PNS Study

[lobelsteve]

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Pain intensity and opioid consumption after temporary and permanent peripheral nerve stimulation: a 2-year multicenter analysis | Regional Anesthesia & Pain Medicine

N=126
N=26 at 24 mo
56 complications reported

 

[drusso]

Here are the graphs based on the study's primary and secondary outcomes:

1. Pain Intensity Change Over Time:
   • This graph shows the mean pain intensity scores (NRS) for overall, temporary PNS, and permanent PNS cohorts at baseline, 3 months, 6 months, 12 months, and 24 months.
2. Comparison of Pain Intensity Change at 12 Months:
   • This bar chart compares the mean reduction in pain intensity (NRS) between the temporary PNS and permanent PNS cohorts at 12 months.
3. Proportion of Patients Using Opioids Over Time:
   • This graph shows the percentage of patients using opioids at baseline, 6 months, and 12 months for overall, temporary PNS, and permanent PNS cohorts.
4. Mean Daily Oral Morphine Equivalent (OME) Consumption Over Time:
   • This graph shows the mean daily OME consumption at baseline, 6 months, and 12 months for overall, temporary PNS, and permanent PNS cohorts.
5. Complication Rates in Temporary vs Permanent PNS Cohorts:
   • This bar chart compares the number of complications for temporary and permanent PNS cohorts across different complication types such as skin reactions, lead fractures, lead migration, worsening pain, site infections, and others

 

[Orin]

Yeah, so PNS works but still kinda buggy?

 

[lobelsteve]

Yeah, so PNS works but still kinda buggy?

You can’t assume that. Either bocf or locf will show far worse results.
The study as presented self selects thew few who did well.

 

[gaspasser127]

Way too many limitations in the study to take any meaningful results away from it.

With regards to a difference between permanent and temporary PNS therapies in terms of pain relief the study is not powered to detect such a difference with how many dropped out.

The adverse events are quite minimal and nothing I’d be concerned about or surprised by.

 

[Orin]

Drop out is a problem over this time frame for sure. Seems to effect more the temporary PNS after 6 months as compared to the 'permanent' systems
7 of the 69 temporary PNS cases got repeat applications it sounds like but they treated the first one as the index procedure for the analysis
Case volume is a problem IMO with 8 years of volume across 2 institutes and only 126 patients

Random misleading stat:
4 out of 126 dead in 12-24 months. 3% risk of death in 2 years if you get PNS?

 

[MitchLevi]

The curves look impressive until you actually look at the Y axis. Opiate dose graph is hilarious.

 

[Laryngospasm]

“I still need my oxys doc”

 

[clubdeac]

so 100 out of 126 were lost to f/u at 24 months?!? Am I reading that right? What a joke

 

[nvrsumr]

Are the temporary pns systems done at an asc? Any office based options?

 

[drusso]

Are the temporary pns systems done at an asc? Any office based options?

Yes, because all the reimbursement is in the facility SOS by design.

 

[nvrsumr]

The office approved si fusion company hit me up again recently. 125 cases done so far per them. Saw some eobs with good reimbursement. Better than a kypho.

Seems like new pns systems would be super easy in office. I only did them with scs leads and ipgs back in the day.

 

[runfastnow]

Sprint PNS system can 100% be done in office but reps have always been pessimistic it will ever be approved for that.

It is technically easier and faster than most RFs I do.

 

[drg123]

Sprint PNS system can 100% be done in office but reps have always been pessimistic it will ever be approved for that.

It is technically easier and faster than most RFs I do.

You mean like in a regular clinic room, not procedure suite? I agree. It's just a US-guided injection basically.

 

[runfastnow]

In office procedure room with C-arm would obviously be easier but you could do the easy US Sprints in a clinic room assuming enough set up space.

 

[Orin]

In office procedure room with C-arm would obviously be easier but you could do the easy US Sprints in a clinic room assuming enough set up space.

We replace them in clinic if they migrate with ultrasound
They aren't priced for a non-HOPD/facility location as noted above but they comp the leads if it migrates

 

[drusso]

Sprint PNS system can 100% be done in office but reps have always been pessimistic it will ever be approved for that.

It is technically easier and faster than most RFs I do.

There are competing commitments on the payment side. Keeping it in the HOPD guarantees higher SOS payments and subsidies for health system-employed physicians,

 

[au bon pain]

It’s both comedic and kinda infuriating when a device company tries to feign a decrease in opioids in a study. The devices don’t treat dependence and it doesn’t seem like a typical KOL’s interests are aligned to do so (at least for these studies).

 

[SC Tian]

Can anyone share their experiences with reactiv8, like long-term complications, like migrations etc? thanks.

 

[cowboydoc]

Can anyone share their experiences with reactiv8, like long-term complications, like migrations etc? thanks.

N=2 no migration or complications. One home run 6 months out in a hypermobile, somewhat obese young female. Essentially useless in an 84 yo retired fighter pilot 18 months out.

I was begged from all sides to implant both. Reluctantly caved after > 1 year of conservative care and everything I could throw at them.

May have a place, I’m not sold.