am I wrong or does each MBB have to give relief? ie if the first didn't work then you can't move forward?
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That’s generally how it works
That's the purpose. 80% reduction of pain for appropriate duration of the different local anesthetic used with improved functioning.
its was a rhetorical question. my 75 y/o LOL in NAD is not activating her multifidi or doing planks on a daily basis.
in general, you will find that PT doesnt really work for joint arthritis. anywhere. but the PTs will tell you it works. and insurance will continue to make us jump though hoops
I’d generally agree for back pain in the elderly, PT very rarely seems to help. For neck pain though I’ve had some surprisingly good results, even with terrible looking facets. Not all or even most of the time, but definitely some.
id agree with that. in the neck, you dont have the weight of the body always bearing down on the facets
I tell people that PT and HEP is most likely not going to make pain better but it is important over the next 20-30 years to do HEP to maintain functionality and balance.. and get MRI approved.
In my area I'm able to get both MBBs scheduled at once. So only do a visit after the second.
If they are medicare I will typically put an addendum on the second op report saying they had the 80% relief from previous injection.
In my state, Medicare is going prior auth in 26. So I’ve just been telling them to start getting used to coming back in for everything now so it’s not a surprise in January. They all get PT for their chronic radic that’s been there for like 15 years that respond to prn injections. Nope can’t do it unless you’ve done PT in the last 12-18 months
Last I saw that’s not final yet. Congress was fighting back and refusing funding for that ridiculously stupid WISER program
I'm happy even if they get 30% benefit but patients often seem disappointed. Perhaps I need to do a better job of setting expectations with these partial relief patients.
30% mbb?….I’m all for not being strict on exactly 80, but that’s just asking for a failed rf
haha agreed, I was just exaggerating. I'm pretty strict with MBB cut offs but think that I'm probably not catching everyone who could benefit from RFA.
Id rather have a failed RF than not offer it to some people who would benefit.
A lot of times patients will still have pain after an RF, but they will find themselves being able to walk longer, golf, and be more active than before. We all know the pain scale is subjective. If you can tease out ANY benefit with the mbb, it should go to RF.
The only ones that shouldn’t proceed are the “that was the most incredible pain after for several days” on a cervical mbb with 25g needles. Had one last week.
“Well, you definitely shouldn’t have a cervical rfa then as it would be many times more painful after.”
“Well, you definitely shouldn’t have a cervical rfa then as it would be many times more painful after.”
Noted. Good advice. I am going to incorporate more of this thinking into my practice.
