Are you happy in pain?

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lobelsteve said:
My bad. Wenchen Qu at Mayo


Informal survey shows 10 to 20% of people at SIS did some type of RegMed. But that includes prp, amniotics, and sc.
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Wenchun is a good guy. Was my co-resident and co-fellow. Very academically minded. If he comes up with good data I would believe it. Would imagine that Maus, Diehn, and Pingree would be involved in some capacity (all SIS guys).


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I thought the Hernigou study on BMAC for AVN was compelling. Your own results weren’t enough to keep you in?
 
lobelsteve said:
My bad. Wenchen Qu at Mayo


Informal survey shows 10 to 20% of people at SIS did some type of RegMed. But that includes prp, amniotics, and sc.
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If Lutz and Qu are involved then it will be legitimate. Solid guys. Otherwise, I'm not certain that SIS Evidence Committee possesses the content expertise required to be authoritative and has ideological COI given its make up:

Response to: "DePalma is lying to hype Mesoblast"

SIS Divisions and Committees - Spine Intervention Society

RegenMed *IS* PRP, BMAC, wound care, diet/lifestyle counseling, exercise RX, etc. Everything directed to achieve tissue healing. Blood patches are RegenMed procedures.

P.S. Don't stick fat globs in eyeballs...
 
algosdoc said:
I did PRP but did not have the results I anticipated. As for stem cell treatments, I never found a treatment that had enough scientific support, and the FDA continues their gyrations as to what is acceptable. With the permanent blinding from stem cells, I expect the FDA will become more stringent. Stem cells have tremendous potential but I do not think injecting cellular debris and undesirable cells is in the patient's best interest- limitations imposed by the FDA.
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Regarding PRP, did you use variable PRP concentrations and inject directly into certain lesions/anatomic structures?
 
Yes, and tried various methods of activation including ultrasound of the PRP before injecting, freeze/thaw, and light activation. Tried various chelating agents including ACD and EDTA. Purchased a microscope and stains for platelet counts.
 
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drusso said:
If Lutz and Qu are involved then it will be legitimate. Solid guys. Otherwise, I'm not certain that SIS Evidence Committee possesses the content expertise required to be authoritative and has ideological COI given its make up:

Response to: "DePalma is lying to hype Mesoblast"

SIS Divisions and Committees - Spine Intervention Society

RegenMed *IS* PRP, BMAC, wound care, diet/lifestyle counseling, exercise RX, etc. Everything directed to achieve tissue healing. Blood patches are RegenMed procedures.

P.S. Don't stick fat globs in eyeballs...
Click to expand...

But no bias from our local Regenexx rep?
 
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algosdoc said:
Yes, and tried various methods of activation including ultrasound of the PRP before injecting, freeze/thaw, and light activation. Tried various chelating agents including ACD and EDTA. Purchased a microscope and stains for platelet counts.
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sorry to hear.....but when you did do it, your results werent positive? Ive said this before, but i was my first PRP patient s/p knee scope 1 year out and benefit was immediate. Maybe i should have just injected saline first.
 
drusso said:
I don't know your rep, but I think Cara was at SIS.
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I meant you. But you knew that.
You were poking SIS for taking money for a booth.

I do not know if Regmed is going to work. Good basic science looks promising for msc that is not minimally manipulated. But that is not fda kosher right now. So doing a review on all available data is necessary. Regmed is still the wild west. No standard treatments and no standard patient selection. Lots of money to be made by providing false hopes and lies. That's not good medicine.
 
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lobelsteve said:
I meant you. But you knew that.
You were poking SIS for taking money for a booth.

I do not know if Regmed is going to work. Good basic science looks promising for msc that is not minimally manipulated. But that is not fda kosher right now. So doing a review on all available data is necessary. Regmed is still the wild west. No standard treatments and no standard patient selection. Lots of money to be made by providing false hopes and lies. That's not good medicine.
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I think that you're reading too much into what I'm saying...

No practitioner should do anything that is not within FDA's HCT/P guidelines. I've gone on record saying that. No one should be doing things that are more than minimal manipulation. See orthobiologics ethics:

Orthobiologic Ethics

SIS can take money from whomever they want. They are a private entity. I would never begrudge any organization its First Amendment rights.

Agree with Regen Med as wild west. I've gone record saying that, I've already reviewed 2 cases; 2 more on the way. I found both below standard of care.

Kosher? Argument could be made that PRP is gelatin. Probably Halal, definitely not Treif. Defer to Rabbi's.

Bottom line: I've seen too many "Kangaroo-Court," Bogus-EBM/GIGO guideline committees in my career: Oregon HERC, CDC guidelines, worker's comp etc come into "save the day" and "protect patients" when in reality all they do is interfere with the patient/doctor relationship and restrict options for patients. All suffered from "competing commitments," "confluence of interests," ideological biases, and lack of CONTENT expertise in the topic being reviewed. You really want addiction doctors making chronic pain treatments guidelines? Chiropractors deciding if SCS is covered benefit for injured workers? Garbage.

Lutz & Qu are legit content experts. Should also get Malanga, Maunter, Bowen, and Smith on board. If they are driving the bus, then they can they can help guide SIS Evidence Committee toward asking and answering good questions. If they are not driving the bus, then you're lost. Just building the Death Star out of Legos...
 
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What was below standard of care in cases you reviewed? No hood when preparing injectate?
 
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nvrsumr said:
What was below standard of care in cases you reviewed? No hood when preparing injectate?
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Can't really say, but no. It's a good idea, however, that images taken from your procedure actually correspond to areas of the body that you say you're injecting...just say'in...
 
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drusso said:
Incomplete partial rotator cuff tear; no retraction. Failed PT, steroid injections, etc. Patient doesn't want surgery. Normal BMI, no serious medical conditions, active/outdoor-minded.
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OK. And in a perfect world, where ideally would you want the needle tip? Would you use unmodified bone marrow? If you don't mind my asking...
 
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drusso said:
Incomplete partial rotator cuff tear; no retraction. Failed PT, steroid injections, etc. Patient doesn't want surgery. Normal BMI, no serious medical conditions, active/outdoor-minded.
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In think prp works better for these folks..just sayin..
 
hyperalgesia said:
OK. And in a perfect world, where ideally would you want the needle tip? Would you use unmodified bone marrow? If you don't mind my asking...
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Right into the defect/tear. BMAC (concentrated bone marrow). Comfort sling for 2 weeks; PT. Then, I do follow up with a PRP 1-2 weeks after starting PT, @Dr. Ice. Re-image in (either US or MRI) in 6 months.
 
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algosdoc said:
There were scientific articles early on that pointed to the potential of stem cell therapies, but some later studies were more subdued. Ultimately I did not find enough scientific advances to support wholesale adoption of stem cells as viable therapies, especially given the massive proliferation of stem cell use in the US. Bimini was to be a cultured stem cell operation with pure stem cell lines used in co-culture with a patient's healthy cells to produce a template for stem cells. But when there are a gazillion docs injecting garbage into patients in the US and marketing them as stem cells, it is likely naive patients would not know the difference between those operations and co-cultured differentiated stem cells.
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I would harken back to one of your previous threads:

A New Hope for Pain Medicine

Despite the low quality stuff going on out there, we do have good colleagues in this specialty and overlapping specialties working diligently to properly develop this form of therapy.

If I may make a suggestion, I would consider going to the Interventional Orthopedics Foundation Annual Meeting at least once before you decide to quit completely. I think you may enjoy it and it may possibly change your outlook. If private practice Pain is no longer of interest to you, perhaps wind down through an academic affiliation where you can be part of the movement to legitimize Regen Med?
 
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Disciple said:
I would harken back to one of your previous threads:

A New Hope for Pain Medicine

Despite the low quality stuff going on out there, we do have good colleagues in this specialty and overlapping specialties working diligently to properly develop this form of therapy.

If I may make a suggestion, I would consider going to the Interventional Orthopedics Foundation Annual Meeting at least once before you decide to quit completely. I think you may enjoy it and it may possibly change your outlook. If private practice Pain is no longer of interest to you, perhaps wind down through an academic affiliation where you can be part of the movement to legitimize Regen Med?
Click to expand...

IOF is my preferred conference but ive only gone 2 years. I hear TOBI is right up there but i havent gone.
 
Doctodd said:
IOF is my preferred conference but ive only gone 2 years. I hear TOBI is right up there but i havent gone.
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TOBI is good as well. A little more broad based. IOF is the most focused one I've been to for IPM, I-Spine, Non-op Sports Med.
 
plus i cant ski in San Diego at TOBI
 
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I am finished, gave up pain completely, and closed my addiction management unit 6 weeks ago. It was the correct decision for me. But there are many practicing pain that continue to find the immense joy in it that I had when I first started doing pain management in residency in 1987. I wish the best for all the warriors that feel the fire and passion of doing something they love, and knowing they are occupying a unique nexus between several specialties, none of which have the breadth of knowledge as do you. Kudos to all of you!
 
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med2928 said:
Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)?
What was your reason for going into IPM in the first place?
Do you like your hours? Do you feel like you have enough time with your family/other interests?
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why?
Do you feel fairly compensated?
Would you choose pain again?
If you HAD to choose a different specialty, what would it be?
Anything else you'd like to share?

Thanks for your input!
Click to expand...

I am at a not for profit hospital that takes all comers and I love it.

I was previously in a very busy private practice and did not like it- too much emphasis on pt, volume, high overhead, and diminished institutional emphasis on quality of care, as opposed to economics. I did not like it at all.

I think everyone went into medicine (at least most) just to do medicine and most are not interested in the business aspects of medicine, which robs the joy of practicing.
 
Interventional pain was good (i am retired). If i did it all over again (40 years!) i would pick Derm. No idea if that would be wise, but that is what i would tell my younger self if i could time travel. And stay away from primary care or general internal medicine. And...move to New Zealand. That's it, be a dermatologist in N.Z. Perfect...
 
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I like doing pain. I feel appreciated every day. Good lifestyle/hours/pay. Technically fun and interesting. Derm would probably be my do-over. But then a lot of derms are doing cosmetic botox and hair removal. I could also do that but choose not to so there is that.
 
What’s so exciting about derm? Lasers sound cool until you realize they don’t actually go *pew pew pew*
 
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Agast said:
What’s so exciting about derm? Lasers sound cool until you realize they don’t actually go *pew pew pew*
Click to expand...
Ugh. You’ve been using the wrong ones....
 
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willabeast said:
Interventional pain was good (i am retired). If i did it all over again (40 years!) i would pick Derm. No idea if that would be wise, but that is what i would tell my younger self if i could time travel. And stay away from primary care or general internal medicine. And...move to New Zealand. That's it, be a dermatologist in N.Z. Perfect...
Click to expand...

I envy dermatologists...
 
Doctodd said:
sorry to hear.....but when you did do it, your results werent positive? Ive said this before, but i was my first PRP patient s/p knee scope 1 year out and benefit was immediate. Maybe i should have just injected saline first.
Click to expand...

We did PRP 25 years ago. IT DID NOT WORK! It did not work, so everyone abandoned it; too bad no one published the negative results.

Everything old is new again. The shocking thing is that NO ONE believed us when this reared its ugly head again. Why? There was a lot of money to be made.

Another tragic episode in the history of pain management. I can almost excuse the IDETs, Dekompressors, and Nucleoplasty when there was not a history of it. But PRP and SI joint fusions? That has really been unexcusable and has only been driven by profit through some of the dubious centers that happen to be in a state that begins with K and W.
 
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hawkeye2009 said:
We did PRP 25 years ago. IT DID NOT WORK! It did not work, so everyone abandoned it; too bad no one published the negative results.

Everything old is new again. The shocking thing is that NO ONE believed us when this reared its ugly head again. Why? There was a lot of money to be made.

Another tragic episode in the history of pain management. I can almost excuse the IDETs, Dekompressors, and Nucleoplasty when there was not a history of it. But PRP and SI joint fusions? That has really been unexcusable and has only been driven by profit through some of the dubious centers that happen to be in a state that begins with K and W.
Click to expand...

most docs only charge around $300-500....so i wouldnt say it is a huge money maker. It is just another tool in the toolbox. And maybe you guys made it differently back then.
 
Copying the tread from the anesthesiology forum.

Are you happy working as an interventional pain specialist? (0-10)? Yes, I believe I have one of the best jobs in medicine. 10/10 for happiness.
What was your reason for going into IPM in the first place? I wanted to be an anesthesiologist and was blown away by my first pain rotation. Also, one of my early med school mentors was a pain physician who I continue to admire to this day.
Do you like your hours? Do you feel like you have enough time with your family/other interests? Yes, I work 4d/week in an employed model. Yes I have plenty of time. I do not have children but have plenty of time for my poodles.
Do you work in an academic center or private practice? Have you ever switched from one to the other, if so why? I am hospital employed. first job.
Do you feel fairly compensated? Yes
Would you choose pain again? YES
If you HAD to choose a different specialty, what would it be? Palliative Medicine
Anything else you'd like to share? Happiness is right under your nose!

Thanks for your input!
 
hawkeye2009 said:
We did PRP 25 years ago. IT DID NOT WORK! It did not work, so everyone abandoned it; too bad no one published the negative results.

Everything old is new again. The shocking thing is that NO ONE believed us when this reared its ugly head again. Why? There was a lot of money to be made.

Another tragic episode in the history of pain management. I can almost excuse the IDETs, Dekompressors, and Nucleoplasty when there was not a history of it. But PRP and SI joint fusions? That has really been unexcusable and has only been driven by profit through some of the dubious centers that happen to be in a state that begins with K and W.
Click to expand...
Doctodd said:
most docs only charge around $300-500....so i wouldnt say it is a huge money maker. It is just another tool in the toolbox. And maybe you guys made it differently back then.
Click to expand...

300 is really cheap for PRP. In LA most docs, particularly ortho charge $1200.

I’m the cheapest as I do I for $975

To Hawkeye- I agree that SIJ fusions are terrible. However, regarding PRP- it was made differently then. If you take the time to do it with good PRP and good technique it works well most of the time.
I had 4 PRP patients return today, 2/4 were 75%better, one was completely cured, and one it didn’t help. I’ll take those statistics anyday compared to most of our pain treatments, and I didn’t have to fight the insurance companies to do them.
75% patients achieving 75% relief or more ain’t bad.

I also don’t use PRP unless truly indicated which likely improves my stats.
 
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bedrock said:
300 is really cheap for PRP. In LA most docs, particularly ortho charge $1200.

I’m the cheapest as I do I for $975

To Hawkeye- I agree that SIJ fusions are terrible. However, regarding PRP- it was made differently then. If you take the time to do it with good PRP and good technique it works well most of the time.
I had 4 PRP patients return today, 2/4 were 75%better, one was completely cured, and one it didn’t help. I’ll take those statistics anyday compared to most of our pain treatments, and I didn’t have to fight the insurance companies to do them.
75% patients achieving 75% relief or more ain’t bad.

I also don’t use PRP unless truly indicated which likely improves my stats.
Click to expand...

Not all PRP is the same...

Expert Opin Biol Ther

. 2020 Jul 21.
doi: 10.1080/14712598.2020.1798925. Online ahead of print.
Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system
Elizaveta Kon 1 2 3, Berardo Di Matteo 1 2, Diego Delgado 4, Brian J Cole 5, Andrea Dorotei 1 2, Jason L Dragoo 6, Giuseppe Filardo 7, Lisa A Fortier 8, Alberto Giuffrida 1 2, Chris H Jo 9, Jeremy Magalon 10 11, Gerard A Malanga 12, Allan Mishra 13, Norimasa Nakamura 14, Scott A Rodeo 15, Steve Samspon 16, Mikel Sánchez 4 17
Affiliations expand
Abstract
Introduction: Platelet rich plasma (PRP) is able to modulate the joint environment by reducing the inflammatory distress and promoting tissue anabolism. Therefore, it has gained increasing popularity among clinicians in the treatment of osteoarthritis (OA), and it is currently proposed beside consolidated options such as viscosupplementation.
Areas covered: A systematic review of all available meta-analyses evaluating intra-articular PRP injections in patients affected by knee OA was performed, in order to understand how this biologic treatment approach compares to the traditional injective therapies available in clinical practice. Moreover, a novel coding system and "minimum reporting requirements" are proposed to improve future research in this field and promote better understanding of the mechanisms of action and indications.
Expert opinion: The main limitation in current literature is the extreme variability of PRP products used, with often paucity or even lack of data on the biologic features of PRP, which should not be considered as a simple substance, but rather a "procedure" requiring accurate reporting of the characteristics of the product but also all preparation and application modalities. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost effectiveness of this treatment.
Keywords: classification; growth factors; hip; injection; knee; osteoarthritis; prp.
 
Not all PRP is the same...
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now that is a concern with PRP - that and the fact that the majority of my patients cant afford, which is the main limitation.


it is unlike any injection we otherwise do with specific doses..
 
Ducttape said:
now that is a concern with PRP - that and the fact that the majority of my patients cant afford, which is the main limitation.


it is unlike any injection we otherwise do with specific doses..
Click to expand...
I get what you're saying, but plts can be quantified. Both pre and post processing. There are suggestions out there for concentrations that should be used for joints, ligaments, etc.
 
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What is the typically salary, excluding benefits etc, for employed position for a hospital?

I feel like I might be lowballed because I'm a new grad. Feel free to PM me!
 
changeofheart2016 said:
What is the typically salary, excluding benefits etc, for employed position for a hospital?

I feel like I might be lowballed because I'm a new grad. Feel free to PM me!
Click to expand...
Look at salary potential, fit and growth potential. With a good set up and hard work, your guaranteed starting salary is a moot point.
 
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cowboydoc said:
Look at salary potential, fit and growth potential. With a good set up and hard work, your guaranteed starting salary is a moot point.
Click to expand...

True, but knowing a baseline to compare to is also useful.

I'm just looking for a ball park range for hospital employee starting salary.
 
changeofheart2016 said:
True, but knowing a baseline to compare to is also useful.

I'm just looking for a ball park range for hospital employee starting salary.
Click to expand...

Depends on region, size of the hospital system, etc. the usual factors. But a good estimate is probably 300-350 starting. I know a new grad in the Carolinas who started off making 400 as a hospital employee working 4 days a week.
 
changeofheart2016 said:
True, but knowing a baseline to compare to is also useful.

I'm just looking for a ball park range for hospital employee starting salary.
Click to expand...
Having a great starting salary in a bad situation or getting overpaid early and having difficulty earning that salary in subsequent years will lead to great stress and problems. You will make a lot more than in fellowship regardless. Bet on yourself to be a producer and put yourself in a good situation to thrive. A guaranteed salary is either a way to suck someone in or bare minimum expectation that should be far surpassed. Don’t put much weight in it. I’d argue “fair” compensation is more tied to your production. A generous starting salary may be inversely proportional to how you will be treated.
 
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hawkeye2009 said:
We did PRP 25 years ago. IT DID NOT WORK! It did not work, so everyone abandoned it; too bad no one published the negative results.

Everything old is new again. The shocking thing is that NO ONE believed us when this reared its ugly head again. Why? There was a lot of money to be made.

Another tragic episode in the history of pain management. I can almost excuse the IDETs, Dekompressors, and Nucleoplasty when there was not a history of it. But PRP and SI joint fusions? That has really been unexcusable and has only been driven by profit through some of the dubious centers that happen to be in a state that begins with K and W.
Click to expand...

It is kind of crazy to make an argument in 2020 that PRP doesn't work in certain people. It is great in the knee and hip, and really good in the shoulder.

There are other successful uses for it, but those seem to be the most reliable.
 
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SommeRiver said:
It is kind of crazy to make an argument in 2020 that PRP doesn't work in certain people. It is great in the knee and hip, and really good in the shoulder.

There are other successful uses for it, but those seem to be the most reliable.
Click to expand...

r u guys doing PRP in subacromial bursa or capsular/glenohumeral joint space?
 
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