SCS Trial vs Implant pain relief?

[Status Sciaticus]

I've noticed that patients whom I have trialed and implanted as well as those from others tend to have very good pain control with SCS trials, but that the implant doesnt quite provide the same degree of relief (say 90% pain relief vs 60%).

I wanted to see if this is a common phenomenon or if theres some scientific explanation behind it.

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[Agast]

“Hopes and dreams” add 20% boost to the reported trial improvement score

 

[Taus]

Yep. Exactly how I explain to patients why the first mbb got 100% relief but the second one was only 80%. The response was mostly real, but 20% of was placebo component. Our goal on the RF is to get close to that 80%. I see this quite frequently.

 

[MitchLevi]

Honeymoon was extremely fruitful, marriage is pretty good.

 

[BoardingDoc]

I've noticed that patients whom I have trialed and implanted as well as those from others tend to have very good pain control with SCS trials, but that the implant doesnt quite provide the same degree of relief (say 90% pain relief vs 60%).

I wanted to see if this is a common phenomenon or if theres some scientific explanation behind it.

Incredibly common.

We explain it like a new car. The first time you drive a Porsche, it's amazing. You've never experienced anything like it.

2 months after you buy it, it's still great, but now it's also just the car you take to work every day. Some of the shine wears off the apple.

Our goal is to get you as close to the experience that you had with the trial as possible, but most people tend to think it's slightly less impressive the second time around.

We explain all of this before we do any trials, or before we implant anyone who is sent to us for a perm but had the trial elsewhere.

 

[nvrsumr]

50 % of patients have 50% improvement a year out was the findings of a Medtronic study from years ago.

Won’t get you a lot of takers when given the real numbers

I’m sure electricity is so much better now.

 

[SpineandWine]

I’ve had numerous with 80% relief with trial, no relief with implant

Think of all implants that don’t have relief or “implant never worked” from outside practice or your own. You get X-ray, position looks good or perc implant.
All the trials had to have 50% relief for the implant to have occurred


So this is more than just honeymoon

 

[Status Sciaticus]

I’ve had numerous with 80% relief with trial, no relief with implant

Think of all implants that don’t have relief or “implant never worked” from outside practice or your own. You get X-ray, position looks good or perc implant.
All the trials had to have 50% relief for the implant to have occurred


So this is more than just honeymoon

right. And thats where I am stuck. Tolerance doesnt develop that fast. Programs supposedly are identical from the external generator vs. IPG.

I wonder if people have different results by turning the implant on after the incisions heal and surgical pain subsides vs. starting the stim in post-op. Because thats the only differing things that I can think of between the trial and the implant are the incision and pocket site.

 

[BobBarker]

They just want to stay on their medications. Don’t overthink it.

 

[Asclepius186]

Thanks for bringing up this very simple phenomenon that very much matches my lived experience in the field.

What the KOLs don’t want you to know…

It’s like sex panther. 60% of the time, it works every time.

 

[CleanUp]

right. And thats where I am stuck. Tolerance doesnt develop that fast. Programs supposedly are identical from the external generator vs. IPG.

I wonder if people have different results by turning the implant on after the incisions heal and surgical pain subsides vs. starting the stim in post-op. Because thats the only differing things that I can think of between the trial and the implant are the incision and pocket site.

I wonder if anyone lets the incisions heal and then turn it on.

 

[K-hole]

My conspiracy theory is it has to do with the way they program in the trial vs the implant. Not sure what they do but I feel like it’s the industries dirty little secret. It’s too big of a discrepancy to be explained away by the placebo effect in my opinion.

 

[bedrock]

My conspiracy theory is it has to do with the way they program in the trial vs the implant. Not sure what they do but I feel like it’s the industries dirty little secret. It’s too big of a discrepancy to be explained away by the placebo effect in my opinion.

But why wouldn’t those companies continue this “special” program after the implant? It would mean even more sales.

 

[K-hole]

But why wouldn’t those companies continue this “special” program after the implant? It would mean even more sales.

I think it’s a battery life issue. I’ve seen reps say this exact thing to patients.
“ I can’t run the trial program now because the battery will have to be replaced in 6 months.” Not sure what it is. Something is fishy though.

 

[SpineandWine]

My conspiracy theory is it has to do with the way they program in the trial vs the implant. Not sure what they do but I feel like it’s the industries dirty little secret. It’s too big of a discrepancy to be explained away by the placebo effect in my opinion.

I have been thinking this as well.
Maybe it’s a program that’s not sustainable in long term

R/o confounders
- was it a good week? This one is hard to prove unless they don’t have good weeks
- did they follow the same restrictions during the trial as afterwards? For example, if they bend less during trial and they didn’t do it before the trial, I have them do it next week after trial and compare those two weeks
- are they giving objective findings or subjective as well- I.e., can they walk longer etc


That being said, I don’t accept trial to perm unless they get 80% relief with trial. Even with ideal lead positioning in implant, it still gets drop off.

 

[Taus]

I think it’s a battery life issue. I’ve seen reps say this exact thing to patients.
“ I can’t run the trial program now because the battery will have to be replaced in 6 months.” Not sure what it is. Something is fishy though.

Then that is complete bull**** if those patients are given a non-rechargeable battery on implant.

 

[clubdeac]

I think it’s a battery life issue. I’ve seen reps say this exact thing to patients.
“ I can’t run the trial program now because the battery will have to be replaced in 6 months.” Not sure what it is. Something is fishy though.

It’s called programmed obsolescence and it’s a real thing.

 

[Gnarvin]

Then that is complete bull**** if those patients are given a non-rechargeable battery on implant.

I know Abbott was doing this. In the trials the programming would be continuous burst and then for the implant they would have it set up to do something like cycle a 1:3 ratio of burst on to completely off to save battery life because they were pushing nonrecharge IPG.

And yes I know someone did a small poorly designed study to show that their program of cycling on and off still worked but I don’t completely buy it.

 

[Ducttape]

i have a few surgical implants.

when these get put in, the surgeons usually do not start stim until the patient presents for 2nd and last follow up appointment, usually 2 weeks later.

does it make a difference? i dont really think so.



i think Evoke was specifically targetted to look at this phenomenon they attribute to tolerance. i havent tried but word of mouth on this forum didnt seem that supportive....