Preferred SCS company?

[tmvguy03]

I wanted to get a sense of who other people are using. I’m 18 months into my practice now. During fellowship I did ~ 45 trials/implants (60% Medtronic, 20% St Jude/Abbott, 20% Nevro)
Only Boston cases were explants......
My first year out almost exclusively Nevro- fast trials and good outcomes (92%T/P 60 cases). But, 3-6 mo post implant, a lot of patients c/o battery charging times and decreased efficacy. Super frustrating.
My colleague uses all the companies and recommended BS. I’ve done ~30-40 trials with the infinion leads/ wave writer and have had some surprisingly good outcomes especially for LBP. So I’m pretty much just using Boston now.

Has anyone had any experience with Nuvectra? I had a patient request it specifically b/c a family member has one. I don’t even know if I can do it at my hospital...very specific regulations on devices etc.
I appreciate hearing what you guys do

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[BobBarker]

Nuvectra is comparable to Boston.
Has head only MRI same as the wavewriter so I would use it without hesitation. Nuvectra is trying for full body MRI where Boston is not for the wavewriter as far as I know.

I use ABT, Nuvectra, Nevro in that order.

 

[SommeRiver]

I use Abbott and Nevro. I prefer Abbott overall.

You did 60 cases your first year out of fellowship? Really? Ever tried or heard of gabapentin?

 

[lobelsteve]

I use Abbott and Nevro. I prefer Abbott overall.

You did 60 cases your first year out of fellowship? Really? Ever tried or heard of gabapentin?

Anyone wonder why our field is broken? Declining reimbursement, pills for shots, etc.

 

[DOctorJay]

ABT, Nevro, MDT in that order


Sent from my iPhone using SDN

 

[jettavr6]

Boston and Medtronic. Much of it depends on your local rep support and these two seem to be the best in my area.

 

[SommeRiver]

Boston and Medtronic. Much of it depends on your local rep support and these two seem to be the best in my area.

At the end of the day, this is far more important than the product itself.

 

[gdub25]

Anyone wonder why our field is broken? Declining reimbursement, pills for shots, etc.

This whole thread is what’s wrong with our field. We have several level one studies recently published that show great efficacy in pain relief, opioid reduction, improved ODI scores yet we still have doctors making statements like “I prefer x,y,z in that order” or “x is the same as y”. Until we start using what has been proven to work, continue to publish level one studies, and stop listening to reps on what works best we will continue to see declining reimbursement and spotty outcomes.

Nuvectra came to market with a device that offers traditional stimulation with no MRI compatibility and no studies to show they work any better or differently than any other tonic system already available. Believe it’s better or different if you want but the only thing to say that it is are the reps. Period.

Abbott did a level one study and showed a very poor response with less than 50% responders. They claim real world results are better yet have never published the “optimized Burst data” where the went back and reprogrammed the burst trial patients. The reason, I believe, is that the results were no different. Two different investigators in the study have told me their patients who were enrolled had a 0.1 VAS score reduction after optimization.

Nevro has good data but even still only 73% get long term relief. That means you’re going to see 27% of those patients not do well. That’s the reality of stim. Not all patients will do well. Also, trial with any of the companies out there currently or from 15 years ago and you’ll see the same success rate. 85% of all trials want the perm, it’s what happens after three months that we’re interested in. Nevro has shown us that 73% do well, history has repeatedly shown us that tonic SCS will give us roughly 50%. One caveat is that Boston has a couple of studies that show that maybe they are getting better results with toninc with their contouring of the electrical field but they have yet to do a level 1, prospective study.

Can we please challenge ourselves, each other, to follow what the evidence shows us and stop listening to marketing from these companies and reps? If there are any shortcomings in my logic or thought process I would love feedback.

 

[callmeanesthesia]

This whole thread is what’s wrong with our field. We have several level one studies recently published that show great efficacy in pain relief, opioid reduction, improved ODI scores yet we still have doctors making statements like “I prefer x,y,z in that order” or “x is the same as y”. Until we start using what has been proven to work, continue to publish level one studies, and stop listening to reps on what works best we will continue to see declining reimbursement and spotty outcomes.

Nuvectra came to market with a device that offers traditional stimulation with no MRI compatibility and no studies to show they work any better or differently than any other tonic system already available. Believe it’s better or different if you want but the only thing to say that it is are the reps. Period.

Abbott did a level one study and showed a very poor response with less than 50% responders. They claim real world results are better yet have never published the “optimized Burst data” where the went back and reprogrammed the burst trial patients. The reason, I believe, is that the results were no different. Two different investigators in the study have told me their patients who were enrolled had a 0.1 VAS score reduction after optimization.

Nevro has good data but even still only 73% get long term relief. That means you’re going to see 27% of those patients not do well. That’s the reality of stim. Not all patients will do well. Also, trial with any of the companies out there currently or from 15 years ago and you’ll see the same success rate. 85% of all trials want the perm, it’s what happens after three months that we’re interested in. Nevro has shown us that 73% do well, history has repeatedly shown us that tonic SCS will give us roughly 50%. One caveat is that Boston has a couple of studies that show that maybe they are getting better results with toninc with their contouring of the electrical field but they have yet to do a level 1, prospective study.

Can we please challenge ourselves, each other, to follow what the evidence shows us and stop listening to marketing from these companies and reps? If there are any shortcomings in my logic or thought process I would love feedback.

Just went back and looked at the paper - 90% of Senza trial participants were on opioids, with an average MME per day of about 110. They didn’t report how many smoked, at least not in that table. Yet now there are studies showing that patient in high dose opioids and patients who smoke are much less likely to respond. How good could the outcomes be if you make people taper off opioids and quit smoking to be implanted?

 

[DOctorJay]

This whole thread is what’s wrong with our field. We have several level one studies recently published that show great efficacy in pain relief, opioid reduction, improved ODI scores yet we still have doctors making statements like “I prefer x,y,z in that order” or “x is the same as y”. Until we start using what has been proven to work, continue to publish level one studies, and stop listening to reps on what works best we will continue to see declining reimbursement and spotty outcomes.

Nuvectra came to market with a device that offers traditional stimulation with no MRI compatibility and no studies to show they work any better or differently than any other tonic system already available. Believe it’s better or different if you want but the only thing to say that it is are the reps. Period.

Abbott did a level one study and showed a very poor response with less than 50% responders. They claim real world results are better yet have never published the “optimized Burst data” where the went back and reprogrammed the burst trial patients. The reason, I believe, is that the results were no different. Two different investigators in the study have told me their patients who were enrolled had a 0.1 VAS score reduction after optimization.

Nevro has good data but even still only 73% get long term relief. That means you’re going to see 27% of those patients not do well. That’s the reality of stim. Not all patients will do well. Also, trial with any of the companies out there currently or from 15 years ago and you’ll see the same success rate. 85% of all trials want the perm, it’s what happens after three months that we’re interested in. Nevro has shown us that 73% do well, history has repeatedly shown us that tonic SCS will give us roughly 50%. One caveat is that Boston has a couple of studies that show that maybe they are getting better results with toninc with their contouring of the electrical field but they have yet to do a level 1, prospective study.

Can we please challenge ourselves, each other, to follow what the evidence shows us and stop listening to marketing from these companies and reps? If there are any shortcomings in my logic or thought process I would love feedback.

I applaud this post. I think we absolutely need to be offering our patients therapies with the best evidence behind them. I hear docs talk about the Nevro studies and how they were not the greatest studies and real world data isn't tracking their results. We only have Level 1 studies for Nevro and St. Jude and I agree there are flaws with them.

When I help a patient select a therapy it's based on a number of factors including patient preference (do they want to charge daily, have ability to switch between non-paresthesia and paresthesia coverage), physical ability (can they reach behind their back to charge), and likelihood of need for MRI in future (MS patients, syrinx, etc). I also put some weight on rep service for my recommendations. Our Abbott team is fantastic and does a great job with our patients. Our Nevro and MDT reps are less in number and aren't able to provide the same level of support but still do a good job.

I typically tell patients these are the 3 companies we use. I give them the pros/cons of each and help them choose what they feel is right for them. I'm not a consultant for any of these companies. So when I say Abbott, Nevro, MDT in that order, that's simply how it plays out in my office.

 

[Timeoutofmind]

Here is the real question:

If you were failed back surgery with chronic radic what company would you chose?

 

[BobBarker]

I would choose Nevro with a senza 2 but my patients are older and less educated than me, so easier to use or easier to understand systems are better for them.

 

[BobBarker]

Nuvectra is the best option for a rechargeable tonic system in my market. I can’t do Boston on my Medicare/Medicaid patients... and the rep is still in her non compete for me anyways.

 

[Ferrismonk]

Did Medtronic in fellowship, now Nevro exclusively.

 

[drusso]

I smoke Camel's when I can't find Salem's.

Take a puff, It's Spring Time...

 

[thecentral09]

Abbott. Good rep, burst has been good. Non rechargeable battery

 

[MD87]

Any experience with stimwave? I knew they had PNS systems but just found out they have one for SCS without a battery

 

[Crybaby]

I/m curious about Stimwave as well. Just went to a talk where they showed us some data that is currently being published that looked good. I just want to read a bit more before I give it a try.
I really wonder if patient compliance will be an issue since they have to have the pad/ battery to communicate with the receiver

 

[Timeoutofmind]

I struggle with what to do with old people (like 65 yrs+) with axial pain s/p fusions

I think nevro has good data for axial, but I am always tempted to use burst so they dont have to recharge

Are people having success with burst in this population?

 

[DOctorJay]

I struggle with what to do with old people (like 65 yrs+) with axial pain s/p fusions

I think nevro has good data for axial, but I am always tempted to use burst so they dont have to recharge

Are people having success with burst in this population?

For these patients (if I'm pretty convinced it is indeed neuropathic pain) I'll go with Nevro first based on their data.

 

[Timeoutofmind]

For these patients (if I'm pretty convinced it is indeed neuropathic pain) I'll go with Nevro first based on their data.

How do you determine if its neuropathic in these folks? You mean more rest pain as opposed to just mechanical with activity?

 

[DOctorJay]

correct, or rule out with MBBs/SIJ as indicated

 

[emd123]

Abbott Burst>>>> everyone else.

Tried nevro twice. One trial failed. The other went to implant (barely) and got infected (different implanter) and then explanted.

 

[Ducttape]

Abbott Burst>>>> everyone else.

Tried nevro twice. One trial failed. The other went to implant (barely) and got infected (different implanter) and then explanted.

and that summarizes pain medicine in 1 paragraph.

Woah is the profession....

 

[lobelsteve]

Abbott Burst>>>> everyone else.

Tried nevro twice. One trial failed. The other went to implant (barely) and got infected (different implanter) and then explanted.

Please read what you wrote. Now read it as if some newbie wrote it. N=2. Literature with N=1000's. FDA superiority. Letting personal bias interfere with good clinical judgement.

 

[thecentral09]

Yes I practice in an are where our old axial low back pts have less than a HS education and no cell phone. No chance of charging everyday. If Nevro didn’t require such routine charging I would be much more open to it.

 

[tmvguy03]

Firstly, I have no financial ties/ consulting etc. to any company. Like most of us I have experience with Medtronic/Abbott/Nevro/BS. I had been using mostly Nevro once I finished fellowship but overall wasn’t seeing as much back coverage as I would like once implant was done (although most trialed very well)
My colleague uses pretty much Abbot and Boston. Because of some successes he’d had with the Boston Wave writer/ infinion leads I gave it a shot. I’ve been very impressed. Less charging burden than compared to Nevro, and in my experience so far very good back coverage. It’s what I use primarily now but still keep some variety.
One downside is that it is not currently MRI compatible for lumbar imaging so that’s occasionally a deal breaker for patients (and me depending on the clinical situation)
Just food for thought since I had zero Boston experience in fellowship except a couple explants.

 

[BobBarker]

I like Boston too but I don’t think they are going to fix that mri issue with the wavewriter. If they were then Montague wouldn’t exist.

 

[tmvguy03]

I like Boston too but I don’t think they are going to fix that mri issue with the wavewriter. If they were then Montague wouldn’t exist.

That is true....

 

[emd123]

Please read what you wrote. Now read it as if some newbie wrote it. N=2. Literature with N=1000's. FDA superiority. Letting personal bias interfere with good clinical judgement.

Are you so sure the FDA has the full story?

"Implantable Pulse Generator Manufacturer Fails to Submit MDRs"
Implantable Pulse Generator Manufacturer Fails to Submit MDRs | 2018-03-09 | FDANews

 

[emd123]

and that summarizes pain medicine in 1 paragraph.

Woah is the profession....

Sounds like moral preening & virtue signalling. Regardless, I'll give a fuller explanation for those willing to actually read my reasoning.

First off all, data is often heavily influenced by industry, especially early on in product development. So skepticism is healthy, especially early in a product's lifespan. Second, the FDA's record is far from perfect. Remember that they endorsed oxycontin as "safer, less addictive and without euphoria" as well as that new pump that's killing people.

I don't take a penny from these companies, not even a sub sandwich. I don't speak for them. I'm loyal to no one. I take all studies from them the first couple of years (at least) with a grain of salt, until results play out in the real world. I like my independence and will quit using a company tomorrow, if I find a better mouse trap. I tell this to the reps' faces.

5 or 6 years ago, I used to use Medtronic simply because that's the equipment I was comfortable, because that's what my fellowship used. Despite trying other companies, I never really had a feeling that any one company was noticeably better than another. That's probably because I had very little real world experience. But you have to narrow it down somehow, so I went with the equipment I was most familiar with.

The I decided to try St Jude/Abbott when burst came out. My trial to implant ratio went from 60% to 90% immediately so I started using them a little more. The results were noticeably better from a new product and have held for a good 2 years.

When Nevro came around, I decided to try them, too. No reason not to. Word of mouth and data indicated they might have a promising system. So I tried one, and it failed. No big deal, just "n of 1" right? Yep. So, I tried them again. Patient 2 wanted implantation, but barely. They were on the fence. Still, 1 of 2 and only "n of 2" so, keep trying them, right? After implantation for patient 2, by an outside surgeon, who I refer to a lot and have never had an operative with any of my patient, she shows up in my office with a red hot pocket about to burst with puss. The first trial or implant I'd ever been associated with, that got infected. Okay, still only an "n of 2."

Then news breaks, from the FDA itself who @Ducttape and @lobelsteve love to quote as gospel, that Nevro has (allegedly) "123 complaints related to reports of infections and/or deaths for which the company had not yet opened corrective or preventive action files." So, I'm supposed to ignore all that and keep using a product I'm not comfortable with, while quoting the good FDA data and ignoring the bad?

Huh?

Find me better equipment for my patients, with real results in the real world, not from sales BS coming out of company reps' mouths or studies heavily influenced by industry and I'll switch to it tomorrow. I also won't be blind to adverse events companies (allegedly) may be hiding from us.

I use the best mouse trap today, based on weighing all the factors. And I'll switch to a better one tomorrow, gladly. But reality needs to match up with the hype. You don't have to be in Medicine long, to see the latest greatest drugs or technologies not live up to the hype in the real world.

 

[244913]

I use Nevro and Abbott. I like Abbott a lot, esp. the non rechargeable battery. Initially I was very bullish on Nevro, and still use it if patient has signif. axial pain component but recently have thrown most of my business towards Abbott. It's really nice being able to map out tonic coverage- as opposed to having to bring patients in for xray with Nevro to find out where leads are- if problems arise.

I will say that I haven't seen any infection problems with Nevro, implants N of around 60.