Go to a NANS meeting and tell me that stim isn't BS. There are specific patients that do well with stim but according to the more prolific neuromodulators at NANS, there are an endless number of uses for stim. You name it and it will work for it. They lie, misrepresent the truth, and are used car salesmen.
I go to NANS every other year. I think that certainly there are those who have stretched the indications for stim. Exaggerating benefits of a particular treatment modality is par for the course for any pain meeting. I would say that ISIS and and Lax's meetings are probably the worst offenders in that regard. You just have to understand their marked bias and take away what may be beneficial from the meetings. NASS and ASRA are probably a couple of the more legit meetings.
However, when a patient has predominantly radiating neuropathic pain, they work very well. They are not "BS" by any means when patients have refractory radicular pain; I think that perhaps your perception is in contrast to results reported in the literature and the experience of most practitioners. In fact, I would offer that stim and cervical rf are probably THE most effective treatments we have.
How many stims have you done? I have done them for 28 years and do about 40 a year, so I am over a thousand. I have had three infections in that time and only five explants for lack of efficacy. Is your patient selection for those only with radicular symptoms, or have you performed stim for axial pain? The latter, of course, has a very high failure rate.
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Three infections out of over a thousand is far below the usual rates I’ve seen in the literature. What are your protocols (pre-op prep, abx, closure, etc)? Do you implant smokers? Diabetics?
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I do implant both diabetics and smokers. I do not implant anyone who has had a history of infections with other surgeries. If there is any indication of that, I'll check nasal and axillary cultures for MRSA. Perhaps it is luck, but I have been blessed with a very low infection rate. I was trained by neurosurgeons, not pain guys, and they taught me how to operate from an idiot's point of view (anesthesia pain- not a real surgeon). Keep it simple- it keeps you out of trouble.
I give pre and post op antibiotics (even though the literature says this is probably not needed, I still do anyway). However, the MOST important issues in my opinion, in reducing infections is-
1. a dry field- one must be meticulous in making sure that you don't have any bleeders remaining and have a dry field. This is probably THE most important issue of all of them. Blood is a wonderful medium for infection.
2. minimal surgical trespass- the less you traumatize tissue, the better off you are. Often people muck around when it is not necessary- this is a subcutaneous procedure, after all, and is not rocket science.
3. rapid surgical times- it takes me 45-50 minutes for a stim implant. I hear about stims taking 2-3 hours and wonder what the heck someone could possibly be doing for that length of time. I guess I would get bored after a while and just walk away.
4. very good fascia closure- run your finger along the fascia line and make sure you have no gaps.
5. Don't poison the patient with "vicryl toxicity"- I have seen other people's stims who put in way too many sutures- have faith that your sutures and ties are good- you don't need that many.
6. skin closure with staples- it pinches the skin and prevents a "highway" going to the fascia from skin sutures.
