Which SCS?

[Yo GabbaPentin]

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Which SCS company are you all going with and why? All of the companies have their own studies which are mostly BS. All of the reps are liars and fos.

 

[DOctorJay]

predominant leg pain - Abbott BurstDR
predominant back with leg pain component - Nevro
true need for follow up MRIs - Medtronic
focal problem - Abbott DRG

why - because studies, rep support, and anecdotal results

 

[Tapspatellas]

New Medtronic system is coming out and looks very promising. Much improved IPG, better interrogater interface, wireless trial system and better charging. Looking forward to trialing some

 

[BobBarker]

New MDT should be good for really slim patients as well.

I use mostly St Jude Proclaim non rechargeables. My patients are too old to charge daily.

 

[NJPAIN]

predominant leg pain - Abbott BurstDR
predominant back with leg pain component - Nevro
true need for follow up MRIs - Medtronic
focal problem - Abbott DRG

why - because studies, rep support, and anecdotal results

I agree 100% with DOctorJay. However, I cannot comment on DRG from personal experience because despite 25 years of stim experience I am not worthy of the training. But, I am confident that St. Jude only has the best interest of the patients in mind and that their decision has nothing to do with their desire to drive more patients to their most lucrative clients. LOL.

 

[Yo GabbaPentin]

Boston has a massive monopoly in this region. Rep freaked out when he found out that I used st Jude for a single trial. Started saying st Jude batteries are all still leaking and under recall. Then quoting some bs studies proving Boston is the best.

 

[BobBarker]

Not true, haha. Keep giving st jude a try. It is very good.

 

[Timeoutofmind]

predominant leg pain - Abbott BurstDR

This seems controversial.

There is no study comparing BurstDR to Nevro for this indication.

I am honestly curious why you think BurstDR would be necessarily superior in terms of pain relief? Especially because leg pain improvements with Nevro were greater than leg pain improvements with tonic during the SENZA trial...

I can understand the decreased recharge burden though and that makes sense.

 

[Ducttape]

This seems controversial.

There is no study comparing BurstDR to Nevro for this indication.

I am honestly curious why you think BurstDR would be necessarily superior in terms of pain relief? Especially because leg pain improvements with Nevro were greater than leg pain improvements with tonic during the SENZA trial...

I can understand the decreased recharge burden though and that makes sense.

agree with your first statement, but im not sure how you have decided that he is thinking that BurstDR is superior to Nevro. without direct studies, one cannot say that Nevro or BurstDR is superior, or that BurstDR is not noninferior to Nevro.

BurstDR is supposedly better than regular tonic stim...

Burst spinal cord stimulation for limb and back pain. - PubMed - NCBI

RESULTS:
Burst stimulation was able to improve back, limb, and general pain by 51%, 53%, and 55% and tonic stimulation by 30%, 52%, and 31%, respectively. Pain now, least, and worst pain were improved by 50%, 73%, and 36% by burst stimulation, respectively, and 26%, 46%, and 13% by tonic stimulation. In comparison with placebo, burst, corrected for multiple comparisons, was significantly better for all measurements.

but you cant cross compare between the 2 separate studies.

 

[DOctorJay]

This seems controversial.

There is no study comparing BurstDR to Nevro for this indication.

I am honestly curious why you think BurstDR would be necessarily superior in terms of pain relief? Especially because leg pain improvements with Nevro were greater than leg pain improvements with tonic during the SENZA trial...

I can understand the decreased recharge burden though and that makes sense.

yup, that is my rationale. set it and forget it, patients seem to love that. I want them focusing on their pain as little as possible and just live their lives.

 

[Timeoutofmind]

yup, that is my rationale. set it and forget it, patients seem to love that. I want them focusing on their pain as little as possible and just live their lives.

Good point

 

[gdub25]

agree, there are no direct studies, we have to make some inferences. St. Jude published their 12 month data on Burst and if you're going to make decisions based on evidence based medicine hard to chose them. VAS difference between burst and tonic was 0.7, overall pain relief was 44% reduction from baseline, and looking at these results compared to the Boston arm of the senza study, the North study, Kumar study...basically every level one study to date, these results underperformed all of them. St. Jude claims they didn't know how to program well back then and they've changed things for better results since the study but they did have burst in Europe for several years before the US study so weak argument in my opinion.

However, I do use st Jude as my second choice behind Nevro because I like the idea of paresthesia free and no charging. Trial to implant ratio is high with them but I've challenged myself to keep tabs on implants and see how they're doing at 3 months, still using burst or not, etc. I'm seeing some drop off of efficacy, not enough to abandon ship.

Nevro was compared to tonic and was superior in the back and leg pain relief. If burst only offered 0.7 lower VAS score from a tonic system that only dropped pain by 44%...can we make decision based on the available data? That's the question I'm asking myself. Can continue to justify St. Jude as my number 2?

 

[BobBarker]

I think where they screwed up that study is the criteria for entry was way too broad. I think if they just showed us the failed back or non op back and leg pain patients the outcomes could have been different. They should have done a better job with the study.

 

[Malayil]

What these new novel waveforms/pulse trains shows us is that we have options and that patients respond differently just like any other treatment.

 

[unchockey21]

What these new novel waveforms/pulse trains shows us is that we have options and that patients respond differently just like any other treatment.

We have options. I’m just not sure the reps know how to fully take advantage of the technology they put out. I didn’t feel like either Burst or Boston’s new Wave Writer lived up to the hype.

 

[myrandom2003]

well word on the street is the new boston and medtronic batteries can run multiple waveforms and frequencies simultaneously. Just marketing as of now but due out soon and at NANS at the latest.

 

[unchockey21]

well word on the street is the new boston and medtronic batteries can run multiple waveforms and frequencies simultaneously. Just marketing as of now but due out soon and at NANS at the latest.

Yes, Boston’s Wave Writer can do multiple waveforms and frequencies. But it is out in certain markets. I wasn’t impressed with it. Certainly not enough to use it over Nevro. But like I said above, I think the reps still need a lot more training. We had really good BoSci reps too.

 

[emd123]

I was a Medtronic guy until I started trying Abbott burst. My implant ratio is close to 90% and patients love it, versus tonic still they seem to "like" but not "love." Recently started trying Nevro and the results seem good but I haven't done enough with them yet to say whether or not they're better than St Jude/Abbott Burst, or not. I honestly wasn't that big on stim until St Jude came out with burst, and it's renewed my faith in the therapy. I'm trailing many more people now. Disclosure: None of the companies pay me a penny and I do lectures for zero of them.