Axial LBP with no Hx of back surgery in a pt with stenosis and facet disease is not an indication for SCS.
I'm dealing with this as we speak. A local POS pain group was bought out by PE, the founder of the clinic was fired and now it's an even worse POS and there are SCS patients being sent out looking for implanters and trialers. Of course, the rep sends two to me.
I meet one, a 73 yo guy who is extremely healthy (takes Lisinopril) with mod to severe L3-5 spinal stenosis from an MRI over two years ago with golf ball facets and classic axial low back pain. Huge facets at L5-S1 with facet edema (which the radiologists DIDN'T include by the way). He had "injections," no clue what type or when...
He has never seen an MD at that clinic, and has been managed by PAs the entire time. Never once seen the MD except for getting "injections." I will tell you 99% of PAs will NOT look at that images on the CD, and if they do they're not gonna pick up subtleties like clinically significant facet edema. There's also no way a PA will pick that up and mention it if the radiologist didn't say it.
What is clearly apparent to me is the fact small pain groups live and die on stimulators and a few other things...Monthly opiate visits at 214 and urine to go along with it.
They hoard patients bc the electricity bill needs to be paid, employees need paychecks, etc.
Surgery is indicated for symptomatic stenosis in extremely healthy 73 yo gentleman, not spinal cord stimulation.
"I don't want surgery, but I was told surgery won't treat this and the stim-uh-lader will let me live out the rest of my days without pain."
Here's an amazing back and forth - I texted the rep basically telling him I won't accept these patients anymore and that I don't see any way a stimulator will help this guy and the rep replies to me, "I wouldn't over promise long term relief for arthritis pain but the axial back pain we should get good relief with."
That is a direct quote from my text messages. If yall ever think your rep knows anything at all about back pain or how best to treat your patients, read that quote again.
I'm getting a new MRI and will offer him an ablation or an ESI, if he declines or it fails I will offer a referral to one of our spine surgeons. If he declines that he can go find someone else to do it.
I am blocking all referrals from that practice.
They once sent me an implant pt who did a 12 hour trial that failed. She was a smoker on immunosuppression with a BMI around 16. Didn't even trial for 24 hours.
In the next 5 years it will become more and more restrictive to put a stimulator in a patient.
IMO, the only reason to do it is CRPS, FBSS with persistent radic, FBSS with axial pain or some other neuropathic process.
Preoperative axial back pain is a BS stimulation target, and anyone who does it and tries to tell me they get good results is either blind or FoS.
The other thing...Your avg pain doctor would probably make more money stacking ESI/RFA patients instead of putting in stimulators. At least, that's true of implants.