New Rfa guidelines?

[myrandom2003]

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Are there new guidelines for RFA published somewhere? I read something in doximity about new guidelines being published from a consortium of pain groups.

Recommendations On Diagnostic MBB and RFA From AAPM

There are few conditions as controversial as lumbar medial branch block (MBB) and radiofrequency ablation (RFA). There is a wide variation between ...

opmed.doximity.com

Can someone post the original full article?


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[SommeRiver]

Here we go...

BTW, if I had it my way, and it is probably best that I didn't, I'd say there are some pts who should be able to go straight to the RFA without MBB. If it doesn't work it doesn't work...I just saved us all a few trips to the procedure room and radiation...I'm talking about ppl who appear to be obviously experiencing facetogenic pain. Geriatric pts with golf ball joints.

 

[Taus]

They can rec 50% relief on a single block all they want..... 80% x2 is what most insurers require...

 

[SommeRiver]

80% is BS in my opinion. I had Evicore deny my pt an RFA who went from a 9 to a 3, took no pain meds that day, and was able to go on a 3 mile walk with her husband.

You can't put a number of functional improvement, and function is what I treat - I tell pts I am a doctor of function and sometimes pain too...

How many times have you seen an MBB go from 8/10 to 0/10, and then have the same pt fail the RFA...

 

[callmeanesthesia]

80% is BS in my opinion. I had Evicore deny my pt an RFA who went from a 9 to a 3, took no pain meds that day, and was able to go on a 3 mile walk with her husband.

You can't put a number of functional improvement, and function is what I treat - I tell pts I am a doctor of function and sometimes pain too...

How many times have you seen an MBB go from 8/10 to 0/10, and then have the same pt fail the RFA...

There’s one insurer in my area that tries to do math with the pain diary. I gave a long-winder explanation to a peer reviewer on the difference between ordinal and interval/rational scales of measurement and that within reason, an 80% reduction in pain is what the patient says it is. I agree it’s all about the functional improvement not numbers.

 

[Wkrdoc]

80% is BS in my opinion. I had Evicore deny my pt an RFA who went from a 9 to a 3, took no pain meds that day, and was able to go on a 3 mile walk with her husband.

You can't put a number of functional improvement, and function is what I treat - I tell pts I am a doctor of function and sometimes pain too...

How many times have you seen an MBB go from 8/10 to 0/10, and then have the same pt fail the RFA...

Bc all this is subjective BS.

I tell my patients if you want the ablation then you say 80% even if it was 67.4567% improved

Just like my SCS patients, they’re happy with 50% improvement

 

[SommeRiver]

If there were no pain diaries to fill out, no MBB, no "rules," the utilization of RFA would probably go up by 150%, and outcomes would plummet.

...but still, explaining the process of the MBB then RFA is rocket science to a lot of my pts and I can't tell you how many times I have a pt on the table that says, "So what exactly are we doing today?"

I've explained it to them in simple language and given them a handout I wrote that walks you through it...

 

[Laryngospasm]

Bc all this is subjective BS.

I tell my patients if you want the ablation then you say 80% even if it was 67.4567% improved

Just like my SCS patients, they’re happy with 50% improvement

me too

 

[Dr. Ice]

If there were no pain diaries to fill out, no MBB, no "rules," the utilization of RFA would probably go up by 150%, and outcomes would plummet.

...but still, explaining the process of the MBB then RFA is rocket science to a lot of my pts and I can't tell you how many times I have a pt on the table that says, "So what exactly are we doing today?"

I've explained it to them in simple language and given them a handout I wrote that walks you through it...

Or they say....”so how many of these epidermals do I need to have”

 

[Ferrismonk]

Or they say....”so how many of these epidermals do I need to have”

... to get my percocet?

 

[geauxg8rs]

Or they say....”so how many of these epidermals do I need to have”

Just tell them the insurance is in charge and dictating this

 

[deleted993114]

Are there new guidelines for RFA published somewhere? I read something in doximity about new guidelines being published from a consortium of pain groups.

Recommendations On Diagnostic MBB and RFA From AAPM

There are few conditions as controversial as lumbar medial branch block (MBB) and radiofrequency ablation (RFA). There is a wide variation between ...

opmed.doximity.com

Can someone post the original full article?


Sent from my iPhone using SDN

I have always felt two test blocks was excessive. However, we have only done rf on patients who report very significant relief with test blocks. I believe the VA system in some areas does not require any test blocks, as there was an "Anesthesiology" article about 8-10 years ago that showed no difference in outcomes with and without test blocks.

Regarding stim- We used to do sensory .5- 1V, then motor 2X sensory with multifidies twitch and no root stim. In the early 90s, we would actually do EMGs to verify multifidies denervation in the lumbar area.
Then ISIS at some point recc no stim at all. I still do sensory in the neck, but not in the back and no motor anywhere. Looks like they want sensory and motor stim again.
I guess we just have to do (as always) what the insurers want and what the organizations recommend. I do about 4-5X as much cervical as lumbar rf (cervical works a lot better). Everyone is going to have different sets of experience/views regarding these issues. However, we are no longer the ones "calling the shots".