How many SCS trials per patient and which order to do you do?

[drusso]

If a patient doesn't respond to one manufacturer do you re-trial with another? Do you flip a coin to determine which manufacturer to use first or just go by day of the week? It's Tuesday, must be Nevro...

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[BobBarker]

Nevro vs dealer’s choice most frequently

 

[pmrmd]

Personally Abbott for my senior patients. They can't be trusted to actually recharge the thing. Most people get Boston. No one gets Nevro because it under-performs. Medtronic when there is already a Medtronic pacer in place. Rare Intellis implant but maybe that changes soon.

 

[10KHertz]

Nevro trial for 5-7 days, then swap to HD or burst programming for days 7-10. I see Nevro as over performing compared to others , so I start trials with that system. I implanted Medtronic and ST Jude for many years and have swapped defunct IPGs to NEVRO with marked improvement. There is a study pending on this IPG crossover (funded by NEVRO!).

 

[Sig123]

Personally Abbott for my senior patients. They can't be trusted to actually recharge the thing. Most people get Boston. No one gets Nevro because it under-performs. Medtronic when there is already a Medtronic pacer in place. Rare Intellis implant but maybe that changes soon.

Just did 2 Medtronic DTM this week.

Curious to see how It works.

 

[painfree23]

Do you mean you pull leads and then try another stim trial a few weeks later?

 

[Agast]

Do you mean you pull leads and then try another stim trial a few weeks later?

A lot of the companies have a cross-competition adapter to attach to their external battery so you can just switch it in during the trial. That means you will be extending the trial past 7 days.

 

[gdub25]

I do Nevro with every patient unless there is a reason not to. Example would be dementia that would make charging unreliable or a legitimate need for frequent MRIs in which case medtronics superior MRI compatibility would be best. If after a few days into the Nevro trial they aren’t doing well then I’ll have them programmed on tonic, and if that doesn’t help then they can try burst. No patient fails SCS in our practice without trying multiple waveforms. Waveforms being the key word here, not companies. Tonic stim is simply tonic stim. Pulse width, frequency, and amplitude are the variables. That’s it. Thinking one tonic system is better/different than another is nonsense in my opinion based on research over the past 30 years. If you get tingling where the pain is that’s as good as it’s gonna get.

 

[DOctorJay]

when you say "then they can try burst" does that mean you have Abbott come in and trial BurstDR or are you referring to Nevro's version of burst?

 

[deleted993114]

If a patient doesn't respond to one manufacturer do you re-trial with another? Do you flip a coin to determine which manufacturer to use first or just go by day of the week? It's Tuesday, must be Nevro...

You must have attended the Boston Scientific "kool aid" meeting in Dallas. Some crazy chick trials everybody 10-14 days and always with two different systems. She chooses 'the best" trial of the two for the implant. I am sure that the insurance companies just love her.

I let the nurses choose the system, as they will identify the reps that give the best service. Nevro does have a small subset of patients for which their programming is superior; burst stimulation is unique as well. Otherwise, its V= IR and these companies are more similar than not.

Gotta spread the work around to help drive competition and innovation.

 

[Ferrismonk]

You must have attended the Boston Scientific "kool aid" meeting in Dallas. Some crazy chick trials everybody 10-14 days and always with two different systems. She chooses 'the best" trial of the two for the implant. I am sure that the insurance companies just love her.

I let the nurses choose the system, as they will identify the reps that give the best service. Nevro does have a small subset of patients for which their programming is superior; burst stimulation is unique as well. Otherwise, its V= IR and these companies are more similar than not.

Gotta spread the work around to help drive competition and innovation.

No matter how many times you say it, this seems ridiculous to me. You should know the reps, the advantages/disadvantages of each system, and make the informed choice yourself. Not "the nurses".

I use Nevro for everything standard (PLS, Unresponsive Radic, Axial low back and radic). I use Boston for CRPS or more unusual targets.

 

[Crybaby]

I give each patient information on Nevro, Abbott, Medtronic (never used), and occasionally Stim Wave (never used for SCS). I let them choose. I ask that they go read about the good, bad, and dirty online via websites that are not company sponsored. If they need to hash it out some more they come back and see me or I have the reps contact them.

I feel if they cannot truly do this then maybe stim is not for them.

Nevro typically wins out, and luckily our reps in my area are wonderful. If they do not respond I give them the option of switching devices around day 6 and will consider extending trial another 2-4 days with abx.

Retrial is a pain to get authorized and more needles for patient.

 

[Crybaby]

No matter how many times you say it, this seems ridiculous to me. You should know the reps, the advantages/disadvantages of each system, and make the informed choice yourself. Not "the nurses".

I use Nevro for everything standard (PLS, Unresponsive Radic, Axial low back and radic). I use Boston for CRPS or more unusual targets.

What have you found about Boston is more effective for CRPS?

 

[lobelsteve]

I only do implants. Or so it seems.

 

[Ferrismonk]

What have you found about Boston is more effective for CRPS?

Honestly, I'm not sure there is a big difference. Sometimes CRPS people like the paresthesia so they get confirmation "it's working".

Also, Evicore won't allow HF10 for CRPS.

https://www.evicore.com/-/media/files/evicore/clinical-guidelines/solution/msk--advance/2020/evicore_cmm-211-spinal-cord-implant-periph-nerve-stims_eff021420_pub101519.pdf

 

[gdub25]

At least Evicore is looking at the evidence in regards to what they will and will not allow for CRPS. Nevro has never been studied for that indication. That being said I still use Nevro for CRPS all the time, the codes are the same and you don’t have to write down what company or therapy you are using when you’re getting authorization, just submit for 63650 x2.

 

[bedrock]

At least Evicore is looking at the evidence in regards to what they will and will not allow for CRPS. Nevro has never been studied for that indication. That being said I still use Nevro for CRPS all the time, the codes are the same and you don’t have to write down what company or therapy you are using when you’re getting authorization, just submit for 63650 x2.

In my area, cigna uses evicore guideline religiously and also require that you input what type of device you're trying to get authed. In my limited experience in this state, they will use HF10 as an excuse to deny, while Cigna will auth non HF10 companies. So I don't use Nevro for any of my Cigna patients but I do use them frequently for other patients.