS is (Stress control system)

2) i know vaguely of a CRNA that was doing stim trials in rural illinois. i think he stopped...

 

[TX PAIN DOC]

I was at a Boston Scientific Capstone course a few weeks ago and one of the instructors mentioned that CRNAs in New Hampshire were doing SCS trials. Anyone on the forum from NH that can verify this?

He mentioned one specific case where there was a serious complication from a cervical case done on a patient with no prior MRI. The CRNA would do trials and then send to a surgeon for implant.

 

[rubenk1]

Man that really pisses me off...let's face it we are all well past the point where we HAVE to make Pain Medicine a completely separate medical residency and not simply an added one-year fellowship...if nothing else then to legitimize this field properly and give ourselves a specialized name (algosology and algiatry both sound reasonable)...as silly as that sounds it really is a matter of creating barriers to mid-levels arbitrarily choosing to perform procedures and make clinical decisions they are wholly not suited for. Once nurse practitioners start doing interventional cardiac procedures and PAs start doing liver transplants I may admit that such things aren't important but until that time I truly believe that is the state this field is in. If I find out one of these companies are actually providing resources to CRNAs for surgical pain procedures I am going to have a pleasant talk with my local rep.

 

[pjuer]

1) alpha stim is like tens.
alpha SCS is (Stress control system)

2) i know vaguely of a CRNA that was doing stim trials in rural illinois. i think he stopped...

Where in Illinois was he located? There was a CRNA in Sparta, IL doing multiple procedures including TFESI without contrast (got copies of his op notes). He has since left the state.

 

[sweetalkr]

thank god those are tens units. and for the guy in illinois, has someone sued him yet?

 

[Jcm800]

Where in Illinois was he located? There was a CRNA in Sparta, IL doing multiple procedures including TFESI without contrast (got copies of his op notes). He has since left the state.

i think Dekalb?

 

[joshmir]

there is an old thread re CRNAs doing stim in NH and some dartmouth-affiliated pain MDs' responses

 

[clubdeac]

i know this has probably been brought up in other threads but what do you guys think is the best system. I think no leads steer better than BS, anyone disagree. However, I've heard their fractionalization push is all bs and if you use it like it should be used, your battery is gonna be out in a couple years. Anyone else hear that? They also push this thing called the OMG. Anyone use that? They claim they can improve anyone's trial with a competitor by simply hooking the lead up to their technology. Has anyone seen this in action?? I'm getting a lot of pitches from BS and SJ and am looking for some unbiased experienced opinions...

 

[TX PAIN DOC]

i know this has probably been brought up in other threads but what do you guys think is the best system. I think no leads steer better than BS, anyone disagree. However, I've heard their fractionalization push is all bs and if you use it like it should be used, your battery is gonna be out in a couple years. Anyone else hear that? They also push this thing called the OMG. Anyone use that? They claim they can improve anyone's trial with a competitor by simply hooking the lead up to their technology. Has anyone seen this in action?? I'm getting a lot of pitches from BS and SJ and am looking for some unbiased experienced opinions...

I prefer the Bos Sci system over the others. I also agree that steering the Bos Sci leads is better. Their independent current control to each contact helps when there is increased resistance from uneven scarring along the lead after a few months. The need to recharge the battery is dependent on the patient program, but Bos Sci's battery will not die or lose charging ability if a patient lets it run down all the way. They have a 5 year battery warranty.

Next time you perform an ANS or Medtronic trial that fails, have your patient come back and try the boston scientific system via the OMG. I have had patients that say the stimulation feels "softer, gentler, smoother, more mellow" and want to trial the Bos Sci system. The OMG connects to the other companies' leads directly and can be tested in the office. The OMG test is not always successful, but it gives the patient a second try at pain relief.

ANS is really making a push to gain market share by stressing customer service and providing patient education and support. I get that from my Bos Sci rep already. Regardless of the system used, I think that is more important.

I introduce both systems to patients and show them the trial and perm hardware for each. I have them talk to both reps and have them participate in the decision. However, I have noticed that a lot of patients seem to prefer the Bos Sci charging system if given a choice.

 

[pjuer]

ANS is really making a push to gain market share by stressing customer service and providing patient education and support. I get that from my Bos Sci rep already. Regardless of the system used, I think that is more important.

In our area Medtronics has by far the best customer support. We also have 2 of their programmers. Years ago our ANS rep came from 2 states away. The first system I implanted we could not reprogram, and we had to wait for this rep to come. What a pain in the ass that was.

 

[SleepIsGood]

I prefer the Bos Sci system over the others. I also agree that steering the Bos Sci leads is better. Their independent current control to each contact helps when there is increased resistance from uneven scarring along the lead after a few months. The need to recharge the battery is dependent on the patient program, but Bos Sci's battery will not die or lose charging ability if a patient lets it run down all the way. They have a 5 year battery warranty.

Next time you perform an ANS or Medtronic trial that fails, have your patient come back and try the boston scientific system via the OMG. I have had patients that say the stimulation feels "softer, gentler, smoother, more mellow" and want to trial the Bos Sci system. The OMG connects to the other companies' leads directly and can be tested in the office. The OMG test is not always successful, but it gives the patient a second try at pain relief.

ANS is really making a push to gain market share by stressing customer service and providing patient education and support. I get that from my Bos Sci rep already. Regardless of the system used, I think that is more important.

I introduce both systems to patients and show them the trial and perm hardware for each. I have them talk to both reps and have them participate in the decision. However, I have noticed that a lot of patients seem to prefer the Bos Sci charging system if given a choice.

I had a discussion about this scarring business with someone earlier in the week. Bos Sci and other claim that scarring occurs around the leads. Also, if anyone has ever revised/removed a ITP or IPG you will see that the foreign body gets encapsulated.

So..my question is. When we remove leads or have to explant a system, why doesnt more dural tears occur? You would think that the leads would have fibrosis around them and to the dura and tugging on them months later would cause adverse things like tears. Obviously one hopes to NOT have to remove them, but stuff happens...