NANS Conference

[deleted993114]

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okay....

tangential thought, maybe its a Southern thing? but I believe the grammatically correct phrasing would be "Have any of you gone?"



when I was involved in clinical research, both as anesthesia resident and in the ER, the power assessment was one of the first "tasks", because too much data in some respects was as problematic as insufficient quantities. in this case, one cannot make the determination that that power analysis wasn't done, equally as one cannot assume that it was.

Indeed-

Don't get me wrong- I really like stim and feel that high freq and burst are significant improvements in previous stim. High freq is great, but the data regarding anything above 1kHZ is very "muddy". Hopefully I did not come across as being "snotty"- if so, slap me in the head and say, "stop being a jerk".

Perhaps other studies will show that very high freq is the route to go. If you put a Nevro system in, you have that latitude, so if that is your preferred system, it is somewhat of a moot point. However, if you are a medtronics guy and you really, really believe that over 1kHz is the route to go, you are kind of out of luck. It's just from my read of the literature, the benefit of freq greater than 1kHz is inconclusive. Someone else can read the same literature and arrive at a different conclusion. The damn good thing is that we are able to talk about it, which hopefully increases interest in this issue.

This is one of those things that will be evaluated extensively over time and we will know far more conclusively what perameters are the "best" for certain patient groups. I certainly don't know the right answers for sure and am very much open to new information in this area. Again, perhaps very high freq will be the route to go and we will find that to be superior. It sounds like some guys here feel that way and have had very good results using high freq to cover the back. Time will tell- we are, however, captives of our own observations and will choose treatments based on those experiences.

From my experience and what the literature says, it seems as though "burst" compared to tonic stim is a little more definitive and there is not nearly as much debate about it .

 

[Green Grass]

Indeed-

Don't get me wrong- I really like stim and feel that high freq and burst are significant improvements in previous stim. High freq is great, but the data regarding anything above 1kHZ is very "muddy". Hopefully I did not come across as being "snotty"- if so, slap me in the head and say, "stop being a jerk".

Perhaps other studies will show that very high freq is the route to go. If you put a Nevro system in, you have that latitude, so if that is your preferred system, it is somewhat of a moot point. However, if you are a medtronics guy and you really, really believe that over 1kHz is the route to go, you are kind of out of luck. It's just from my read of the literature, the benefit of freq greater than 1kHz is inconclusive. Someone else can read the same literature and arrive at a different conclusion. The damn good thing is that we are able to talk about it, which hopefully increases interest in this issue.

This is one of those things that will be evaluated extensively over time and we will know far more conclusively what perameters are the "best" for certain patient groups. I certainly don't know the right answers for sure and am very much open to new information in this area. Again, perhaps very high freq will be the route to go and we will find that to be superior. It sounds like some guys here feel that way and have had very good results using high freq to cover the back. Time will tell- we are, however, captives of our own observations and will choose treatments based on those experiences.

From my experience and what the literature says, it seems as though "burst" compared to tonic stim is a little more definitive and there is not nearly as much debate about it .

So you're saying burst is definitively better than tonic, but HF10 isn't?

 

[gdub25]

Wondering how you guys are both agreeing Burst is better than tonic stim. I mean technically it did perform better than the tonic arm in the study but just barely, and both arms actually were worse than any other level 1 study has ever seen. That’s going all the way back to the 2000s with the North and Kumar studies.

St Jude/Abbott has done a terrific job marketing. They publish the worst data in the space in nearly 2 decades and still sell the product. I actually used a fair amount of Burst when it first came out. I’ve always said I would make my own decisions regarding what products to use and base them on good reasoning. When the SUNBURST study was published it was the first time I actually had a hard time sticking to the old saying “do the right thing”. I had to sit down with my St. Jude rep and tell him we wouldn’t be working much together, I didn’t feel his product was the best option I had for my patients. It was a hard discussion because I knew it would have a big impact on his paycheck, Meeting his quota, affect his family, but it was the truth. A day will come when I do the same thing with my Nevro rep, and they know that.

 

[Green Grass]

Wondering how you guys are both agreeing Burst is better than tonic stim.

I'm not.

 

[Ducttape]

being "friends" with them and doing business with them are separate activities.

personally, I don't trust them to be both - I expect them to be selling their product at all times.

and don't feel bad if you start selling less - its due to their product. they can still make decisions as to what they do. the current Nevro reps in this part of the state were all former BSci/Abbott/Medtronics reps, and they also switch in between the 3.

 

[deleted993114]

So you're saying burst is definitively better than tonic, but HF10 isn't?

Look at the studies that advocate 10kHz. Why would 1kHz and 3kHz be no better than sham? Do you really believe that? That would essentially be saying that the whole concept of dorsal column stim is bunk.

It really makes one question the results of the study, beyond the study design not being the best.

Does burst work better than tonic stim? Yes- in some patients- others do just peachy with tonic stim.

 

[Crybaby]

Has anyone tried American meeting of pain and neuroscience? This year was in Miami. I considered this meeting, however chose SIS as I have really enjoyed those conferences and courses in the past.
I have not yet tried ASSIP or NANS.
I did try Kauai pain conference, good content overall, a bit of regional content that did not apply to me at all. Awesome location🙂

 

[No Pain All gain]

Have any of you guys went?

I have gone for the last 4 years. This is where I landed my fellowship as my home anesthesia institution did not have an in house program. Highly recommend going and networking.

General rule of thumb in life - Dont hate the player hate the game. Love them Or hate them - the networking will get you in the door at some places. You just have to show face and shake hands and express interest. They would rather meet you in person than on paper on some generic application.

Worthwhile going to?

Yes

I’m asking specifically from the perspective of a CA-2 resident looking to get my foot in the door for interviews and also learning a thing or two during the conference itself.

Do it. PM me. See ya there.

As for ASPN - the panels were awesome. Mixed bags and debates.

As for @drusso - lets be serious - maybe 1 selfie.

A lot of what you said is true - but go with an open mind - keep what you heard in mind and be an adult and make your own judgements.

Lots of people getting tangential with your actual questions 🙂

Agree [emoji817]- you will be marketed to everywhere you go. NANS courses are the most unbiased out there and occasionally do accept residents.

There’s a reason NANS is where most major data is presented in stim - because it is the biggest meeting and has pain docs, neurosurgeons, neurologists, engineers, and more all in the same room.

For those haters out there, instead of complaining I would recommend you politely ask these speakers about their conflicts. Or just don’t believe them.

Go for the data and the training. Applications to the residents and fellows course are open.

NANS moves to Orlando in 2021 and 2022 then back to Vegas in 2023.

I served on the RFS committee and found it to be incredibly helpful for my career. I have mentors all over the world now because of NANS.

 

[No Pain All gain]

Has anyone tried American meeting of pain and neuroscience? This year was in Miami. I considered this meeting, however chose SIS as I have really enjoyed those conferences and courses in the past.
I have not yet tried ASSIP or NANS.
I did try Kauai pain conference, good content overall, a bit of regional content that did not apply to me at all. Awesome location🙂

ASPN is intimate and is all panels. The discussions were excellent I thought and Miami in July wasn’t as bad as I thought!

 

[Spine101]

Over the years I stopped going to ASRA ASIPP and SIS due to redundancy and lack of progress. NANS and ASPN are all about hype. Now I just stick with NASS.