Explaining RFA process to patients

[stsa84]

I realized I give a nerve block/RFA spiel a few times a day, and it always feels like this bulky thing I'm semi-effectively explaining to my patients.

I've picked up some good lines from you guys; I'm sure there must be a better way to explain RFA's than what I'm doing.

What's your simple, concise spiel?

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[pastafan]

Blah, blah, blah, blah....

 

[No Pain All gain]

Low back pain is not a diagnosis. These shots may help us find your pain generator and give you a treatable diagnosis. If they work on two occasions for a few hours we can come back again and instead of just numbing the nerve we make a burn the size of a grain of rice at the nerve location using an electric needle. The best evidence and insurance policy is to “Measure twice, burn once”.
The alternative is to stimulate the medial branches to strengthen the muscles around your spine.

Talk track modified now that I give people choice between medial branch stim for 60 days or RF.

 

[callmeanesthesia]

Talk track modified now that I give people choice between medial branch stim for 60 days or RF.

Tell us more about this? Sprint PNS? How do you get it reimbursed and what have you seen for results? I’ve been very tempted to try for people with axial low back pain and benign imaging as an adjunct to PT. Nervous about lead fracture though - sounds like a high incidence with those PNS devices.

 

[No Pain All gain]

I’ll have to say it’s easier and faster than RF, with almost immediate patient satisfaction. Not sure about long term results, I haven’t really done enough. N is about 10 now.

 

[No Pain All gain]

They have a reimbursement guide. It’s straightforward.

 

[geauxg8rs]

No matter what i actually say about RFA, the patients still think it is lasers

 

[callmeanesthesia]

“Radiofrequency ablation blocks pain by cauterizing nerves to the joints so you can’t feel the arthritis any more. Insurance requires we do test shots first to make sure we have the right spot. This will numb the joints for about 4 hours. During that time I want you to test it out by doing activities that would normally bother your back (or neck) to make sure you have good relief. It will wear off after a few hours. If you get good relief, then we will get you set up for the ablation. The nerves do eventually regenerate but it typically lasts at least 6-12 months, and we can repeat the ablation.”

I also give a handout from Painbytes, and I have another sheet that they receive when they come for branch blocks that reminds them it will wear off in a few hours, and success is defined as 80% or more relief for a few hours and increased activity tolerance.

 

[paindoctor2014]

What is yalls process, obviously need two good results prior to the rf. How many, if any clinic visits in between? If they aren’t hurting anymore, still progressing to next block? Curious. It gets cumbersome, I do some phone notes etc. trying to streamline my process

 

[pastafan]

No visit between diagnostic block. Patient instructed to call next day with duration of the pain relief. Visit after both blocks to discuss RFA and consent.

Never perform any procedure if patient is asymptomatic. I'm not a chiropractor.

 

[Laryngospasm]

Doesn’t matter what you say they won’t listen and will come back and say the mbb didn’t work and when questioned they will say it worked for a few hours.

 

[paindoctor2014]

Doesn’t matter what you say they won’t listen and will come back and say the mbb didn’t work and when questioned they will say it worked for a few hours.

This is super difficult. I’ve tried explaining it 30 different ways. There is a direct correlation with education level I’ve found if they can understand a diagnostic block

 

[callmeanesthesia]

This is super difficult. I’ve tried explaining it 30 different ways. There is a direct correlation with education level I’ve found if they can understand a diagnostic block

It helps to repeat it twice during the initial appointment, and before and after the procedure, and give them a handout after the initial appointment and after the injection, and have your MA/nurse explain it to them before they are discharged after the procedure.

 

[ateria radicularis magna]

What about when they say it helped a lot, like 50% of the pain was gone? Do you take that as a positive or a negative ?

 

[Ducttape]

that would be an equivocal result, unless you can back the 50% decrease with concomitant functional improvement.

the patient's insurance carrier probably would not let you go to RFA based on just a 50% decrease without documented functional improvement or without a follow up MBB that showed 80% reduction.

 

[SSdoc33]

ive come to the conclusion that it is essentially impossible to explain it so that everyone understands. i give my typical spiel, and if they dont get it, they dont get it. most do, but many dont

also, i will be a bit liberal with what i see as a "positive" result, and will stretch the truth a bit to get it authorized. i would say i lie on my documentation, but i definitely paint it in the patient's favor. id rather have a patient get some relief than not be able to offer them any.

that being said, i only offer an MBB to patients i am relatively sure will have benefit from them

 

[Dr. Ice]

“That epidermal didn’t work doc”

But it wasn’t an epidural..it was a diagnostic procedure to block the nerves that go to your joints to see if your joints are causing your pain. That’s why you got a pain diary to fill out.

“Like I said, that epidermal wasn’t no good”

Good times

 

[Laryngospasm]

You forgot the part about that hydrocodone that the pcp gave really helping though.. just enough to get them to your office..

 

[ateria radicularis magna]

that would be an equivocal result, unless you can back the 50% decrease with concomitant functional improvement.

the patient's insurance carrier probably would not let you go to RFA based on just a 50% decrease without documented functional improvement or without a follow up MBB that showed 80% reduction.

I think the lcd I read said 50 % improvement in previously painful movement and/or 80 % reduction in pain for the duration of action of the local anesthetic... but... lots of patients and people don’t really understand percentages, or fractions, so it’s a weird conversation...

 

[Laryngospasm]

I had a patient tell me the other day the rfa hadn’t worked. Then she said.. you know Ive been able to get out of bed easier and brush my teeth easier.. without much pain maybe it did work.. LOL you might as well explain cold fusion to most patients as explain the whole process and how it works. Just use your judgment.

 

[NJPAIN]

I think the best approach is to call them the next day to get a report of response. I can’t seem to orchestrate that in my office. I have them fill out a diary which is usually totally effed up. Then on f/u visit they tell me that they had a week of relief after 0.25 ml of 0.5% bupiv.

 

[Crybaby]

I have noticed the percentages are really difficult for people. The past few weeks I have started joking with patients when they say the block is great with only 50-60% improvement..... I ask them if they really meant to give me an F or a D? That seemed to help somehow. So I think I am switching to ABCDF system.
Still doesn't solve the next day when bupi has worn off 🙂

 

[NOSfan]

I tell them they will undergo ionized radiation guided fulguration that utilizes alternating electocurrents in the hectometer band of the electromagnetic spectrum for symptomatic amelioration………....but only if their insurance allows.