which patients succeed with SCS

[heathermed]

Hello Everyone

I'm trying to get better at patient selection for trialing spinal cord stimulators and was wondering if some of you who have done so for many more years than I can share the type of pain this technology you have found most success with.

what are some of the patient presentations and diagnosis that you start thinking stim with as opposed to others?

thank you

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[willabeast]

CRPS, especially lower extremity, probably best indication where i practice.

 

[101N]

Old people with Medicare and no active litigation or psychiatric issues can sometimes do well, at least initially.

 

[emd123]

Crps, neuropathic pain, radicular leg pain >>>>>> back pain. The less the total opiate dose the better. The less the psychosomatic component of pain the better. The less dramatic and catastrophizing the patient, the better. If patient expectations are too high, it's less likely to work. If patient expectations are too low, it's less likely to work. Cautiously optimistic, but realistic patients are best.

You can never be 100% sure ahead of time, who will respond. That's why you do the trial.

 

[dhcofc]

Are you guys trialing patients with FBSS without radic? Boston Scientific talks about the holy grail of stimulation being that they can cover low back pain. I've had attendings say no to stim for patients without radiculopathy or clear neuropathic component to their back pain. Is it worth it to trial these patients?Would like your thoughts...

 

[lobelsteve]

Are you guys trialing patients with FBSS without radic? Boston Scientific talks about the holy grail of stimulation being that they can cover low back pain. I've had attendings say no to stim for patients without radiculopathy or clear neuropathic component to their back pain. Is it worth it to trial these patients?Would like your thoughts...

Used to be good for profit because the trial was paid for and they didnt go to implant. No good data from BS to support their claims. Unsure on Nevro data but promising early on.

 

[clubdeac]

Are you guys trialing patients with FBSS without radic? Boston Scientific talks about the holy grail of stimulation being that they can cover low back pain. I've had attendings say no to stim for patients without radiculopathy or clear neuropathic component to their back pain. Is it worth it to trial these patients?Would like your thoughts...

I wouldn't get in the routine of doing this for axial FBSS patients w/o radic. Like Steve said, Nevro might be a different story

 

[emd123]

Are you guys trialing patients with FBSS without radic? Boston Scientific talks about the holy grail of stimulation being that they can cover low back pain. I've had attendings say no to stim for patients without radiculopathy or clear neuropathic component to their back pain. Is it worth it to trial these patients?Would like your thoughts...

Low success rate. It can be done, but high rate of failing trial or implant/explant. They seem to end up with most of the stim in the legs, not enough in the back, get frustrated and end up not liking the stim or end up wanting explant.