I remember as a fellow having a strange feeling that I was surrounded by very legitimately skilled and smart people while doing the NANS fellow course. It made me reconsider the value of my fellowship training.
Where I did my fellowship, the year I was there it won the Pain Medicine Fellowship Excellence Award handed out by AAPM, and past years it won several times as well. NANS made me feel like my attendings were stupid. Like I wasn't getting a legitimate training experience bc we should be putting stimulators in many, many more patients. There isn't a pain Dx that stim won't treat, including mechanical back pain.
Yes, there are people at NANS who swear by stim for mechanical back pain.
I've been an attending now for two yrs and I can honestly say my perspective has changed immensely, and the mouthpieces at NANS are just a bunch of purchased physicians who shoot off their mouth about selective victories they've had with certain patients, and either downplay their failures or outright lie about them.
Maybe I'm embellishing unintentionally, maybe not. I chose not to go this past Jan bc going will not change my practice, and I'd rather spend those couple days seeing pts. I don't trust anything I hear at NANS bc there is a MONSTROUS amount of salesmanship taking place.
It isn't a conference for serious debate or scientific rigor; it is a dog and pony show.
By the way...Stim for lower back pain has a reasonable amount of success. I've had some good results and some bad results with it. What is of huge importance is why it hurts. If you've had an L4-5, L5-S1 fusion with instrumentation and severe adjacent segment disease, stim MIGHT work. You better RFA that pt first obviously. That is NOT at all the same as a pt with facet disease throughout the lumbar spine with 100% mechanical pain. Stim isn't going to work, but at NANS those details don't matter at all.
It is just called chronic low back pain and stim is a great option.
In fact, throw bilateral T12 DRG leads in and call it a day...Next patient please. Too easy. I could do this in my sleep. My pts always get better. No problem. I'd implant that pt and it takes me about 45 min. Never had any adverse events and I do about 100 cases a year. I'm really good at my job.
Stim for back pain- I think it is pretty low yield and I won't do it for isolated back pain. It seems like about 1/4 th of the patients get back coverage with all the "tricks", thus I only do people who have a radic and if they get back coverage, its a bonus. I know other people say they can back coverage in a higher percentage of patients, but I can't.
We'll see how this lateral stim but works- it will take quite a few before there can be any reliable benefit and that will take time.
There will always be blowhards at meetings who say everything works. They are generally insecure guys who are afraid to admit that they have failures and complications, just like everyone else. When they start with those bold, fantastic statements, you know that you can't trust anything else. Bilat T12 DRGs in 45 min? I would pay admission to see that! In my hands, DRG stim takes A LOT longer and it is a very niche type procedure that does not come up that often, so I don't think I am very good at it at all compared to conventional stim. WIth the hassle, I am left wondering about the utility, but again, I am pretty gullible. I am not pleased with the mucking around the roots and the "brutane" involved with that technique as well, but then again, I think I suck at it.
I was a little disappointed in North turning to the dark side, as he used to be pretty objective. Ken Follett was always unbiased and honest, but he does not do the meetings very often anymore. We used to call the recent grad speakers with all the answers "this year's model". That seems to change about every 3-4 years and they stop doing talks when they wise up.
Sounds like you are building your confidence with stim and developing your own views. If at an academic center, please teach those boys to operate a little faster, as speed seems to not be at a premium among new grads. I don't know if it is lack of reps, or faculty not just whipping them enough, but I know that op times are getting slower. You can do 45 stims as well, but in an academic center, who cares?
PS- It does take me only 45-50 min to do a stim, but I have been at it a while. Gotta keep the hands moving even when the nurse and rep are messing around. Dry field, no vicryl poisoning with interrupted starting in the middle, and skin with staples. The only thing you need is a dry field and a good fascia closure and you are good to go. The reps waste a TON of time with their programming. Pull back the top of the lead until you don't feel it at the ribs with the top leads, then verify at the bottom that it goes to the feet and you are done. The reps screw around way too much and you have to focus them or you will be there forever. The best advice I got from one of the old neurosurgeons (who had like zero infections) was minimal tissue injury and mucking around, dry field, good fascia closure, and get the hell out.
And EVERYBODY has complications- EVERYBODY- the only guys who don't are liars.
