Just matched but worried about perceived low procedural volume in the program and attendingship

[lobelsteve]

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[SommeRiver]

I've done it 4 times, so I'm not exactly Mr. RegenMed, but yes, every time. My steroid injections last 3-6 months on average with a waning relief over time, SI RFA lasts about 6mo to a year, SI PRP hasn't needed any repeats since my first in May of this year (5 months). Still zero pain in the SI joints on everyone.

I got a few pts I've considered offering it to but I'm going to hate myself if I end up stealing $500 from them.

 

[Ferrismonk]

I got a few pts I've considered offering it to but I'm going to hate myself if I end up stealing $500 from them.

Just be honest. I tell them about good evidence in knees and tennis elbow. Mixed results elsewhere, hard to study, etc. Choose appropriate patients. Most people who opt for RegenMed either want to avoid steroids (osteoporosis/old age) or care much more about long-term relief than a cheap bandaid.

If you're worried about $500, think of it this way. Medicare pays roughly $246 for an in office B/L SI joint. Do that twice and you're at $500.

 

[SommeRiver]

Just be honest. I tell them about good evidence in knees and tennis elbow. Mixed results elsewhere, hard to study, etc. Choose appropriate patients. Most people who opt for RegenMed either want to avoid steroids (osteoporosis/old age) or care much more about long-term relief than a cheap bandaid.

If you're worried about $500, think of it this way. Medicare pays roughly $246 for an in office B/L SI joint. Do that twice and you're at $500.

I hear you.

 

[10KHertz]

I've done it 4 times, so I'm not exactly Mr. RegenMed, but yes, every time. My steroid injections last 3-6 months on average with a waning relief over time, SI RFA lasts about 6mo to a year, SI PRP hasn't needed any repeats since my first in May of this year (5 months). Still zero pain in the SI joints on everyone.

If you believe the SI joint is the primary pain source , why not go “all in” with SI Bone(ie SI fusion)? Vs q 5 months of PRP. Sounds like your patient’s options are limited, and they have the resources to embark on this journey.

I don’t personally recommend this surgical option, but maybe your patient may consider it ....

 

[Ducttape]

Just be honest. I tell them about good evidence in knees and tennis elbow. Mixed results elsewhere, hard to study, etc. Choose appropriate patients. Most people who opt for RegenMed either want to avoid steroids (osteoporosis/old age) or care much more about long-term relief than a cheap bandaid.

If you're worried about $500, think of it this way. Medicare pays roughly $246 for an in office B/L SI joint. Do that twice and you're at $500.

yes, except... patients using Medicare to cover their procedures aren't pulling that money out of their wallet and away from their budget...

just saying...


you are providing services to the patient, so I wouldn't necessarily feel bad about it if that person has money to spend, and $500 is not the rip-off of $1000+ quoted elsewhere...

 

[Ferrismonk]

If you believe the SI joint is the primary pain source , why not go “all in” with SI Bone(ie SI fusion)? Vs q 5 months of PRP. Sounds like your patient’s options are limited, and they have the resources to embark on this journey.

I don’t personally recommend this surgical option, but maybe your patient may consider it ....

Risk/Benefit is why.

And surely you're not suggesting I do interventions on things that don't hurt now, are you?

 

[SommeRiver]

SI fusions do nothing more than cause pain.

 

[10KHertz]

SI fusions do nothing more than cause pain.

Correct ... that’s why early in one’s career you avoid offering esoteric options such as SI fusions and mesenchymal stem cells q3-6 months. You will have fair outcomes, bad reviews, and scant patient/family referrals .

 

[SommeRiver]

True, but I wouldn't equate stem cells with PRP.

 

[10KHertz]

True, but I wouldn't equate stem cells with PRP.

Some CD34+ Cells... if you're lucky.
I am curious if pain physicians are using general terms with patient such as “regenerative medicine” and not actually explaining the difference between mesenchymal/stem/pluripotent vs prp/anti inflammatory/recruitment .

 

[SommeRiver]

I would seriously hope they're educating the pt about what they're doing considering we're talking cash for service.

The people I know using SC are doing BM aspirate and I think they just refer to it as such.

I've seen 15k and higher out of pocket, which I can't fathom.

Let me again plug that Wondery podcast called Bad Batch.

 

[No Pain All gain]

Strongly encourage both the NANS fellow course AND the new attending course. Beware though, you'll be forced underneath a torrential downfall of lies and deception, but it is still good to see different people's methodology for entry point, approach angles, closure, etc...Tons of nuances and there are 50x ways to do good SCS work.

It is a GOOD treatment for failed back with persistent radic and very good at CRPS. Those are the most common Dx you'll implant/trial. Failed back is far and away the most common for me (two spine surgeons in my group and I'm the only guy doing SCS).

I do SCS for FBSS and the pt only has back pain and it simply is unreliable. You'll take out 80% of the implants you do for that Dx.

What do you mean by “torrential downfall of lies and deception”?



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[SommeRiver]

What do you mean by “torrential downfall of lies and deception”?



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The guys who are paid to run the cadaver stations are utterly FoS and will tell you all types of BS. I realize that is an unfair blanket statement and I should pull it back, but nah...

I've told the story many times of instructors telling me all sorts of mistruth. One guy told me something along the lines of his having done 75 or so DRG leads and never saw a migration or a failure, and never had one adverse event.

If you look at the original DRG studies there were a significant number of adverse events but colorful use of vocabulary downplayed those events.

This instructor (I won't say his name but I would guarantee every person here knows his name) just flatly denied all that. I'm doing a station and all they would let us do is watch him do DRG placement, and bc of FDA restrictions would not let us touch the DRG equipment. I did the actual DRG course later, and he wasn't there...My course was lead by a guy that was actually pretty honest and forthcoming...surprisingly.

I guess if you can attend those courses and just realize you're dealing with shills much of the time you're going to come away better than before...You will learn good technical skills no matter what, bc those instructors have done a lot of stim.

Edit to add clarifying info - So that anyone reading this doesn't get the wrong impression...I haven't been pressured to use any specific company or product at either NANS courses I went to, and my main complaint is the "procedural hubris" that I witnessed. People making bold claims about technical prowess and success. I think it is important to delineate that from company pressure - Use Abbott or Boston or Back Stimulator from Mars Version 3000.

 

[Baron Samedi]

Only tangentially related, but I have anecdotally had a few post-SIJ fusion patients who have done well with peripheral field stim.

 

[BobBarker]

Kudos to you for calling it peripheral field stim which is exactly what they are all doing.