Interstitial Cystitis- Neuromodulation

[NJPAIN]

Anyone have experience with Nevro HF10 for pain due to interstitial cystitis? I know that there is data from Corey Hunter regarding DRG Stim at S2 and L1 for IC but patient had two failed InterStim and not enthusiastic to have more sacral leads.


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[Agast]

I placed 2 DRG leads at L1 for interstitial cystitis pain and got good results

 

[bedrock]

Anyone have experience with Nevro HF10 for pain due to interstitial cystitis? I know that there is data from Corey Hunter regarding DRG Stim at S2 and L1 for IC but patient had two failed InterStim and not enthusiastic to have more sacral leads.


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Where does urology place leads with interstim?

 

[NJPAIN]

I believe, s2,s3,s4? I am told that one lead was left in. First device removed because of infection. Implanted a second time and she claims it didn’t work and caused back pain. Needless to say, chronic pelvic pain patient with lots of oddities.


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[Orin]

For bladder function, it's a single lead into S3 or S4 normally.

I would consider tibial nerve stimulation with one of the PNS systems

 

[Ferrismonk]

Thinking of adding some of this stuff to my arsenal: Here's a good article for your information.

 

[lobelsteve]

From article above:

Limitations: Evidence to support the various treatments, while encouraging, is based on small studies and case series. Large-scale randomized, placebo-controlled clinical trials are warranted to evaluate the clinical efficacy and safety of the different treatments described, particularly neuromodulation.

Conclusions: In addition to the percutaneous, injection-based treatments described herein, neuromodulation remains a plausible option for recalcitrant cases that fail to respond to more conventional means.


Also, has Bob Levy's name on it. So you can toss it away and know that it is sales pitch.

 

[deleted993114]

From article above:

Limitations: Evidence to support the various treatments, while encouraging, is based on small studies and case series. Large-scale randomized, placebo-controlled clinical trials are warranted to evaluate the clinical efficacy and safety of the different treatments described, particularly neuromodulation.

Conclusions: In addition to the percutaneous, injection-based treatments described herein, neuromodulation remains a plausible option for recalcitrant cases that fail to respond to more conventional means.


Also, has Bob Levy's name on it. So you can toss it away and know that it is sales pitch.

Agreed- I have interstitial cystitis after chemo and partial cystectomy for bladder CA. Stim is not read for prime time with that disease process; meds and some pelvic floor exercises are about all I have found in myself (as well as patients) to be effective.

Interestingly, with the notion that many types of visceral pain have a neuropathic component, I found Elavil, nucynta, and gabapentin to be very helpful. Narcotics did not work for me, nor on any of my patients with the same diagnosis. Anecdotes are just anecdotes, however.

 

[Orin]

I've done two cases of IC where the functional issues improved after sacral nerve root stim with the Interstim device. It's on my algorithm but it's near the very end of the more conservative options that I would try it. If you wanted to do something simple, a percutaneous tibial nerve stimulation may be a good test to show yourself there may be some efficacy.

 

[Ferrismonk]

Agreed- I have interstitial cystitis after chemo and partial cystectomy for bladder CA. Stim is not read for prime time with that disease process; meds and some pelvic floor exercises are about all I have found in myself (as well as patients) to be effective.

Interestingly, with the notion that many types of visceral pain have a neuropathic component, I found Elavil, nucynta, and gabapentin to be very helpful. Narcotics did not work for me, nor on any of my patients with the same diagnosis. Anecdotes are just anecdotes, however.

In all fairness, Nucynta is a narcotic.

 

[lobelsteve]

In all fairness, Nucynta is a narcotic.

As strong as codeine. Mu binding 1/18th MSO4.

 

[painfree23]

As strong as codeine. Mu binding 1/18th MSO4.

have u seen the MMEQs for it in the PMP?

 

[lobelsteve]

have u seen the MMEQs for it in the PMP?

100=40

not based on efficacy or safety.

 

[deleted993114]

In all fairness, Nucynta is a narcotic.

Actually, there is a very, very small component of the action of Nucynta- it is mostly norepinephrine.

 

[Ferrismonk]

As strong as codeine. Mu binding 1/18th MSO4.

100=40

not based on efficacy or safety.

Actually, there is a very, very small component of the action of Nucynta- it is mostly norepinephrine.

Still a narcotic.

 

[deleted993114]

Still a narcotic.

Yes, it is classified as such.

However, "narcotic" can be ascribed to a wide range of drugs. Given that nucynta has very little mu opioid binding activity and primarily functions through norepinephrine, it is a far cry from pure mu opioid agonists. In my opinion, relative to pure mu agonists, it is markedly underprescribed and has an addiction rate comparable to tramadol. In a similar vein, tramadol can be described as a "narcotic".

I personally could not work without it, as I was previously miserable. I was prescribed opioids by my internist, which were ineffective and sedating.

 

[Ducttape]

remember that "narcotic" is a legal term, not a medical term.
.

 

[gaseous_clay]

As strong as codeine. Mu binding 1/18th MSO4.

Yet certain states’ PMP databases convert tapentadol’s MME to higher than that of oxycodone.

 

[deleted993114]

Yet certain states’ PMP databases convert tapentadol’s MME to higher than that of oxycodone.

Indeed. This reflects an ignorance on their part about the pharmacologic activity of the drug. I find it odd to have "morphine equivalence" to such a drug when it has minimal mu opioid receptor activity. It would be like "opioid equivalence" for anti-convulsants or non-steroidals.