Best SCS technology for axial, non surgical back pain?

[painfree23]

I don’t know TBH. I was only Abbott for awhile, now I'm back on Nevro. I'm incredibly underwhelmed with Abbott for axial LBP. I've won some and lost some, but the loss column is big enough that I'm really not doing stim for strictly axial pain any longer.

I have a gentleman I see who is BMI 43-45 with axial LBP and has multilevel and severe stenosis with facet dz. Nothing has worked. Sent to me for stim and instead I ablated him unsuccessfully. Again, nothing works and he is utterly miserable. Retired cop. Refuses Norco BID.

I may pull the trigger and stim him but at this point if there isn't any leg pain I'm not doing stim. Nothing worse than implanting someone and 3 months later they tell you it doesn't work.

Why’d you offer norco bid??

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[SommeRiver]

Why’d you offer norco bid??

Because he is the lowest level of opiate risk, truly miserable and he is his wife's caretaker (wheelchair bound, don't recall her Dx). Transferring her is a problem and he is losing his ability to do it.

...not always wrong to give opiates dude.

 

[Ducttape]

but... you want marbling in strip steaks...

 

[Ferrismonk]

I don’t know TBH. I was only Abbott for awhile, now I'm back on Nevro. I'm incredibly underwhelmed with Abbott for axial LBP. I've won some and lost some, but the loss column is big enough that I'm really not doing stim for strictly axial pain any longer.

I have a gentleman I see who is BMI 43-45 with axial LBP and has multilevel and severe stenosis with facet dz. Nothing has worked. Sent to me for stim and instead I ablated him unsuccessfully. Again, nothing works and he is utterly miserable. Retired cop. Refuses Norco BID.

I may pull the trigger and stim him but at this point if there isn't any leg pain I'm not doing stim. Nothing worse than implanting someone and 3 months later they tell you it doesn't work.

Sounds like a surgical case.

 

[SommeRiver]

Sounds like a surgical case.

Off the top of my head I can't remember why, but there's a reason that isn't possible. He has his own PMH. I'm pretty sure the post op recovery worries him too bc of his wife, and straight back pain isn't a slam dunk surgically.

This is why I've debated a stim trial on him but I'm just certain it won't work. He was sent to me for stim by an outside pain practice who hadn't ever ablated him BTW...

 

[SommeRiver]

Anyone doing stim on dialysis pts? I don't think I ever have, but I'm about to do one.

 

[Ducttape]

ugh... be careful of coagulopathy in dialysis patients............

 

[SommeRiver]

ugh... be careful of coagulopathy in dialysis patients............

That's my concern...Anyone have much experience with that? I'm trying to find a way out of doing it.

 

[lonelobo]

That's my concern...Anyone have much experience with that? I'm trying to find a way out of doing it.

Say no

 

[SommeRiver]

Say no

It is my idea...Failed back, RLE severe radic, failed several TFESI, struggling patient. On HD for 19 yrs now.

 

[lonelobo]

It is my idea...Failed back, RLE severe radic, failed several TFESI, struggling patient. On HD for 19 yrs now.

One of the most important things I learned earlier in my career is that no matter how much we would like to, we just can't help everyone.

 

[SommeRiver]

I've learned that as well, but there is a treatment that could help this guy (stim)...It just makes me nervous to try.

 

[lobelsteve]

I've learned that as well, but there is a treatment that could help this guy (stim)...It just makes me nervous to try.

For good reason.

 

[PM&R90]

Anyone try using SRP therapeutics peripheral nerve stimulation system to stimulate the medial branches for nonspecific axial low back pain?

 

[painfree23]

Anyone try Medtronics “new” DTM?

 

[painfree23]

Anyone doing stim on dialysis pts? I don't think I ever have, but I'm about to do one.

How’d it go?

Anyone done one on a transplant (liver) patient? The immunosuppressants scare me.

 

[Agast]

Anyone try Medtronics “new” DTM?

I have one classic postlaminectomy pain that trialed at 80% relief and is going for implant. He’s going to need frequent imaging for hx of prostate cancer and pancreas problems so I thought Medtronic would be smoother overall.

 

[SommeRiver]

How’d it go?

Anyone done one on a transplant (liver) patient? The immunosuppressants scare me.

Canceled it. Updated MRI (old one was 2018) reveals severe stenosis, multilevel and bilateral. He has recurrent stenosis within his surgical bed.

The risk is high; the potential for benefit is low; I won't allow him to be put in that position.

He is on Percocet and I'll probably switch him to something like Butrans perhaps. I may do Belbucca. He hasn't come back in yet, but I think I see him Tuesday.

 

[painfree23]

Canceled it. Updated MRI (old one was 2018) reveals severe stenosis, multilevel and bilateral. He has recurrent stenosis within his surgical bed.

The risk is high; the potential for benefit is low; I won't allow him to be put in that position.

He is on Percocet and I'll probably switch him to something like Butrans perhaps. I may do Belbucca. He hasn't come back in yet, but I think I see him Tuesday.

U mean thoracic stenosis? R u going to refer to surgery?

 

[myrandom2003]

How’d it go?

Anyone done one on a transplant (liver) patient? The immunosuppressants scare me.

Yes and went well.

Wife’s a transplant hepatologist, she sent me the patient. The patients that have the transplant do ALOT better tolerating everything than the patients that have liver dysfunction and not transplanted. Immunosuppression not that scary. Just have their transplant team in the know.

 

[SommeRiver]

U mean thoracic stenosis? R u going to refer to surgery?

No and no

 

[painfree23]

Yes and went well.

Wife’s a transplant hepatologist, she sent me the patient. The patients that have the transplant do ALOT better tolerating everything than the patients that have liver dysfunction and not transplanted. Immunosuppression not that scary. Just have their transplant team in the know.

Nice. Any differences in the trial procedures? Just get so nervous about infection. Don’t u usually send home on abx for trial but may consider it here..

 

[Ducttape]

in a patient post transplant, should not be any difference, as long as the transplant is "working"...

clotting abnormalities should have returned to relative normal with functioning transplant.

 

[painfree23]

in a patient post transplant, should not be any difference, as long as the transplant is "working"...

clotting abnormalities should have returned to relative normal with functioning transplant.

They r on like 3 immunosuppressants, that’s what worries me more than anything

 

[craigkes]

I like to tell them “too much marbling in those strip steaks” every chance I get.

Ha, that's EXACTLY what I say. I usually start my MRI review with "you've seen a side of beef cut down the middle right....". I tell folks the same thing about the ribeye and how I wouldn't pay for that at a steak house if it was that fatty. I have to have a good feel for the patient first of course......