Cluneal PNS

[gaspasser127]

Anyone doing much cluneal PNS? Not getting any exposure to it during fellowship but recently met with our Nalu rep who talked about it.

My questions are:
- what’re the indications?
- who’s the ideal patient?
- how’s insurance coverage in non-Medicare patients?
- have you seen positive results with it?

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[lobelsteve]

No indications.
No patients.
Not covered.
Great results.

 

[Orin]

Anyone doing much cluneal PNS? Not getting any exposure to it during fellowship but recently met with our Nalu rep who talked about it.

My questions are:
- what’re the indications?
- who’s the ideal patient?
- how’s insurance coverage in non-Medicare patients?
- have you seen positive results with it?

Pain reproduction with palpation of the cluneal along the iliac crest from PSIS lateral. Generally people with what looks like SI pain but it is more inferior or lateral, and doesn't respond as cleanly to an SIJ injxn.
If they have a good response to a field block of the superior or middle cluneals, can consider a PNS trial.

Some private payors cover 64555 for M79.2 but many are explicit about non-coverage like UHC/Cigna.

I've seen people doing it in the community that love it but have generally offered RFA or DRG over PNS due to the external charging apparatuses.

 

[MitchLevi]

How do you get DRG covered for this?

Man, there's some BS out there in the community.

Every time you fight tooth and nail to get an RFA approved for someone whose pain went from 7 to 3 on an MBB I want you to think about your colleagues putting DRG leads in for "cluneal neuralgia."

 

[drusso]

Anyone doing much cluneal PNS? Not getting any exposure to it during fellowship but recently met with our Nalu rep who talked about it.

My questions are:
- what’re the indications?
- who’s the ideal patient?
- how’s insurance coverage in non-Medicare patients?
- have you seen positive results with it?

We're seeing a tsunami of cluneal neuralgia post-COVID. Look for an association between Modic-related axial low back pain and medial branch causalgia. The constellation of these three diseases--Cluneal Neuralgia, Modic-related axial low back pain, and medial branch causalgia--are the scourge of our time. #nonopioid solutions #outcomes matter #right patient right therapy

 

[RoloTomassi]

Does Medicare cover? Seems reasonable for cases of elusive buttock pain

 

[drusso]

Does Medicare cover? Seems reasonable for cases of elusive buttock pain

Yes.