SCS for post laminectomy pain without radiculopathy?

[cameroncarter]

What is your patient selection criteria for SCS in treating primarily axial FBSS?

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[SgtThunderfistMD]

everything else i have to offer didn't work (therapies, injections, RFA, non-opioid meds) >>>> SCS

 

[CleanUp]

1. If they can’t tolerate an addl surgery
2. No instability
3. No to minimal opioids
4. Realistic expectations
5. Has a real goal in mind
6. Lacking depression
7. Failed epidurals mbb rfas and esp SIJ interventions
8. Willing to engage in PT

 

[RoloTomassi]

I'd add failed Intracept to the list if Modic

 

[lobelsteve]

I'd add failed Intracept to the list if Modic

But no one has ever failed Intracept....

 

[MitchLevi]

But no one has ever failed Intracept....

Haha. During an epidemic of vertebrogenic pain, there are no procedure failures, only procedures that over or underperform.

It's like MILD, even though it did nothing for pain, I can walk further (though I never actually measured these data before or after the procedure). Vertos published that data, and I recite that.

 

[bedrock]

You guys are too harsh. I’ve sent out about 18 patients for intracept and 15/18 had 70% or greater relief.

That’s why I’m getting trained on intracept this year. It definitely helps people and as I’m now part owner of the ASC, the ASC will get a nice $6,000 profit on commercial insurance cases.

 

[cameroncarter]

everything else i have to offer didn't work (therapies, injections, RFA, non-opioid meds) >>>> SCS

So what’s the success of SCS in treating axial LBP in these FBSS patients? Seems low if they already failed everything else.

[mention]SgtThunderfistMD [/mention] [mention]lobelsteve [/mention] [mention]RoloTomassi [/mention]

 

[RoloTomassi]

So what’s the success of SCS in treating axial LBP in these FBSS patients? Seems low if they already failed everything else.

[mention]SgtThunderfistMD [/mention] [mention]lobelsteve [/mention] [mention]RoloTomassi [/mention]

My n is too low to give a % but I would say not great. But that's what the trial is for.

 

[SgtThunderfistMD]

50/50 at best success rate after 5-day trial

 

[lobelsteve]

So what’s the success of SCS in treating axial LBP in these FBSS patients? Seems low if they already failed everything else.

[mention]SgtThunderfistMD [/mention] [mention]lobelsteve [/mention] [mention]RoloTomassi [/mention]

It's the person and not the drug/procedure/therapy.
Enable neuroplasticity mode via CBT. Then things can stat to work.
If patient cannot engage in that, there is no hope and they can seek care elsewhere.

 

[RoloTomassi]

If you told me that all these procedures didn't work because I don't have enough neuroplasticity, I'd be pissed

 

[lobelsteve]

If you told me that all these procedures didn't work because I don't have enough neuroplasticity, I'd be pissed

The procedures work. Unless you pick the wrong patient.

 

[au bon pain]

I've seen 0 meaningful success of SCS for axial pain. Maybe my n is too small. Or I and my colleagues are bad.
Or, more likely, it just doesn't work.

 

[Ducttape]

probably the latter, but it is definitely worth a trial. agree, success rate is very low. and havent noticed a significant difference with HF10 vs other companies.



at the very least, it can show the patient that they need to think "outside the box" regarding pain management.

 

[cameroncarter]

I've seen 0 meaningful success of SCS for axial pain. Maybe my n is too small. Or I and my colleagues are bad.
Or, more likely, it just doesn't work.

So it seems like the consensus here is that SCS is rarely effective in treating axial pain s/p lumbar fusion. Yet that seems to be the most common indication I see it used for in my community? What gives?

 

[lobelsteve]

So it seems like the consensus here is that SCS is rarely effective in treating axial pain s/p lumbar fusion. Yet that seems to be the most common indication I see it used for in my community? What gives?

Picking procedure to make money vs what would benefit the patient.
CBT>meds/SCS if patient not retired or FT employed.

 

[Dr. Ice]

So it seems like the consensus here is that SCS is rarely effective in treating axial pain s/p lumbar fusion. Yet that seems to be the most common indication I see it used for in my community? What gives?

Nobody wants to be the one to say, “there’s nothing I can do for you” cause the guy down the street will do something.

 

[Ducttape]

Nobody wants to be the one to say, “there’s nothing I can do for you” cause the guy down the street will do something.

it isnt easy saying that, but imo im pretty good at it.

which is one reason my reviews are so bad. being a lot older, seeing that there were a lot of times that nothing could be done in my former career.

 

[Tramadeezy]

So it seems like the consensus here is that SCS is rarely effective in treating axial pain s/p lumbar fusion. Yet that seems to be the most common indication I see it used for in my community? What gives?

Common diagnosis that most insurances cover. $$$

 

[oreosandsake]

60 percent of the time, it works every time

 

[au bon pain]

it isnt easy saying that, but imo im pretty good at it.

which is one reason my reviews are so bad. being a lot older, seeing that there were a lot of times that nothing could be done in my former career.

Do you have a good one-liner for when you tell a patient you have nothing more to offer?

My current way is to tell patients to continue HEP/ keep staying as active as possible and just live their life and we can always touch base in a year to see if there’s anything new worth considering. I’m very upfront with patients but I also don’t like to crush hope. Most seem to get the message. But I’m always looking for new material to add to/improve my routine

 

[soccrwz]

Do you have a good one-liner for when you tell a patient you have nothing more to offer?

My current way is to tell patients to continue HEP/ keep staying as active as possible and just live their life and we can always touch base in a year to see if there’s anything new worth considering. I’m very upfront with patients but I also don’t like to crush hope. Most seem to get the message. But I’m always looking for new material to add to/improve my routine

In my professional opinion, risks out weigh the benefits… but reflect on the options provided and what to consider with serious consequences like 10 level surgery etc. I discuss competencies of overall health like weight loss, smoking cessation, nutrition, finding hobbies that provided enjoyment and discuss CBT. I feel that I’m providing where we’ve been, what they should continue to do, and what to avoid gives a 360 picture. It also is specific to the patient and their needs so it dorsnt come off as dismissive, but compassionate.

 

[BobBarker]

Just give them things that they can work on.
Going for walks, staying part of their grandkids lives, eat more/eat less, positive mindset, accepting that we all age.

 

[clubdeac]

Guy in my practice offers SCS for axial mid back pain. Talk about a long shot…total money grab

 

[lobelsteve]

Guy in my practice offers SCS for actual e mid back pain. Talk about a long shot…total money grab

I have trialed none but implanted two last year.
Both doing well. And yes, wonder how many trials failed.

 

[clubdeac]

I have trialed none but implanted two last year.
Both doing well. And yes, wonder how many trials failed.

Interesting.. where do you put the leads to cover the mid back

 

[lobelsteve]

Interesting.. where do you put the leads to cover the mid back

Where ever they put them in the trial. C7-T4 if I recall

 

[MitchLevi]

What is that billed as? IIRC, don't you only use Nevro?

I, probably mistakenly believed, that Nevro requires the T8 + T9 placement.

 

[RoloTomassi]

How to people get this stuff reimbursed outside of lumbar FBSS and CRPS?

 

[MitchLevi]

How to people get this stuff reimbursed outside of lumbar FBSS and CRPS?

That's what I'd like to know. Nevro isn't even approved for CRPS.

 

[CleanUp]

That's what I'd like to know. Nevro isn't even approved for CRPS.

Call it causalgia?

 

[Laryngospasm]

Nobody wants to be the one to say, “there’s nothing I can do for you” cause the guy down the street will do something.

I say it fairly often.. they usually go and get a fusion or scs. Sometimes they return and most are worse. I had one get mad after I told them they were fine.. then they had a fusion and they were significantly worse. They yelled at me and demanded opioids and said “you told me there was nothing wrong with me”.. one of the few times I’ve literally walked out.

 

[bedrock]

I think it is ok to say “there is nothing else I can for you” unless their issue is discogenic pain.

In that situation I also specifically warm them that a fusion will likely make them worse long term and not to do it.

 

[lobelsteve]

That's what I'd like to know. Nevro isn't even approved for CRPS.

Nevro for FBSS, chronic radic, PDN, CRPS, Nonsurgical vascular disease (ischemic limb/angina with no further surgery).
Have done it for all of these. And even one radiation neuropathy.

 

[MitchLevi]

Nevro for FBSS, chronic radic, PDN, CRPS, Nonsurgical vascular disease (ischemic limb/angina with no further surgery).
Have done it for all of these. And even one radiation neuropathy.

I thought it was clearly written no CRPS coverage.

 

[RoloTomassi]

Nevro for FBSS, chronic radic, PDN, CRPS, Nonsurgical vascular disease (ischemic limb/angina with no further surgery).
Have done it for all of these. And even one radiation neuropathy.

Doing them is one thing, but do you know if you (or the hospital) getting paid for it?

 

[lobelsteve]

I thought it was clearly written no CRPS coverage.

That’s an insurance question.

 

[lobelsteve]

Doing them is one thing, but do you know if you (or the hospital) getting paid for it?

Yes. If we were not able to get paid the hospital would not allow it.

 

[epidural man]

What is your patient selection criteria for SCS in treating primarily axial FBSS?

Consider Reactiv8