HF SCS vs traditional

[Nonphysiologic]

Hey,

Don't mean to be inflammatory here at all but I read up on the SENCZA trial...is there anybody here who have patients that prefer parasthesia based SCS? Our patients at our fellowship love Nevro and it has a very impressive success rate and at this point I can't think of a good reason not to use HF SCS. But I want to know if I'm missing anything or not considering something.

Thanks



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[Stim4me]

First nevro trial last week for thoracic radiculopathy and axial mid back pain secondary to multilevel vcfs and stenosis. Patient did surprisingly well, and no way traditional stim would have worked... im a fan now

 

[Ducttape]

As of right now, the main reason I can see is if they have a previously implanted Medtronic or St. Jude or BS pacemaker.


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[bedrock]

Gotta admit that Nevro is intriguing. I'm excited to finally start using it at my new practice.

 

[Taus]

I've been impressed. Then again, both Medtronic with HD and st Jude with burst can do parasthesia free. I am most intrigued by burst. Much less frequent charging and full body MRI. Wireless trial is also a bonus. They have some data to support but not as robust as Nevro.


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[Orin]

The re-charge burden sucks with these power sucking patterns but for me the inability to do conventional stim is somewhat limiting with that device or did I misunderstand their reps/labeling? Love using the paresthesia free systems, but not sure if N is worth the $ premium for the limitations.

 

[deleted472101]

I like having Burst and traditional
Mri is a definite plus
Not having daily recharges is also a plus after speaking to more and more patients.

 

[cbest]

I've never understood the recharge issue. I can't imagine most patients that have SCS placed don't have a little downtime to charge up the battery.


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[BobBarker]

They have the time but not the ability.

 

[bedrock]

They have the time but not the ability.

I doubt they lack the ability, just the self-motivation.

 

[BobBarker]

You have more faith in the 70 year old + 20 years of opioids and benzos crowd than I do.

 

[bedrock]

You have more faith in the 70 year old + 20 years of opioids and benzos crowd than I do.

I don't ever allow opioids and benzos simultaneously. If on modest opioids and they are still too stupid to recharge the battery then I generally don't implant.

If patient or family insists, I send to university for paddle implant with non-rechargeable battery, that their surgical fellows can exchange every few years.

 

[unchockey21]

We do a ton of Nevro. Seems to be a big all or nothing phenomenon with them. You can do sub threshold with the other companies too. Main considerations are battery charging, current or future need for both cervical and lumbar coverage, need for MRI compatibility. One of the biggest things is quality of the rep and level of service. One fellow isn't going to have a Nevro rep within 5 hours of him next year. Boston would tell you HF has the potential to cause hypersensitivity down the road. Who knows. By the time we find out or figure out the mechanism for HF vs conventional, there'll be a new tech out.

 

[Agast]

I haven't tried Nevro yet. My friend has been doing a few and she liked it but found she was having trouble capturing foot pain and that it may not cover feet as well as traditional stim does. Anyone see something similar?

 

[lobelsteve]

Nope.

 

[Nonphysiologic]

Nice thanks for the points. Yeah so far we haven't put any thing BUT nevro except one guy with Medtronic. It just seems like patients are so much happier with HF. Do you know if the 10,000hz is a patented frequency? Can you even patent a frequency? If not then I'd imagine the rest of the companies will catch up and provide it


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[Stim4me]

Nice thanks for the points. Yeah so far we haven't put any thing BUT nevro except one guy with Medtronic. It just seems like patients are so much happier with HF. Do you know if the 10,000hz is a patented frequency? Can you even patent a frequency? If not then I'd imagine the rest of the companies will catch up and provide it


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Nevro has patent from 1200 to 100,000hz per the rep

 

[ampaphb]

Nevro has patent from 1200 to 100,000hz per the rep

Reps lie all the time. The patent makes specific claims about frequencies between 1.5k - 50k hz.

Nowhere in the document is any reference made to 1.2k - 100k hz.

I've heard them make the exact same claims you have, but the patent simply doesn't support their sales pitch

http://patft.uspto.gov/netacgi/nph-...8,359,102.PN.&OS=PN/8,359,102&RS=PN/8,359,102

 

[Stim4me]

Have people hooked up their failed medtronic/stj/bs trials to nevro system? Apparently it's compatible

 

[unchockey21]

Have people hooked up their failed medtronic/stj/bs trials to nevro system? Apparently it's compatible

We've done a lot of OMGs. Gone both routes- BS to Nevro and Nevro to BS. I've heard the reps of the company you switch to get a nice little bonus for it. Not a perfect test drive because lead placement is different but it's an awesome save for the patient when it works.

 

[unchockey21]

Nice thanks for the points. Yeah so far we haven't put any thing BUT nevro except one guy with Medtronic. It just seems like patients are so much happier with HF. Do you know if the 10,000hz is a patented frequency? Can you even patent a frequency? If not then I'd imagine the rest of the companies will catch up and provide it


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As the other guys mentioned, it is patented. Boston challenged it in court and lost. The number 10k (vs 9000 or 8435 or whatever other number) was chosen for IP reasons, not as a result of a dose response curve.