DRG for interstitial cystitis

[ufmd14]

Hi all,
Just need some opinions. I have a 65 year old female patient who has interstitial cystitis. Patient previously had an interstim a few years ago which failed and was removed. She had had multiple hypogastric blocks which initially helped however she's only receiving about 2 weeks worth of relief . Has anyone tried DRG for for pelvic pain/ interstitial cystitis? I know the global indication is for CRPS but does anyone know which diagnosis codes may be helpful to get this approved through insurance?

Thanks!

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[lobelsteve]

SOunds like you need industry support to set up a research study.

 

[DODOCSS]

fibro

 

[callmeanesthesia]

Interstitial cystitis is, as far as I know, generally considered a centralized pain syndrome. Seems like doing SCS for fibromyalgia. Personally I’d stay the hell away from that, especially in someone who failed interstim - wouldn’t you be placing sacral leads anyway? That said, some people appear to have gotten with it:
Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. - PubMed - NCBI

 

[Orin]

Interstim is a pretty limited system designed primarily for functional issues targetting primarily S3/S4, so understanding what the failure was due to would be useful before pursuing another stimulation modality. Still I have had luck with it for some male/female pain states that are associated with on-label bowel/bladder functionality issues, but I hesitate to use it until I'm looking at IT pump vs electrical implants.

I might try something less invasive with similar data for bladder function, such as percutaneous tibial nerve stimulation, prior to another round of implantables.

I would clarify also what you mean by hypogastric blocks, as in inferior or superior hypogastric?
Do they help pain or function?

Is it more reasonable to just do q2w injections with local anesthetic only?

If you're playing cleanup then, you would benefit from showing that selective nerve root blocks of individual DRGs perhaps help your pain pathology, and then build a case for DRG or peripheral nerve mediated pain causing secondary bladder issues. You could then place an Abbott or Stimwave lead through that foramen to target the DRG and nerve root for a trial.

IMO, pelvic pain more than other pains, is far more complex than just finding the pain generator/transducer. In these scenarios, you're playing cleanup, I use the more interventional options only after the patient has committed to cleaning up the rest of their medications and lifestyle things.

IC = CRPS vs fibro of the bladder

 

[SommeRiver]

At my DRG course a guy had done 2 cases for IC and it apparently worked. I don't have any details other than that.

 

[ateria radicularis magna]

SOunds like you need industry support to set up a research study.

Is this sarcasm or a real recommendation? I am leaning towards sarcasm, but I'm not sure. If it is sarcasm, can you tell me the context? Is there a lot of BS funded by stim companies to produce fake literature? Or is there another weird money side to this that I haven't heard about?

 

[lobelsteve]

If you want to experiment on patients tou should write a protocol, submit for IRB approval, and look for funding. Anything less is a money grab by doing a procedure for specious reasons under the guise of being a caring provider.

 

[ateria radicularis magna]

If you want to experiment on patients tou should write a protocol, submit for IRB approval, and look for funding. Anything less is a money grab by doing a procedure for specious reasons under the guise of being a caring provider.

Is doing stim for abdominal or pelvic pain specious?

 

[lobelsteve]

Is doing stim for abdominal or pelvic pain specious?

Nope. As long as you do it as part of a research trial.

 

[painfree23]

Is doing stim for abdominal or pelvic pain specious?

Cant even get these approved for low backpain on patients who haven’t had back surgery.

 

[ateria radicularis magna]

Cant even get these approved for low backpain on patients who haven’t had back surgery.

What if you state its for abdominal/pelvic CRPS?
Not kidding--I think this is fairly commonplace.

 

[painfree23]

What if you state its for abdominal/pelvic CRPS?
Not kidding--I think this is fairly commonplace.

Really? So, for a patient with back pain , just saw it’s pelvic CRPS and it may get covered? I’ve had to turn down 3 patients last week.

 

[SommeRiver]

How exactly is pelvic neuralgia a BS Dx for stim? If it is okay for crps or persistant radiculitis why is this different?

God I'm so glad I don't see pelvic pain...

 

[ateria radicularis magna]

Really? So, for a patient with back pain , just saw it’s pelvic CRPS and it may get covered? I’ve had to turn down 3 patients last week.

No--in that case you could potentially say CRPS of the back. I have not done this, but I have heard it has been done successfully.

 

[painfree23]

No--in that case you could potentially say CRPS of the back. I have not done this, but I have heard it has been done successfully.

Wow. Feel like such an idiot using a diagnosis of crps of the low back. How is that even an icd10 code. Ugh. I wanna move to Canada.

 

[Ducttape]

Wow. Feel like such an idiot using a diagnosis of crps of the low back. How is that even an icd10 code. Ugh. I wanna move to Canada.

you must not be a true needle jockey...

congrats

 

[painfree23]

IS this really what some people do??

 

[ateria radicularis magna]

IS this really what some people do??

Yes--or they code " causalgia of _____." Ask your rep of choice how often they see this in action.