Blitz2006

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I know there are lots of good cadaver courses for stims/kyphos, but anything for pumps?

Also, do you feel you can confidently learn kyphos via cadaver course if you don't do many/any in your fellowship?

Thanks!
 

algosdoc

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SIS used to do them, I am not sure if they do them anymore. Medtronic probably would offer these courses. IT pump implants are becoming somewhat of a rarity due to such low reimbursement for the meds, if a person dies after you receive the med but before filling or moves elsewhere, you may be stuck paying for the cost of the drugs. Some of the compounded drugs are quite expensive. Add prialt, and one person dies before a fill of a pump and you will wipe out your profit on pumps for years. For chronic non-malignant pain, most doctors are replacing pumps that have expended battery lives, repairing or replacing catheters, retracting or removing catheters due to an intrathecal inflammatory mass, are revising the pumps due to migration or rotation or discomfort, or are explanting the entire system due to infection or functional SCS implants. There are very few people implanting new IT pumps for chronic non-malignant pain.
 
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Blitz2006

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So you think pumps are a "dying skill" for future pain docs?

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algosdoc

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Most oncologists do not refer patients for intrathecal infusion pump therapy. Almost all of them manage their own cancer pain patients. Therefore, you are left with spasticity patients (baclofen pumps) and chronic non-malignant pain patients. The use of pumps is declining in the pain world.
 
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Jigsaw

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Pumps are needed in pain Management still. Call your Flowonix rep and ask for a site visit with somone
 
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unchockey21

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So you think pumps are a "dying skill" for future pain docs?

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Yes. Always the chance there's some big discovery of a miracle drug that only works IT but until that happens, pump implants will continue to decline. As a frame of reference, I did 117 SCS trials/implants last year in fellowship and 2 IT trials and 1 implant for nonmalignant pain. None of the 6 of us will be doing pumps in practice.
 
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Blitz2006

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Interesting, thanks for all the responses. Did not realize pumps were on such a decline in the pain world...
 

Jigsaw

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It is not as big as it was maybe 15 years ago but not completely a dead treatment.

Learn it and decide for yourself if it is something you wish to continue to provide the appropriate patients.

Pumps are not really part of an private pain gig kind of how private pain guys don't like implanting. Takes too much time out of your day to go to the OR.

I can implant a pump in 1:00h and stim in 1:15h but the turn over time is always brutal.

Also using services like AIS or Any other infusion, compounding company will take a big headache out of your part.
 

algosdoc

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Pumps have a much higher short and long term complication rate compared to stims, are no less addictive than oral opioids if a hydrophilic opioid is used (such as morphine, that is the only FDA approved opioid for pumps), and frequently are accompanied by oral opioid prescribing. Recently we acquired an entire practice of very high dose intrathecal opioids in a soup of other drugs, sometimes containing 2-3 different opioids simultaneously with some receiving 50mg a day morphine plus 10,000 mcg/day fentanyl plus 240mg oral oxycontin per day . This is one of the dangers of IT pumps- docs that haven't a clue what they are doing and titrate the patients up to infinity with narcotics then when they retire or are arrested, leave these unfortunate patients to be weaned down back into the stratosphere. We do pump maintenance and maintenance surgery, but have not implanted a new pump for pain in years.
 

Ligament

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We do pump maintenance and maintenance surgery, but have not implanted a new pump for pain in years.
I think this speaks volumes. When you have the most experienced of us like algosdoc on this forum saying this, take note.
 

Jigsaw

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Done appropriately I have seen great success.

Done poorly, then you get what was said above.

Pain has some 'bad hombres' that do things improperly. I get pump referrals whom I say no to a lot.

Again learn it and make your decision.
 

oreosandsake

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I think SPPM teaches ARNPs pain procedures...buyer beware. Correct me if wrong..
that was before my time but I know historically they made that mistake. there are folks on this forum that were teaching for them then, and stopped working with sppm over it. also current instructors had issue with it as well.

they learned their lesson as far as I am aware of and no longer do that. it was probably part greed, part poor scrutiny over who signs up online for the course. disclosure: i have intermittently taught for sppm as well
 
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Blitz2006

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that was before my time but I know historically they made that mistake. there are folks on this forum that were teaching for them then, and stopped working with sppm over it. also current instructors had issue with it as well.

they learned their lesson as far as I am aware of and no longer do that. it was probably part greed, part poor scrutiny over who signs up online for the course. disclosure: i have intermittently taught for sppm as well
Thanks for heads up.

Anyone else you know that currently teaches?

Although it appears more and more that its not a very desirable skill....
 

drpainfree

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I know there are lots of good cadaver courses for stims/kyphos, but anything for pumps?

Also, do you feel you can confidently learn kyphos via cadaver course if you don't do many/any in your fellowship?

Thanks!

to answer the question to OP, no, I am not aware of any course teaching pump trial/implant.

Why?

Because it's dangerous to learn how to do a pump in a weekend course.

In my fellowship each fellow probably did 200+ stim trial and over 50 stim implant. We each probably did 50 pump trial and 10 pump implant. On the other hand, the amount of time we spent to prepare for a pump trial, and calculating conversion rate, ordering the right amount medications, etc, and etc, was probably 20-30x more time than what we spent on SCS. As a result, none of fellows were interested in doing pump.

And that was 8 years ago when pump was still not unpopular.

Why we spent so much time PREPARING pump trial/implant? Not because pump is hard to do, it's actually easier than SCS, trial or implant, IMHO. What really hard and time-consuming is the time and effort and meticulous details you have to design your work flow to get correct meds, right conc, right flow rate, etc.

When you do SCS and you mess up with programming, no biggie. When you do a pump, you mess up any one small part on medication, flow rate calculation or programming, the patient could overdose, go into w/d, or die!

Is this something you're willing to risk?

In fact, I think out of everything we learnt in fellowship, pump skills is one thing that cannot possibly skip without going through a formal, structural fellowship.
 
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