paindoc007

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Hey Guys,

Just wondering if people out there had a specific algorithm for which stimulator company to use. I've had good experience with Nevro for axial LBP as well as conventional stim revisions. But what about the other companies? Is there one company that you've found more beneficial for certain problems/conditions?
 
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paindoc007

2+ Year Member
Aug 4, 2017
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Eenie-meenie-miney-mo...

Haha that simple huh? I know reliability of the reps are half the battle, but is there anything to this st jude burst vs Medtronic LD/HD vs bostons technology for certain conditions?
 
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bronchospasm

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Drug Rep and service / availability.

Did prefer MDT dice they were MRI compatible but now have had great results with SJM.
 
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unchockey21

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A lot of it is going to depend on the rep. None of them are good enough to overcome awful reps/ service.
 

gdub25

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Nevro has great level 1 data and demonstrated superiority over traditional stim. These results were repeated from what was done in Europe a few years earlier. These results have shown stable at two years follow-up. I know what stim I'd put in my own mother. Second choice is St. Jude. MRI compatible, with restrictions, and burst is parasthesia free as well as can be placed with non-rechargeable battery. For me, I don't care what the reps say or what anyone else says or experiences have been for that matter. I try to stick to an evidence based approach. Using that approach the choices are quite clear I think.
 

bedrock

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if neuropathic limb pain, you can go either St Jude burst/DRG or Nevro, and make the decision based on MRI compatibility AND the rep.......

If axial spine pain is the primary complaint, then Nevro really is the clear choice unless the Nevro rep literally refuses to show up.
 
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Tapspatellas

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Nevro has great level 1 data and demonstrated superiority over traditional stim. These results were repeated from what was done in Europe a few years earlier. These results have shown stable at two years follow-up. I know what stim I'd put in my own mother. Second choice is St. Jude. MRI compatible, with restrictions, and burst is parasthesia free as well as can be placed with non-rechargeable battery. For me, I don't care what the reps say or what anyone else says or experiences have been for that matter. I try to stick to an evidence based approach. Using that approach the choices are quite clear I think.
With the new wave of stims getting ready to come out in the next year, I won't put as much stock in the SENZA trial. I think you can say that with stringent selection criteria, 10K holds at 24 months, and I like the fact that it is the only thing we have compared to another manufacturer, but it is not compared to a system that is being widely used now. With technological advancement the study becomes obsolete as a comparison to available SCS. Therein lies the challenges and why you get so many people who swear by one system, tends to be based more upon which rep is most readily available, they like, and happened to be most exposed to in training/first courses. I think where the better systems shine is in the challenging cases. For a slam dunk like CRPS or radicular pain, the all work great. FBSS with mainly axial, that is where the men and the boys are separated.
 

Jigsaw

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Most patients I speak to do not like parasthesia. It is why they did not use their conventional system more often.

I switched a lot of older systems to BurstDR and had better usage.

They decreased their medication intake because they used their system for 24hrs.
 

Ducttape

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Therein lies the challenges and why you get so many people who swear by one system, tends to be based more upon which rep is most readily available, they like, and happened to be most exposed to in training/first courses. I think where the better systems shine is in the challenging cases. For a slam dunk like CRPS or radicular pain, the all work great. FBSS with mainly axial, that is where the men and the boys are separated.
i think you are making some assumptions... some are true for sure, but for me, i am not using the company with the rep i "like" the best. the local Medtronic rep is more personable and ive known him for a long time. id go out for a drink with the ANS rep over any of them.
the Nevro rep is a nice guy, dont get me wrong, but not who is most available, nicest, etc.

i agree with your last line, tho.

my trial to implant rate which was roughly 60% is now about 90% with HF10. the 30% difference is primarily due to paresthesias. they really bother people.
 

Orin

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I'm not seeing the Nevro bang in my practice. Their lack of flexibility and transparency with programming is a pain. I'd rather use the other guys and be able to offer some paresthesia and paresthesia free stimulation options.

I do think T9/10 midline placement is real useful for axial low back, but that's not patentable.

If cost/compatibility wasn't an issue, I'd probably put together something with Bosci's leads, Bosci's inject suture thing, Abbot's lead anchors, Medtronic's MRI coverage, Bosci's battery features with Medtronic's battery size, Nevro's charger, Abbot's patient programmer, and Medtronic's Tyrx envelope.
 

Tapspatellas

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i think you are making some assumptions... some are true for sure, but for me, i am not using the company with the rep i "like" the best. the local Medtronic rep is more personable and ive known him for a long time. id go out for a drink with the ANS rep over any of them.
the Nevro rep is a nice guy, dont get me wrong, but not who is most available, nicest, etc.
It isn't true for all, but I believe it is for most. There is a reason they are so aggressive early on, you will use what you are comfortable with, thus most exposed. Same reason you can't eat a free ham sandwich at a university program as a resident, but bet your a$$ the formulary decision makers are getting taken care of by pharma. You will prescribe Xtampza over OxyContin when that is what you were using in training. The companies and reps aren't dumb. Besides, for SCS the studies are not very helpful for deciding upon anything over another, other than Nevro over a precision plus, but we as good clinicians take what evidence we can and run, that is all we have. Maybe if all the manufacturers had the equivalent of an OMG the patient could truly decide what they like best, and we could better study the differences in the systems.
 

NJPAIN

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It baffles my mind why NEVRO can't get their sh-t together and hire a sales force that is not like members of the Addams Family. They are all bizarre, unreliable or both. I have a few trials coming up ( I have done two and implanted two) based on the superior technology for axial LBP but I am not looking forward to dealing with the sales force.


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Taus

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It baffles my mind why NEVRO can't get their sh-t together and hire a sales force that is not like members of the Addams Family. They are all bizarre, unreliable or both. I have a few trials coming up ( I have done two and implanted two) based on the superior technology for axial LBP but I am not looking forward to dealing with the sales force.


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That's unfortunate- the two in my territory are extraordinary.


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lobelsteve

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Mine are great. Worked together since 2004.
 

NJPAIN

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I guess I am just unfortunate enough to have what I have. Started with one that was strange and unreliable. Now have one that is reliable but completely off the wall bizarre. In 25 years and 4 stim companies only had a bad experience once before and it was briefly with SJM. That rep instantly did not pass my sniff test and I stopped using SJM for a short time until they agreed to send another rep. A year later SJM fired the rep when they found out he was texting pictures of his genitals to female members of physician's office staff. Must be the water here in NJ.
 
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lobelsteve

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I guess I am just unfortunate enough to have what I have. Started with one that was strange and unreliable. Now have one that is reliable but completely off the wall bizarre. In 25 years and 4 stim companies only had a bad experience once before and it was briefly with SJM. That rep instantly did not pass my sniff test and I stopped using SJM for a short time until they agreed to send another rep. A year later SJM fired the rep when they found out he was texting pictures of his genitals to female members of physician's office staff. Must be the water here in NJ.
Don't drink the water in NJ. San Pelligrino is much nicer.
 

Yo GabbaPentin

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Hey Guys,

Just wondering if people out there had a specific algorithm for which stimulator company to use. I've had good experience with Nevro for axial LBP as well as conventional stim revisions. But what about the other companies? Is there one company that you've found more beneficial for certain problems/conditions?
Specific formula is:

(Tolerable rep + quality of patient service + clinical data) ÷ lead cost.

I've tried all with last year. Boston is only loser as the leads are 400% more expensive and their reps lie more than most.
 
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