Perc MBB-PNS Before or After Conventional vs Pulsed RFA??

[drusso]

Prospective, Multicenter Study of Percutaneous Medial Branch PNS for the Treatment of Chronic Axial Low Back Pain

One of the most prevalent and challenging musculoskeletal conditions, chronic low back pain (LBP), is a leading cause of disability in adults. The SPRINT

www.sprtherapeutics.com

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[Dr. Ice]

Prospective, Multicenter Study of Percutaneous Medial Branch PNS for the Treatment of Chronic Axial Low Back Pain

One of the most prevalent and challenging musculoskeletal conditions, chronic low back pain (LBP), is a leading cause of disability in adults. The SPRINT

www.sprtherapeutics.com

Have a friend who has been using this and says that it has replaced conventional rfa for him for his patients with chronic axial pain. Haven’t tried it yet but considering..

 

[afob100]

How do you guys code this? Do most private/Medicare carriers cover this?

How do you do this with fluoro?

 

[RoloTomassi]

What insurances are covering? We've had discussions with Sprint and everything we've heard is that reimbursement is iffy and it's an expensive system

 

[Ducttape]

device sponsored study.

not blinded.

not randomized.

no control.

no diagnostic test 3 months prior to the procedure - how was the diagnosis determined (no offence, but i highly doubt MBB was done and the patient was not seen for 3 months later. might have been offered to those who had RFA previously...)

of the 3 endpoints listed,
73% of patients reported >30% reduction in pain intensity;
73% reported reduction in back pain associated disability (Oswestry);
73% reported decrease in pain interference with daily activities.

odd those numbers are exactly the same across all indices.


otoh, appealing because the treatment was for 2 months only and the leads were removed afterwards, and the study was to look for sustained benefit after leads removed. so nothing permanent.

and truth be told, even without the diagnostic test before, this would be an interesting way of treating myofascial pain.

 

[No Pain All gain]

Works and has replaced rf in my practice for the most part.

 

[RoloTomassi]

Works and has replaced rf in my practice for the most part.

Can you comment on payers and your experience of what happens after leads removed?

 

[NJPAIN]

Works and has replaced rf in my practice for the most part.

Really? Durable relief after 60 day implant??

 

[drusso]

Really? Durable relief after 60 day implant??

The chatter on Linked-In is that it's a #gamechanger. A lot of KOL's swear by it. Many people are betting the whole house and the stock option/equity if this takes off is sky-high.

Peripherally Induced Reconditioning of the CNS | JPR

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain

www.dovepress.com

 

[RoloTomassi]

The chatter on Linked-In is that it's a #gamechanger. A lot of KOL's swear by it. Many people are betting the whole house and the stock option/equity if this takes off is sky-high.

Peripherally Induced Reconditioning of the CNS | JPR

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain

www.dovepress.com

Where does ReActiv8 fall into your algorithm? If does well with Sprint but drop off after removal?

 

[callmeanesthesia]

I’d love to give it a try. And if you’re doing L4-5, L5-S1 joint RFA you could still stim the intact L2 medial branches nerve. If I recall correctly that is the target for Reactiv8 anyway.
But again, how are you coding this to get Sprint PNS covered? I’d love to give it a try but I’m not diagnosing everybody with causalgia of the back…

 

[TIVAndy]

lumbar nerve root disorder. doable procedure in office, but impossible due to device cost higher than reimbursement.

 

[Orin]

This device is priced for the SOS. The business model with reduced rep coverage due to the limited life span per device is brilliant. It does work though, but I struggle with it.

 

[lobelsteve]

This device is priced for the SOS. The business model with reduced rep coverage due to the limited life span per device is brilliant. It does work though, but I struggle with it.

What and why?

 

[Agast]

If it’s two medial branch nerves to a facet joint how were they seeing relief by stimulating one nerve bilaterally? What’s the mechanism of action?

I’m not opposed to the idea, but it sounds a little too good to be true.

 

[Ducttape]

The chatter on Linked-In is that it's a #gamechanger. A lot of KOL's swear by it. Many people are betting the whole house and the stock option/equity if this takes off is sky-high.

Peripherally Induced Reconditioning of the CNS | JPR

Peripherally Induced Reconditioning of the Central Nervous System: A Proposed Mechanistic Theory for Sustained Relief of Chronic Pain

www.dovepress.com

in reality, I could care less about what the KOL swear by.


what does the science say? this is a nice prelim study.

do a controlled blinded study (at least blinded to the researchers).


No rush. I mean after all, we have completely stamped out chronic pain because of the multiple #gamechangers now on the market - Nevro HF, Abbott DRG, Burst, Coolief, low dose ITP, Intracept, MILD, SI Fusion devices.



oh snap...

 

[No Pain All gain]

Really? Durable relief after 60 day implant??

About 2/3 of the time relief is durable. I’ve done a number of lumbar and cervical cases. Even a thoracic medial branch adjacent to a comp fx.

 

[fathead88]

Did a lot of these during fellowship. About 20-30. Or saw them in follow up. Did not have the same promising results.

 

[Multimodal]

I like the idea of Sprint but cannot wrap my head around the MOA. Im gonna sit on the sidelines until this tech is better developed. Have used Bioness a few times now and while I hate their anchor system, I have seen really good results with that. 1 lady w/ severe sural neuralgia had her life turned around from Bioness PNS. She only uses it for 2 hours before bed and the relief lasts all night but by the next day, she has to hit it again. Same story for a suprascapular case from 3 weeks ago. Maybe since Ive seen how other PNS devices work, I am not ready to believe Sprint's marketing and scant research papers.

 

[Tboned]

Works and has replaced rf in my practice for the most part.

I’m going to call bull. We did a lot in fellowship similar to the other poster and results were mediocre at best. Patients that did benefit, did not maintain once the device is removed (FDA approved for 60 days if I remember). Absolutely no where near replacing RF.

 

[NJPAIN]

About 2/3 of the time relief is durable. I’ve done a number of lumbar and cervical cases. Even a thoracic medial branch adjacent to a comp fx.

I’ve done only 4-5 lumbar cases. Ages 50-75 with axial low back pain. All had a reasonable degree of relief for the 60 day implant period. None had relief after removal.
Is it patient selection? Are you only using in those who respond to MBB but have not yet had RFN?
Are you placing with fluoro and checking for multif stim with US?

 

[Orin]

What and why?

Patients do well with it. The durability is not a year in my experience outside of cases where there is a defined nerve trauma without ongoing structural issues. I've used it for a lot of different things but it's primarily because it is easy for me and the patient more than something I believe strongly in.

I struggle with the mechanism of action and hand waving about resetting central sensitization/plasticity/etc.

The multifidus data is challenging as I cannot reconcile it with the Reactiv-8 data which shows a much longer wash-in period. The SPR study feels to me me like a lot of patients that probably didn't get the Lobel HEP/core regimen. There's a lot of differences though in the stimulation parameters/etc, but still, it's an annoying discrepancy.

I don't like the business model/pricing as it could be done in a clinic room but is not due to the site of service differential making the margin better in a facility.

It shows me a lot of promise but PNS is still a game of compromises and I suspect will have a course adjustment when CMS starts paying attention to it.

 

[lobelsteve]

Patients do well with it. The durability is not a year in my experience outside of cases where there is a defined nerve trauma without ongoing structural issues. I've used it for a lot of different things but it's primarily because it is easy for me and the patient more than something I believe strongly in.

I struggle with the mechanism of action and hand waving about resetting central sensitization/plasticity/etc.

The multifidus data is challenging as I cannot reconcile it with the Reactiv-8 data which shows a much longer wash-in period. The SPR study feels to me me like a lot of patients that probably didn't get the Lobel HEP/core regimen. There's a lot of differences though in the stimulation parameters/etc, but still, it's an annoying discrepancy.

I don't like the business model/pricing as it could be done in a clinic room but is not due to the site of service differential making the margin better in a facility.

It shows me a lot of promise but PNS is still a game of compromises and I suspect will have a course adjustment when CMS starts paying attention to it.

Defined nerve trauma to the MBB?
Doing it as it is easy for you and the patient?
Don't strongly believe in it?

Have you done any EBM coursework on how to evaluate studies?
Hint: The data is junk.

Sign up for journal review with SIS or do EBM course. You will see things differently.
#skeptic.

 

[Espn123]

Defined nerve trauma to the MBB?
Doing it as it is easy for you and the patient?
Don't strongly believe in it?

Have you done any EBM coursework on how to evaluate studies?
Hint: The data is junk.

Sign up for journal review with SIS or do EBM course. You will see things differently.
#skeptic.

So what do you think about those nevro studies?

just playing devils advocate

 

[lobelsteve]

So what do you think about those nevro studies?

just playing devils advocate

Some are real shiite.
some are decent.
I just finished my extraction for SIS. I did not get to do all of the CI calculations and only 2/20 had categorical data.

p ± 1.96*sqrt [p(1-p)]/n

 

[Tboned]

Some are real shiite.
some are decent.
I just finished my extraction for SIS. I did not get to do all of the CI calculations and only 2/20 had categorical data.

p ± 1.96*sqrt [p(1-p)]/n

I still hear nik bogduk in my sleep
all truth —->2x2 table

 

[drusso]

Some are real shiite.
some are decent.
I just finished my extraction for SIS. I did not get to do all of the CI calculations and only 2/20 had categorical data.

p ± 1.96*sqrt [p(1-p)]/n

Meh,

MPH degree. Statistics are just quantitative rhetoric.

 

[lobelsteve]

I still hear nik bogduk in my sleep
all truth —->2x2 table

Im a fanboy of Nik. I won the auction for his old needles used in early experiments for RF

 

[drusso]

Im a fanboy of Nik. I won the auction for his old needles used in early experiments for RF

Nik was good at the time. I admired him. But the cheese moved.

Who Moved My Cheese? - Wikipedia

en.wikipedia.org

"One day Sniff and Scurry arrive at "Cheese Station C" to find no cheese left, but they are not surprised. Noticing the cheese supply dwindling, they have mentally prepared beforehand for the arduous but inevitable task of finding more cheese. Leaving "Cheese Station C" behind, they begin their hunt for new cheese together. Later that day, Hem and Haw arrive at Cheese Station C only to find the same thing, no cheese. Angered and annoyed, Hem demands, "Who moved my cheese?" The humans have counted on the cheese supply to be constant, and so are unprepared for this eventuality. After deciding that the cheese is indeed gone they get angry at the unfairness of the situation. Haw suggests a search for new cheese, but Hem is dead-set in his disappointment and dismisses the proposal."

 

[BobBarker]

I have been reading about Reactiv8.

1. Not MRI compatible
2. Not cell phone compatible. Seriously. Cell phones should be kept 5 feet away.

what is the point? If I wanted to do this I could place Nalu tined leads in the same location. Or stim wave or whatever you like.

 

[epidural man]

I will say this about the Sprint device.
I placed one near a sciatic nerve for LE CRPS and after placing it, we turned it on and the kid started crying (he was just a kid…25 maybe). He said through the tears, “I never thought I’d feel this pain relief.”

That was fun for me.

 

[RoloTomassi]

I will say this about the Sprint device.
I placed one near a sciatic nerve for LE CRPS and after placing it, we turned it on and the kid started crying (he was just a kid…25 maybe). He said through the tears, “I never thought I’d feel this pain relief.”

That was fun for me.

Nice. Did it last after removal?

 

[DesertDoc16]

I will say this about the Sprint device.
I placed one near a sciatic nerve for LE CRPS and after placing it, we turned it on and the kid started crying (he was just a kid…25 maybe). He said through the tears, “I never thought I’d feel this pain relief.”

That was fun for me.

I had similar experience (N=1) for an older patient with LE CRPS…. Dual leads, Sciatic SPRINT…. Almost immediate improvement in pain that continued throughout the 60 days. She was able to do PT/Rehab and so far has not had any recurrence of pain now at 9 months. Im sure the PT was responsible for the majority of the success but the sprint was an easy way to get her weight bearing and able to tolerate therapy.

 

[DesertDoc16]

I have been reading about Reactiv8.

1. Not MRI compatible
2. Not cell phone compatible. Seriously. Cell phones should be kept 5 feet away.

what is the point? If I wanted to do this I could place Nalu tined leads in the same location. Or stim wave or whatever you like.

I’ve used both NALU and Stimwave. I like NALU system better, Unfortunately NALU PNS leads are NOT MR compatible for the extremity in which they are placed…. Limb cannot be in the coil. Stimwave PNS leads are MR conditional.

 

[epidural man]

Nice. Did it last after removal?

Yes and no. He felt so good, he really was active and capture terminated (lead moved) around 4 weeks so we removed the lead. He was better after lead removal and at follow up (but still had pain) - and I suppose he is doing much better because he hasn't come back.

 

[lobelsteve]

Yes and no. He felt so good, he really was active and capture terminated (lead moved) around 4 weeks so we removed the lead. He was better after lead removal and at follow up (but still had pain) - and I suppose he is doing much better because he hasn't come back.

I saw him for Nevro.