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Ducttape said:
diversionary argument and not addressing the topic of discussion. logical fallacy. attacking the addresser


but ill bite.

i havent done a trial in >5 months.

for my patients, i offer MBB RFA, SIJ and yes, ESI, for which there is good and bad data, and at present, Medicare in their literature review has allowed that practice to continue. i do the occasional MILD for patients who are not surgical candidates and as a palliative treatment.


looking critically at evidence and deciding what we should as a specialty be recommending is not hypocritical.

i never said to not to offer Calmare to your specific patients, just like i have never told drusso that he shouldnt provide his patients with PRP. but neither of those are standard of care and we as a specialty need to be specific as to what we encourage as standard of care and if we are going to go blowing our horns about something, we better need to make sure that it has been thoroughly studied.
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None of those things bolded above is true. I am not specifically attacking you but I am attacking the "standard" that you are using to say that something is helpful or not to the patient because your logic is all over the map and not equally applied in your own personal practice.

There is enough data on scrambler, shockwave, laser, and even ozone to offer these treatments for my selected patients. It is up to the individual physician to do what they think is right for a particular patient. Our goal should be on improving patient's lives. Overly rigid adherence to esoteric notions is many times not in the patient's interest. Keep your eye on the ball.

I
 
Is that how you practice, Ducttape?

If its not, then your comments and critiques are hypocritical and need to be read in that context
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and what do these 2 comments have to do with regards to studies and study design?

Our goal should be on improving patient's lives.
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our goal should be to provide safe and ethical care that follows our oath to also do no harm.

if you think there is enough data to recommend those treatments, then your bar is so low that you would be recommending acupuncture, chiropractic, leeching/bloodletting, electric eel therapy, turmeric/glucosamine/omega-3, laudinum, etc because after all they helped someone smewhere and they did "no harm that i/we know of".....
 
Ducttape said:
and what do these 2 comments have to do with regards to studies and study design?


our goal should be to provide safe and ethical care that follows our oath to also do no harm.

if you think there is enough data to recommend those treatments, then your bar is so low that you would be recommending acupuncture, chiropractic, leeching/bloodletting, electric eel therapy, turmeric/glucosamine/omega-3, laudinum, etc because after all they helped someone smewhere and they did "no harm that i/we know of"...
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Here is the data. I am sure that you will say that it doesn't matter even though there are at least 3 RCTS pulled her. There are about 30 others.
 

Attachments

There is evidence of short term efficacy.

One laser treatment does not usually last more than two months even in responders.

I use it mostly as an adjuvant. However with that said I have dozens who get only laser and avg 6-8 per year. They claim for them its better than any med, injection, or surgery. It is economic and free of risk.
 
study by ip D -
not blinded. not randomized. observational. 5 year duration.

Vallone F -
was randomized. they did use a placebo laser but no placebo group per se. studied out only 3 weeks.

Vallone F -
repeat posting of above.

Jocovic M and Kostantinovic L -
randomized but each group got some form of laser therapy. cannot ascertain how long after treatment the assessments were made. it sounds like right after they were done, assessment was made. so no long term benefit. (kind of like a heating pad, eh)

Konstantinovic LM -
3 groups, 15 therapies over 3 weeks. evaluated "after treatment", which i assume to be right after.
A got med and laser, B got med only, and C got med and placebo laser.

all 3 groups got better.
they did break it down and say that A was better than B and C was better than B, but then one could postulate errors in the study design if placebo laser actually provided benefit...

Djavid GE -
blinded. exercise, exercise laser, and exercise placebo laser. 20 patients per group

no greater effect of laser therapy compared to exercise at any level. no difference at 6 weeks, but they did try to squeeze out a secondary conclusion that exercise laser had better numbers than exercise placebo at 12 weeks.

interestingly, there was a significant larger percentage of males in the laser vs the exercise placebo group.

those who got only laser therapy were not blinded to the treatment; the other 2 groups were. not sure why.

they made pointed statements such as "should" and "could" and "should be investigated in trials with larger sample sizes and longer follow-up periods."

H/ Morshedi -
30 patients, 15 per group - one group the laser apparently was in Off position.
unclear if blinded.

no difference week one or two, but apparently after third week there was advantage, though it does not describe what pain questionaire was used.

S. Nikolic -
35 patients laser, 30 meds only. not blinded.

the patients given laser had faster "pain alleviating effects". cant find out how fast or how long effects lasted.


Basford JR -
35 patients. 2 groups, one in which lasers were deactivated. "pain relieving effect" effect after 3 treatments for 2 of 3 measures - perception of benefit and functional improvement but no change at any point in lumbar mobility. not significant benefit at 1 month period of time.
 
the last study is the only one that seemed to have been done decently enough to make judgements about. it was the only one published that i can tell not in a photolaser journal, and was in a reputable journal, but back in 1999.

most of this stuff was garbage and not worth the time investment to justify treatment other than something to reduce pain at the moment or to recommend this as a significant part of treatment.

if this is the best you got...

addendum: here is a meta-analysis that i found on pubmed, which seems the most rigorous out there:

pubmed.ncbi.nlm.nih.gov

Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials - PubMed

We demonstrated moderate quality of evidence (GRADE) to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. Rigorously blinded trials using appropriate...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Conclusions: We demonstrated moderate quality of evidence (GRADE) to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. Rigorously blinded trials using appropriate laser dosage would provide greater certainty around this conclusion.
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a review by a group for American Pain Society and American College of Physicians showed that the Basford study that you posted seems to be the most rigorous study available back in 2007...
 
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I also use MLS laser for patients and want to post my experience.

In general I find that the laser is most helpful to treat arthritis (versus neuropathic or tendinopathy) related pain in joints that are not very deep.

Cervical facet mediated pain - although cervical RFA is a very successful treatment option covered by insurance, I often run into patients who are not interested in a needle based intervention. I have completely eliminated for >12 months cervical facet mediated pain with completion of a course of laser therapy.

I have had similar experience treating the following:
Coccydynia - patients who had diminishing benefit from corticosteroid injection
Hand arthritis
Foot arthritis
TMJ pain - patients with arthritis or disc displacement
Post knee replacement pain - when scar tissue seems to be related to the pain

When/if the pain returns after several months typically a few maintenance sessions can create sustained pain relief again.

I have found less success with larger joint arthritis like shoulder or knee or even lumbar facet joints, I suspect due to the needed depth for penetration. I like the MLS laser because there is a simultaneous release of two wavelengths of light - one which has been shown to help with inflammation and one which has been shown to help with reducing pain sensitivity. It is a class four laser and causes no harm or pain during the treatment. It’s the only treatment I provide which gives relief without any pain or medication.

I wouldn’t have believed the outcomes myself for these conditions without seeing it for myself.

I also use radial shockwave therapy for tendinopathies. It is a game changer and I highly recommend basic education in shockwave therapy.

These are the most common conditions I treat with shockwave:
Rotator cuff tendinopathy
Plantar fasciitis
Achilles tendonitis
Posterior tibial tendon dysfunction
Greater trochanteric pain syndrome
Tennis/golfers elbow
Cervical/thoracic myofascial pain

Yes it would be great to have high quality studies for laser specific to the device and diagnosis - I do think this is a weakness. If you’re open to learning about other options where you might be able to help some patients I would consider looking into it especially because the risk of harm is less than the risk of harm with most of the procedures we perform. It is also nice having a suite of non insurance based options for patients to consider.
 
Can someone post a link to what is meant by laser therapy? Like a machine with a laser?

I get two patients a month asking me for a 'laser' procedure they heard from a friend or TV. I don't know wtf they are talking about but am sure I would get a strong placebo response. And I'm all for placebo response: win-win
 
bubaghanush said:
Can someone post a link to what is meant by laser therapy? Like a machine with a laser?

I get two patients a month asking me for a 'laser' procedure they heard from a friend or TV. I don't know wtf they are talking about but am sure I would get a strong placebo response. And I'm all for placebo response: win-win
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celasers.com

Cutting Edge Laser Technologies | Therapeutic & Surgical Lasers

CE Lasers is an industry-leading provider of therapy lasers, used by medical & veterinary professionals for pain management, & veterinary surgical lasers.
celasers.com celasers.com
 
I saw two of my laser patients today. One comes in 5-6 times a year and only get laser. The other comes in and gets a whole week every 6 months. I told them about the discussion (no names of course) and they were both independently absolutely appalled by what is being said here.

Patient A who has myofascial pain and spinal stenosis said, "I pay you $50 for every treatment". My copay to see a specialist is $50. I much rather get treatment. I have seen 5 pain management docs before you. They all tried to implant the latest device into my spine, or tried to fill my up with pills, or tried to do perpetual epidurals. Thank you so much for finding a minimally invasive treatment that give me my life back that is cost effective"

Patient B who has mostly facet disease was more aggressive and said I have seen 3 of those guys and it is clear to me that they are getting paid by a company. They met me for 5 minutes and they are trying to implant things. I am glad I found you but they make your field look bad"
 
painisfear said:
I also use MLS laser for patients and want to post my experience.

In general I find that the laser is most helpful to treat arthritis (versus neuropathic or tendinopathy) related pain in joints that are not very deep.

Cervical facet mediated pain - although cervical RFA is a very successful treatment option covered by insurance, I often run into patients who are not interested in a needle based intervention. I have completely eliminated for >12 months cervical facet mediated pain with completion of a course of laser therapy.

I have had similar experience treating the following:
Coccydynia - patients who had diminishing benefit from corticosteroid injection
Hand arthritis
Foot arthritis
TMJ pain - patients with arthritis or disc displacement
Post knee replacement pain - when scar tissue seems to be related to the pain

When/if the pain returns after several months typically a few maintenance sessions can create sustained pain relief again.

I have found less success with larger joint arthritis like shoulder or knee or even lumbar facet joints, I suspect due to the needed depth for penetration. I like the MLS laser because there is a simultaneous release of two wavelengths of light - one which has been shown to help with inflammation and one which has been shown to help with reducing pain sensitivity. It is a class four laser and causes no harm or pain during the treatment. It’s the only treatment I provide which gives relief without any pain or medication.

I wouldn’t have believed the outcomes myself for these conditions without seeing it for myself.

I also use radial shockwave therapy for tendinopathies. It is a game changer and I highly recommend basic education in shockwave therapy.

These are the most common conditions I treat with shockwave:
Rotator cuff tendinopathy
Plantar fasciitis
Achilles tendonitis
Posterior tibial tendon dysfunction
Greater trochanteric pain syndrome
Tennis/golfers elbow
Cervical/thoracic myofascial pain

Yes it would be great to have high quality studies for laser specific to the device and diagnosis - I do think this is a weakness. If you’re open to learning about other options where you might be able to help some patients I would consider looking into it especially because the risk of harm is less than the risk of harm with most of the procedures we perform. It is also nice having a suite of non insurance based options for patients to consider.
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There is a lot of science behind photobiomodulation. The photoreceptor itarget is n the cytochrome c oxidase protein complex in the inner mitochondria in the electron transport chain (oh biochem). If it is stimulated with the appropriate amount of light in the correct wavelength, it will lead to a cascade of events that include a series of anti-inflammatory pathways that lead to relief of pain.
 
mille125 said:
There is a lot of science behind photobiomodulation. The photoreceptor itarget is n the cytochrome c oxidase protein complex in the inner mitochondria in the electron transport chain (oh biochem). If it is stimulated with the appropriate amount of light in the correct wavelength, it will lead to a cascade of events that include a series of anti-inflammatory pathways that lead to relief of pain.
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This maybe true.
But almost every wife or woman i know has a red light gadget at home for face, knees etc

Also so does every chiro

Glad it works for you. But it would be a hard sell in my practice as most people have tried some sort of red light or lazer therapy before seeing me...
 
I talked to a new patient yesterday with semi acute radixulopathy. He is very upset he spent $3000 for "laser spine decompression" at a local chiro that wasted 2 months of time with no benefit. Chiro said he needed another treatment session. I said he needed an MRI for a probable L4 herniation.



I guess the point is we find the patients we want to find to justify our position. None of the patients that I have asked about laser therapy have gotten benefit.

Which is why I still recommend science and data over oral reports. And I for sure will not make people pay for treatments that don't pass my baseline scientific muster.

But to each their own.
 
Ducttape said:
I talked to a new patient yesterday with semi acute radixulopathy. He is very upset he spent $3000 for "laser spine decompression" at a local chiro that wasted 2 months of time with no benefit. Chiro said he needed another treatment session. I said he needed an MRI for a probable L4 herniation.



I guess the point is we find the patients we want to find to justify our position. None of the patients that I have asked about laser therapy have gotten benefit.

Which is why I still recommend science and data over oral reports. And I for sure will not make people pay for treatments that don't pass my baseline scientific muster.

But to each their own.
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Lots of other interventions referenced in this thread, but what are your thoughts on Minuteman, Duct?
 
I remember hearing about scrambler therapy a while ago (10 yrs), and I see above many mentions of 'big hospitals' that use it / used it.

So where is it now? why did it not take off?
 
specepic said:
I remember hearing about scrambler therapy a while ago (10 yrs), and I see above many mentions of 'big hospitals' that use it / used it.

So where is it now? why did it not take off?
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Does it work. Absolutely.
A Few reasons it hasn't taken off

No money to advertise and run big studies

Second (and the bigger reason) it is a money loser for pain groups and even primary physician groups It is true that patient pays $300 per visit but it uses 45 to 60 min of time.

You can do many epidurals or even see 3 to 4 level 4 office visits in that time, all which exceed $300, sometimes by a lot.

Also no benefit to surgery center.


This is why
 
mille125 said:
Does it work. Absolutely.
A Few reasons it hasn't taken off

No money to advertise and run big studies

Second (and the bigger reason) it is a money loser for pain groups and even primary physician groups It is true that patient pays $300 per visit but it uses 45 to 60 min of time.

You can do many epidurals or even see 3 to 4 level 4 office visits in that time, all which exceed $300, sometimes by a lot.

Also no benefit to surgery center.


This is why
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It’s because the machine totally unnecessarily costs $70k. That means ignoring opportunity costs, office overhead, and staff time, at $300 per session you’d have to do over 230 sessions just to pay for the machine.
If it were just the time in, and it really worked as well you say, the other factors would be easily overcome. Shouldn’t be hard to teach a tech to sit with the patient and make adjustments, then the hands on physician time is maybe 5 minutes, making it comparable to an injection with lower risk. If the machine cost $5,000 I bet nearly every pain office would have one. I’d certainly give it a go for my neuropathy patients at least. You could even bring the cost down to $100-200/session and make it more accessible.
 
callmeanesthesia said:
It’s because the machine totally unnecessarily costs $70k. That means ignoring opportunity costs, office overhead, and staff time, at $300 per session you’d have to do over 230 sessions just to pay for the machine.
If it were just the time in, and it really worked as well you say, the other factors would be easily overcome. Shouldn’t be hard to teach a tech to sit with the patient and make adjustments, then the hands on physician time is maybe 5 minutes, making it comparable to an injection with lower risk. If the machine cost $5,000 I bet nearly every pain office would have one. I’d certainly give it a go for my neuropathy patients at least. You could even bring the cost down to $100-200/session and make it more accessible.
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The cost is the cost but the fact that you said that every pain office would have one at $5000 justifies my primary contention which is that it is highly effective especially for neuropathies and FBSS and is at parity with SCS with treating CRPS/FBSS without 10 percent complication and 40 percent failure/explant rate
 
mille125 said:
The cost is the cost but the fact that you said that every pain office would have one at $5000 justifies my primary contention which is that it is highly effective especially for neuropathies and FBSS and is at parity with SCS with treating CRPS/FBSS without 10 percent complication and 40 percent failure/explant rate
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If it works as well as you say.
But why is the cost the cost? There’s no way the build costs are that high, so someone is trying to make a high profit off of it.
 
callmeanesthesia said:
If it works as well as you say.
But why is the cost the cost? There’s no way the build costs are that high, so someone is trying to make a high profit off of it.
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I think that the problem is that you and others can't wrap your head around private pay procedures. There is a high demand for these treatments at any cost. I have patients flying in and renting air bnbs for 7-10 days and thinking nothing of it.

$300 is high cost for 45 min of time?

Epidural cost is $230 for 10 min Medicare
15 min level 4 office visit is $130 Medicare

As I said it is a money loser when I could simply do 4 or 5 epidurals or 3 to 4 office visit in the same time. Either way I come out way behind by doing scrambler.

Docs continue to sell themselves short massively undervaluing their time. Patients pay $50 to $80 dollars for a massage and Medicare pays $83 for 62323 in ASC. Really???

You all need to wake up.
 
mille125 said:
I think that the problem is that you and others can't wrap your head around private pay procedures. There is a high demand for these treatments at any cost. I have patients flying in and renting air bnbs for 7-10 days and thinking nothing of it.

$300 is high cost for 45 min of time?

Epidural cost is $230 for 10 min Medicare
15 min level 4 office visit is $130 Medicare

As I said it is a money loser when I could simply do 4 or 5 epidurals or 3 to 4 office visit in the same time. Either way I come out way behind by doing scrambler.

Docs continue to sell themselves short massively undervaluing their time. Patients pay $50 to $80 dollars for a massage and Medicare pays $83 for 62323 in ASC. Really???

You all need to wake up.
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I’m in private practice but in a poor rural area. 50% Medicare and many of them medi/medi. Another 30% Medicaid (although our local contractor pays Medicare rates, plus specialty access incentives that make them our best payor). I frequently have patients ask me to prescribe them Tylenol or ibuprofen so they don’t have to buy it OTC. I don’t doubt I’d have a decent number of people who’d pay $300 a session to try out scrambler, but not nearly enough to pay for a $70,000 machine. I’m not saying $300 is too high a cost for 45 minutes of my time.

Don’t lump us all together here. I’m not criticizing you for offering this treatment or even trying to debate with you on whether it works. What I’m saying is I think the machine is way too expensive and that puts it out of reach for most of us. I’d take a $5,000 risk on it to try it out, but not 5 figures. We have a couple chiropractors in our group so I’m sure they could use it. I just don’t see it penciling out at that cost for the machine. Same with laser therapy.
 
callmeanesthesia said:
I’m in private practice but in a poor rural area. 50% Medicare and many of them medi/medi. Another 30% Medicaid (although our local contractor pays Medicare rates, plus specialty access incentives that make them our best payor). I frequently have patients ask me to prescribe them Tylenol or ibuprofen so they don’t have to buy it OTC. I don’t doubt I’d have a decent number of people who’d pay $300 a session to try out scrambler, but not nearly enough to pay for a $70,000 machine. I’m not saying $300 is too high a cost for 45 minutes of my time.

Don’t lump us all together here. I’m not criticizing you for offering this treatment or even trying to debate with you on whether it works. What I’m saying is I think the machine is way too expensive and that puts it out of reach for most of us. I’d take a $5,000 risk on it to try it out, but not 5 figures. We have a couple chiropractors in our group so I’m sure they could use it. I just don’t see it penciling out at that cost for the machine. Same with laser therapy.
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I get it that $300 may be too expensive for your population but it is not too high for time used.

It is all decisions we have to make.

Laser, ozone, and shockwave have much lower acquisition costs and you can charge less. I charge $50 for laser. It is less than a massage.

If interested PM me and I can connect you with low acquisition laser, ozone, or shockwave vendors
 
Does Scrambler therapy require you to actively manipulate the device the whole time? Or can you set it and forget it. For example during acupuncture, the needles are placed once and left there for a period of time, and if you have several rooms you can do several patients. It doesn’t hurt to use one exam room for a scrambler patient if it’s going to be effective and you can do other things.
 
Agast said:
Does Scrambler therapy require you to actively manipulate the device the whole time? Or can you set it and forget it. For example during acupuncture, the needles are placed once and left there for a period of time, and if you have several rooms you can do several patients. It doesn’t hurt to use one exam room for a scrambler patient if it’s going to be effective and you can do other things.
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Over the 30 min I am actively in the room for 8 to 10 of them.

I do go into another room, see a f/u and return
 
mille125 said:
I think that the problem is that you and others can't wrap your head around private pay procedures. There is a high demand for these treatments at any cost. I have patients flying in and renting air bnbs for 7-10 days and thinking nothing of it.

$300 is high cost for 45 min of time?

Epidural cost is $230 for 10 min Medicare
15 min level 4 office visit is $130 Medicare

As I said it is a money loser when I could simply do 4 or 5 epidurals or 3 to 4 office visit in the same time. Either way I come out way behind by doing scrambler.

Docs continue to sell themselves short massively undervaluing their time. Patients pay $50 to $80 dollars for a massage and Medicare pays $83 for 62323 in ASC. Really???

You all need to wake up.
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these comments would suggest that every pain clinic would be buying these, particularly in busy metropolitan areas such as NYC.

but this idea that it is a high opportunity device seems, well, hyperbole. something so successful, even if it is multiple therapies with poor physician pay, would entice more than 100 sites across the US to offer it. at the very least, one would see chiros pick it up.

chiropractors buy MRI machines for 100+ grand. pain doctors spend the same for c-arms (tho they will use them more), and ultrasounds for 30-50k, which they may not get reimbursed for.

there are 3 locations in NYC. there are none in Boston, no certified sites in Chicago or Philly (apparently chiros cannot be certified?), and 5 certified on the entire west coast of the country (Seattle, sacramento, santa barbara and 2 in LA and 2 other noncertified sites in California).


something else is up, if this is so successful therapy and high demand, yet noone is offering.



(these are not comments about the effectiveness of the therapy but rather targetting the specific allegation that it is not being done because pain doctors are not aware of the benefits of private pain procedures).
 
Ducttape said:
these comments would suggest that every pain clinic would be buying these, particularly in busy metropolitan areas such as NYC.

but this idea that it is a high opportunity device seems, well, hyperbole. something so successful, even if it is multiple therapies with poor physician pay, would entice more than 100 sites across the US to offer it. at the very least, one would see chiros pick it up.

chiropractors buy MRI machines for 100+ grand. pain doctors spend the same for c-arms (tho they will use them more), and ultrasounds for 30-50k, which they may not get reimbursed for.

there are 3 locations in NYC. there are none in Boston, no certified sites in Chicago or Philly (apparently chiros cannot be certified?), and 5 certified on the entire west coast of the country (Seattle, sacramento, santa barbara and 2 in LA and 2 other noncertified sites in California).


something else is up, if this is so successful therapy and high demand, yet noone is offering.



(these are not comments about the effectiveness of the therapy but rather targetting the specific allegation that it is not being done because pain doctors are not aware of the benefits of private pain procedures).
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I think biggest reason is awareness. I follow a lot of info out of Europe. I was aware that it was in Italy and that it was highly successful for quite awhile but was not aware that it was available here until a colleague told me that he had one. You guys know about it because of this forum but if you asked 100 pain groups at random under 10 or maybe even under 5 would have even heard of it.

Secondly, as I have said it is not a big "money winner" when compared to other things that we do, especially all of the "new" procedures propagated by industry. Yet even compared to a bread and butter operation of ESIs and facets, the clinic does better with these vs scrambler. A lot of pain docs are tied to ASCs now and this in no way fits in that model.

Third, many don't understand private pay or feel that their own population wont pay, even if it is helpful. I am not saying that a lot of patients cannot afford to pay for it but to think that no one in your practice can afford it is being naive. The "stem cell" center down the street has an endless supply of patients paying or seriously thinking about paying 5000 plus for stem cells, yet quite a few physicians that I know in the same community report from a position of "authority" that " none of my patients cant afford even 100-200 for a helpful procedure". You would think that the two are not in the same community. I actually had a peripheral neuropathy patient tell me that he couldn't do scrambler when I estimated 3-5 treatments at $250 each but was about to pay $1600 for his deductible for a stim-trial from another doctor. He ultimately did scrambler with me and only needed 3 treatments.

As far as high demand, I get around two patients per month who seek me out from out of state or at least out of a 2 hr radius. This never happened previously.
 
yes it is based in italy. that may be part of the issue.

but there is a clear disconnect.

i guess you dont see it.

you and in the past different sites have stated that it helps.

you have stated that it doesnt cost too much

you state that patients are willing to pay (which we all know)

yet there are a paucity of sites that offer this treatment.

this is in contradistinction to almost every other pain treatment with touted benefits. within months of intracept and SI fusion and minuteman and cold laser, there were hundreds if not thousands of places that offered such treatment.

and it is not just the cost of the machine. chiros buy MRI scans costing hundreds of thousands or 25k for spinal decompression machine. pain docs buy C-arms costing 100k or US costing 30-50k at the drop of a hat.


(fyi, these comments are not about the purported efficacy but rather why the treatment is not being implemented after 15 years on the market, which raises concerns)
 
Ducttape said:
yes it is based in italy. that may be part of the issue.

but there is a clear disconnect.

i guess you dont see it.

you and in the past different sites have stated that it helps.

you have stated that it doesnt cost too much

you state that patients are willing to pay (which we all know)

yet there are a paucity of sites that offer this treatment.

this is in contradistinction to almost every other pain treatment with touted benefits. within months of intracept and SI fusion and minuteman and cold laser, there were hundreds if not thousands of places that offered such treatment.

and it is not just the cost of the machine. chiros buy MRI scans costing hundreds of thousands or 25k for spinal decompression machine. pain docs buy C-arms costing 100k or US costing 30-50k at the drop of a hat.


(fyi, these comments are not about the purported efficacy but rather why the treatment is not being implemented after 15 years on the market, which raises concerns)
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You have a point but the one thing that goes against your widespread adoption of the technique argument is the fact that MD Anderson, Cleveland Clinic, UCLA, Johns Hopkins, and MD Anderson as well as at least a dozen sites for the VA/US Military use the device faithfully.

You don't often see these kind of places adopt treatments that are scams, frauds, or otherwise ineffective.
 
mille125 said:
You have a point but the one thing that goes against your widespread adoption of the technique argument is the fact that MD Anderson, Cleveland Clinic, UCLA, Johns Hopkins, and MD Anderson as well as at least a dozen sites for the VA/US Military use the device faithfully.

You don't often see these kind of places adopt treatments that are scams, frauds, or otherwise ineffective.
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Cancer draws the argument of “anything that helps, or seems to help, even if it’s placebo”
 
mille125 said:
You have a point but the one thing that goes against your widespread adoption of the technique argument is the fact that MD Anderson, Cleveland Clinic, UCLA, Johns Hopkins, and MD Anderson as well as at least a dozen sites for the VA/US Military use the device faithfully.

You don't often see these kind of places adopt treatments that are scams, frauds, or otherwise ineffective.
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More propaganda techniques.
 
mille125 said:
You have a point but the one thing that goes against your widespread adoption of the technique argument is the fact that MD Anderson, Cleveland Clinic, UCLA, Johns Hopkins, and MD Anderson as well as at least a dozen sites for the VA/US Military use the device faithfully.

You don't often see these kind of places adopt treatments that are scams, frauds, or otherwise ineffective.
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are they?

ive referred a few patients to Cleveland, including a couple of CRPS. ive never seen mention of scrambler treatment in the referral notes.

oh wait, thats because it is offered at the Cleveland Clinic Palliative Care department, not Pain Management.

and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. not the pain clinic.

MD Anderson Cancer Center.

UCLA Health Neuromodulation TMS Service (apparently, a team that focuses on transcranial magnetic stimulation)
 
Cleveland Clinic has just started using it for other conditions.

The other places focus only on CIPN.

If you are in the Cleveland area, University Hospital has a machine and treat a wide variety of things.

If you are closer to Pittsburgh, I am opening a scrambler center there in 3 months or so. It's my hometown.
 
callmeanesthesia said:

Cancer draws the argument of “anything that helps, or seems to help, even if it’s placebo”
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i dont know why you are so against this technique.

if you are a paladin, you can restore a total number of hit points equal to your paladin level x 5 and ALSO neutralize poisons and cure disease. its actually pretty a powerful spell

Lay on Hands

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SSdoc33 said:
i dont know why you are so against this technique.

if you are a paladin, you can restore a total number of hit points equal to your paladin level x 5 and ALSO neutralize poisons and cure disease. its actually pretty a powerful spell

Lay on Hands

roll20.net

Roll20 - Compendium and Rule Set Directory

Browse and reference your favorite RPG rule sets for systems including D&D, Pathfinder, Call of Cthulhu, and Cyberpunk RED.
roll20.net roll20.net
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plasma. said:
Wanted to try scrambler, emailed them but apparently no Canada health approval. Would've been interesting to try it out for my CRPS patients.
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Yes... my understanding is that all devices have to be approved by some body in Canada. I think that they also extract dollars from the company. The scrambler company is very small and either couldn't afford to do this or decided not to....so the treatment is unfortunately locked out of Canada.
 
good one, but cutting edge is not 10+ years old...

oh and also i refer to the pain clinic, not oncology (where Cleveland Clinic seems to do the scrambler therapy)
 
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