Any Feedback or Game Changers from NANS 2019?

[drusso]

Couldn't attend...

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[DOctorJay]

Lots of reports on Saluda ECAP closed loop system but comparisons were only made to traditional tonic stimulation.

Interesting results with T12 DRG stim for axial back pain.

Focus on dosing of energy to the spinal cord and potential for using decreased dosing to mitigate early habituation.

More updates than game changers thus far.


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[SommeRiver]

I've heard ppl swear by T12 DRG for CLBP.

 

[drusso]

Lots of reports on Saluda ECAP closed loop system but comparisons were only made to traditional tonic stimulation.

Interesting results with T12 DRG stim for axial back pain.

Focus on dosing of energy to the spinal cord and potential for using decreased dosing to mitigate early habituation.

More updates than game changers thus far.


Sent from my iPhone using SDN

I've heard a lot about T12 DRG for axial low back pain. Keep those of us chained to the oars back home posted!

 

[thecentral09]

God I hope there becomes data behind that. Those levels are incredibly easy to place.

 

[DODOCSS]

It's called pain management for a reason

no cures

 

[SommeRiver]

It's called pain management for a reason

no cures

Incredibly annoying comment.

 

[lobelsteve]

Axial LBP. 1000 years, no cures.
Would be easier to convert society into believing it is normal than to fix it.

 

[SommeRiver]

Axial LBP. 1000 years, no cures.
Would be easier to convert society into believing it is normal than to fix it.

Makes one wonder why anyone ever thought to consider RFA as a potential treatment, or anything for that matter.

 

[lobelsteve]

Makes one wonder why anyone ever thought to consider RFA as a potential treatment, or anything for that matter.

Not a cure. Just mitigating a component for a a year or so.

Exercises is our best treatment. RF is our best procedure to allow them to do the exercise.

 

[SommeRiver]

Not a cure. Just mitigating a component for a a year or so.

Exercises is our best treatment. RF is our best procedure to allow them to do the exercise.

Is someone here claiming there are "cures" for CLBP, or potential treatments?

 

[Ducttape]

Incredibly annoying comment.

But true.

How many game changers have there been, and we still haven’t made a dent on chronic pain...

Not so long ago, snake oil Burst DRG BS 16 contact lead etc was all the rage...

but we all know it’s CBD oil not snake oil that will cure chronic pain!

 

[SommeRiver]

Which is why people keep doing research. Remember when HIV was completely incurable, or when stim couldn't touch the low back?

You older guys have been burned too many times.

 

[Ducttape]

not sure what world you are living in, but HIV is still not curable.

it is controllable.


then, again, pain of course is subjective.

 

[SommeRiver]

not sure what world you are living in, but HIV is still not curable.

it is controllable.


then, again, pain of course is subjective.

HIV was a death sentence at one point. It had no known treatment and lead to AIDS - Once in AIDS status you were dead. People do extremely well now, frequently with a viral load that is undetectable, a far cry from previous times. You are very much aware of my point, but chose to ignore it for the sake of being annoying. A frequent thing in this forum.

No one here said DRG at T12 was curative of CLBP. Not once was that claim made.

To pipe in with BS comments like, "Not curable" is wholly annoying for anyone with a brain.

You older guys are jaded and miserable. I don't see how yall make it to work each day.

 

[lobelsteve]

HIV was a death sentence at one point. It had no known treatment and lead to AIDS - Once in AIDS status you were dead. People do extremely well now, frequently with a viral load that is undetectable, a far cry from previous times. You are very much aware of my point, but chose to ignore it for the sake of being annoying. A frequent thing in this forum.

No one here said DRG at T12 was curative of CLBP. Not once was that claim made.

To pipe in with BS comments like, "Not curable" is wholly annoying for anyone with a brain.

You older guys are jaded and miserable. I don't see how yall make it to work each day.

I take my Jeep most days. Some days Miata or my XJ, occasionally the motorcycle. This summer the GT should be running. Thats how I get to work. I see my patients and provide the beat care I can based on the best science available.

 

[DOctorJay]

Feedback:
bedrock is a cool dude, glad to have met him in person


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[DOctorJay]

Feedback:
Apparently Nevro is now opening up more options for programming if patients fail 10khz. The IPG is capable of a wide range of energy output and they are now willing to adjust this especially to prevent explanation and switching to another company.


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[swamprat]

Feedback:
Apparently Nevro is now opening up more options for programming if patients fail 10khz. The IPG is capable of a wide range of energy output and they are now willing to adjust this especially to prevent explanation and switching to another company.


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Yes! I didn’t go this year but the Nevro rep stopped off in my office the other day. I told her my big issue was no tonic option and she told me this is no longer an issue. I still am not sure how excited I am to use them but it def opens up the possibility now that it’s not HF10 or nothing


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[paindoc007]

The one issue to the above you don’t know where the parasthesia map will be with nevro leads. You’ll probably get leg at 9-10, but back coverage may be a long shot

 

[DOctorJay]

The one issue to the above you don’t know where the parasthesia map will be with nevro leads. You’ll probably get leg at 9-10, but back coverage may be a long shot

I was thinking the exact same thing when this was discussed. Didn’t have a chance to bring it up though.


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[Ducttape]

HIV was a death sentence at one point. It had no known treatment and lead to AIDS - Once in AIDS status you were dead. People do extremely well now, frequently with a viral load that is undetectable, a far cry from previous times. You are very much aware of my point, but chose to ignore it for the sake of being annoying. A frequent thing in this forum.

No one here said DRG at T12 was curative of CLBP. Not once was that claim made.

To pipe in with BS comments like, "Not curable" is wholly annoying for anyone with a brain.

You older guys are jaded and miserable. I don't see how yall make it to work each day.

i make the point because half truths and lies are, well, lies and fake news.

when someone posits what we believe to be the truth, and you call their statement incredibly annoying, that suggests that you do not fully believe them.


fwiw, purely as an educational exercise, to clear any disinformation about HIV and AIDS, in the past, diagnosis of HIV was predicated on diagnosing AIDS, until roughly 1992 or so.

and yes you are correct. Stage 2 (ie HIV + only) patients do well, and life expectancy gets close to the norm. life expectancy for stage 3 HIV (ie AIDS) is roughly 3 years, however, so people with AIDS still do not do extremely well. only, please do not tell any patient of yours with HIV that he has a curable disease.

 

[DOctorJay]

NHS will be funding a study for an RCT (sham controlled) for HF10 therapy for non surgical neuropathic back pain. The researchers goal is to place HF10 therapy ahead of opioids in the treatment continuum for low back pain. They had a non RCT study that showed it was effective but in order for NHS to cover it they need RCT data.


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[SommeRiver]

i make the point because half truths and lies are, well, lies and fake news.

when someone posits what we believe to be the truth, and you call their statement incredibly annoying, that suggests that you do not fully believe them.


fwiw, purely as an educational exercise, to clear any disinformation about HIV and AIDS, in the past, diagnosis of HIV was predicated on diagnosing AIDS, until roughly 1992 or so.

and yes you are correct. Stage 2 (ie HIV + only) patients do well, and life expectancy gets close to the norm. life expectancy for stage 3 HIV (ie AIDS) is roughly 3 years, however, so people with AIDS still do not do extremely well. only, please do not tell any patient of yours with HIV that he has a curable disease.

You know what...This is such a waste of time discussing this.

The thread is an inquiry about anything being presented at NANS that could be new or promising.

Someone says that DRG at T12 is showing some interesting data. I say that I've heard similar things.

Someone comes in out of the blue and says there's no cure for back pain, a statement that is completely out of place and means nothing considering the gist of the conversation.

I think we all know there is no CURE for chronic lower back pain.

No one in the thread ever said anything about curing anything, rather there are TREATMENTS for back pain. Yes, there are things you can do that keep ppl employed, active, engaged in the community, etc.

One day, after research continues and more money gets thrown around and more pts are enrolled, studied, and data are collected, we may have more options for routine back pain, and for all we know DRG may be on the table at some point - It isn't now.

I mention the HIV thing as an example of something that was once considered exceedingly dangerous, but is now a chronic condition.

At the same time I mention how SCS advancements have provided coverage of back pain too (previously a failure).

But you said nothing about that.

You jumped on a poorly worded statement on my part, even though YOU KNOW what I meant.

By the way people with AIDS usually live 3 yrs WITHOUT TREATMENT - Thank God for treatment though bc the MAJORITY of ppl with HIV in the US receive treatment and don't progress to AIDS.

But here...read this from the NIH if you don't believe me:

The Stages of HIV Infection Understanding HIV/AIDS

I'm done with the discussion. Total waste of my time.

 

[BobBarker]

I think if you put one Nevro lead covering T8 at midline and stagger the other lead to cover the 9/10 “sweet spot” then you should be good for tonic or HF10. That is what I did on the one I did last week.

 

[drusso]

You know what...This is such a waste of time discussing this.

The thread is an inquiry about anything being presented at NANS that could be new or promising.

Someone says that DRG at T12 is showing some interesting data. I say that I've heard similar things.

Someone comes in out of the blue and says there's no cure for back pain, a statement that is completely out of place and means nothing considering the gist of the conversation.

I think we all know there is no CURE for chronic lower back pain.

No one in the thread ever said anything about curing anything, rather there are TREATMENTS for back pain. Yes, there are things you can do that keep ppl employed, active, engaged in the community, etc.

One day, after research continues and more money gets thrown around and more pts are enrolled, studied, and data are collected, we may have more options for routine back pain, and for all we know DRG may be on the table at some point - It isn't now.

I mention the HIV thing as an example of something that was once considered exceedingly dangerous, but is now a chronic condition.

At the same time I mention how SCS advancements have provided coverage of back pain too (previously a failure).

But you said nothing about that.

You jumped on a poorly worded statement on my part, even though YOU KNOW what I meant.

By the way people with AIDS usually live 3 yrs WITHOUT TREATMENT - Thank God for treatment though bc the MAJORITY of ppl with HIV in the US receive treatment and don't progress to AIDS.

But here...read this from the NIH if you don't believe me:

The Stages of HIV Infection Understanding HIV/AIDS

I'm done with the discussion. Total waste of my time.

...the whole thing is more in real life with alcohol...

 

[drusso]

Axial LBP. 1000 years, no cures.
Would be easier to convert society into believing it is normal than to fix it.

The future is Stim and Stem...

 

[gdub25]

My takeaway, from the limited presentations I attended, were that Nevro has continued to pursue studies and currently has strong evidence for axial neck and upper ext as well as a study for peripheral neuropathy with 216 patient enrollment. Pretty consistent message from this company with doing studies and presenting the evidence. I was a bit surprised when they said they can do overlapping of frequencies because I figured they wouldn’t do this unless they had some evidence that it has benefit. Doesn’t sound like they’ve even looked into it, just opening it up to satisfy the masses. There was also study of 1600 consecutive patients implanted at several sites and followed for explant rates, showed very low explant rant, less than 2-3% IIRC. DRG for low back has some promise but also criticism due to increased fluoro time and higher complication rate compared to SCS. Keep eyes on Saluda because it looks very promising. I didn’t learn much about Nuvectra or Boston. Medtronic is working on collecting outcome data with their new Intellis system and hoping to show a better metric than VAS before/after treatments.

 

[Ducttape]

You know what...This is such a waste of time discussing this.

The thread is an inquiry about anything being presented at NANS that could be new or promising.

Someone says that DRG at T12 is showing some interesting data. I say that I've heard similar things.

Someone comes in out of the blue and says there's no cure for back pain, a statement that is completely out of place and means nothing considering the gist of the conversation.

I think we all know there is no CURE for chronic lower back pain.

No one in the thread ever said anything about curing anything, rather there are TREATMENTS for back pain. Yes, there are things you can do that keep ppl employed, active, engaged in the community, etc.

One day, after research continues and more money gets thrown around and more pts are enrolled, studied, and data are collected, we may have more options for routine back pain, and for all we know DRG may be on the table at some point - It isn't now.

I mention the HIV thing as an example of something that was once considered exceedingly dangerous, but is now a chronic condition.

At the same time I mention how SCS advancements have provided coverage of back pain too (previously a failure).

But you said nothing about that.

You jumped on a poorly worded statement on my part, even though YOU KNOW what I meant.

By the way people with AIDS usually live 3 yrs WITHOUT TREATMENT - Thank God for treatment though bc the MAJORITY of ppl with HIV in the US receive treatment and don't progress to AIDS.

But here...read this from the NIH if you don't believe me:

The Stages of HIV Infection Understanding HIV/AIDS

I'm done with the discussion. Total waste of my time.

How did YOU put it? “Incredibly annoying comment”.

Which served to denigrate the original comment...
You brought it on yourself, then compounded it with inaccurate facts. And as scientists, we should all avoid inaccurate facts.


(For my interest only - your quoted standard government fact sheet says nothing about survival rate of full blown AIDS with treatment. Hard to get data, but at least 1 study implied that expectancy of AIDS with treatment was 16 years less than non HIV patients...)

 

[Doctodd]

intradiscal