Your favorite stimulator?

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Agast

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Standard laminectomy and fusion with ongoing radicular pain, leg more than back. What's your go-to, and is it MRI compatible? Is Abbott the only one with a non-rechargeable battery that is MRI compatible? All the IPGs look nice and small now. I figure enough time has passed since the last thread for people to have more thoughts.

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In standard low back post-lami radic, I prefer Nevro. Also use Nevro if they have more Axial than radicular. For everything else, I lean towards Boston.
 
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Boston Scientific Montage and it isn't even close. We all have different experiences and opinions and mine is that Nevro under-performs given their study that showed superiority (to an antiquated system). I have to believe that if they had to include tonic in their offering that the HF didn't do as well as they wished. For oldsters that should have a primary cell I prefer Abbott if no pacer already there. If so, and therefore no MRI anyway, I go Novi.
 
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Abbott- I practice in a rural area with a poor education and elderly population. Frankly, most don’t like tonic, and don’t have the capacity to recharge.
 
My bad I thought this thread was about something else. :eyebrow:
 
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Most stim options can work with the right programming and lead placement. I prefer NEVRO for the ability to use the most waveform programs.

I had a lot of micro lead fractures and overheating IPGs that needed revision with St. Jude after they moved their facility several years ago. I don’t know if Abbott upped their quality after the acquisition.

Also, Abbott/st Jude has perc paddles , which I used prior to HF technology...provided better coverage and programming options .
 
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Whoever wants to pay me the most for using them.
 
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Boston Scientific Montage and it isn't even close. We all have different experiences and opinions and mine is that Nevro under-performs given their study that showed superiority (to an antiquated system). I have to believe that if they had to include tonic in their offering that the HF didn't do as well as they wished. For oldsters that should have a primary cell I prefer Abbott if no pacer already there. If so, and therefore no MRI anyway, I go Novi.
Nevro is also MRI compatible fwiw.
 
My bad I thought this thread was about something else. :eyebrow:
Hitachi or Two Point Hospital?

I'm still using mainly Medtronic. They're all pretty good per the literature but I have not been able to reproduce the Nevro studies or the Abbott salvage, so I leave it open to the patient's discretion. I put my thumb on the scale for Medtronic more often than not due to getting better reps, less bull**** data/marketing, and the best MRI labelling.

I wet tapped too many people with the Boston introducer system, but it is a pretty cool toy like the SJM Epiducer.
I'll also offer a Stimwave system to people that don't like the whole battery inside thing, as their MRI labelling is also solid.
 
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No system is mri compatible. It’s all conditional
 
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Here are the conditions : my local radiology groups typically punt at the MRI unless I emphasize compatibility. Medtronic has a MRI mode which makes it easier for rads groups...


SCS Implant System Conditions
Appendix A, “ImageReady MRI Full Body Patient Eligibility”, contains a form that may be used by the physician managing the patient’s SCS system to confirm the patient meets the SCS Implant System Conditions for MRI Scans as described in this manual.
1. The patient is implanted with a Precision Montage MRI SCS System composed only of components listed in “Table 1. Components that are eligible for Precision Montage MRI System with ImageReady MRI Full Body Technology” on page 2 of this manual.
Note: Full body MRI leads should be connected directly into the IPG. Patient should not be implanted with lead extensions, splitters, or adapters.
2. The lead implant location is epidural.
Note: Retrograde lead placements have not been evaluated.
3. The patient has no abandoned leads or IPGs (i.e. leads or IPGs that are not connected to the
functioning Precision Montage MRI System).
4. The IPG is implanted in the upper buttock or the lower flank.
5. No evidence of fractured leads or compromised IPG-lead system integrity
6. The patient has been informed of what to do or expect in preparation for their MRI scan:
a. Prior to arrival at the MRI Center, the patient should ensure that the IPG is fully charged (IPG charge shown as three (3) bars on the Remote Control) for the MRI scan. The patient should bring the Charger (in case charging is necessary) to the MRI center. The Charger is MR Unsafe and must not be brought into the MRI Scanner Room.
ImageReadyTM MRI Full Body Guidelines for Precision MontageTM MRI Spinal Cord Stimulator System 91075353-02 Rev A 3 of 397
en

MR Conditions of Use
b. At the MRI Center, prior to entering the scanner room, the patient should turn the stimulation “off” using the Remote Control. The Remote Control is MR Unsafe and must not be brought into the MRI Scanner Room.
c. The patient should be aware of the potential perceptible effects of undergoing MRI with an SCS System, which are as follows: vibration or tugging (moving) sensation in the
IPG pocket, warming of the implanted system, and sensation of stimulation. The patient should be directed to immediately notify the MRI personnel if any of these effects become uncomfortable or intolerable. Refer to the “Potential Interactions with MRI Environment” in the Safety Information section of this manual for additional information.
ImageReadyTM MRI Full Body Guidelines for Precision MontageTM MRI Spinal Cord Stimulator System 91075353-02 Rev A 4 of 397
en

MR Conditions of Use
Radiology
1. MRI systems that meet the following criteria:
• MRI magnet strength of 1.5T only, in a horizontal closed bore system (no vertical-field, standing, or extremity systems).
• Gradient systems with a maximum gradient slew rate per axis less than or equal to 200 T/m/s.
• Maximum spatial field gradient less than or equal to 40 T/m (4000 gauss/cm).
2. MRI coil setup:
• Transmit coil: 1.5T Full Body transmit/receive, Head transmit/receive, or Extremity transmit/ receive. RF quadrature1 only.
• Receive-only coil: Any type.
• Hydrogen/proton imaging only.
3. Patient status and positioning:
• The patient is in supine or prone position only.
• The lead implant location is epidural.
• The IPG is implanted in the upper buttock or the lower flank.
• Confirm with the patient that their IPG is fully charged (IPG charge shown as three (3) bars on the Remote Control).
• The patient has turned stimulation “Off” using their Remote Control.
4. MRI system settings:
• Scanner operation at or below Normal Operating Mode limits for RF and gradient exposure: Whole body SAR must be ≤ 2.0 W/kg, Head SAR must be ≤ 3.2 W/kg
5. Monitoring:
• The patient must be under continuous audio/visual monitoring
 
I have implanted all systems and routinely do about 60% medtronic, 30% abbott, remainder grab bag.

Used to do a lot of Nevro and my results were not Senza-like, my facility couldn’t afford Senza 2 batteries and senza 1 was just so big patients didn’t like it. They don’t like abbot proclaim 7 either fwiw. Abbott has a 5 year warranty on their Proclaim XR; but that is really just a new logo on Proclaim 5 and the bold XR settings to make it last 5 years are clinically unlikely, to be nice about it. I’ve had more than a few burn out in less than 2 years. The back pain responder rate is not published in the SUNBURST study but I is in the package insert and was about 39% so I would not use this for back pain.

Medtronic Intellis has best in class full body MRI conditionality. Mri can be performed w fractured leads, IPG doesn’t have to be fully charged, and in general is most accepted by radiology centers. It is also the smallest IPG, and has a 9 year warranty because the novel battery technology has less than 5% fade at 9 years.

Abbott requires MRI mode but can’t enter if there are any contacts with high impedance.

Boston curiously made their latest and greatest wave writer system to have a weird introducer and not be MRI conditional. Silly.

The results from the DTM-SCS study with Medtronic has made DTM the first line therapy in my practice for a patient suitable for a rechargeable. 80% of patients had >50% back pain relief and 63% of patients had >80% back pain relief. Average back pain relief per VAS was 74% and leg pain 72%.

For those of you not familiar with DTM and the rational design of the waveform to target the neuro-glial interaction should do some reading (substantiated by basic science preclinical work with transcriptomics describing a phenotype change in ). There are some upcoming webinars going through this science and it is wildly different than any other explanation of SCS mechanism that I have seen from any company. It is also not a black box, any doctor can see their programming.

The next webinar is 4/28. If anyone needs the link to register it is here:


Relevant disclosures: I am a consultant and investigator for Abbott, Medtronic, and Nevro, among others.


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I have implanted all systems and routinely do about 60% medtronic, 30% abbott, remainder grab bag.

Used to do a lot of Nevro and my results were not Senza-like, my facility couldn’t afford Senza 2 batteries and senza 1 was just so big patients didn’t like it. They don’t like abbot proclaim 7 either fwiw. Abbott has a 5 year warranty on their Proclaim XR; but that is really just a new logo on Proclaim 5 and the bold XR settings to make it last 5 years are clinically unlikely, to be nice about it. I’ve had more than a few burn out in less than 2 years. The back pain responder rate is not published in the SUNBURST study but I is in the package insert and was about 39% so I would not use this for back pain.

Medtronic Intellis has best in class full body MRI conditionality. Mri can be performed w fractured leads, IPG doesn’t have to be fully charged, and in general is most accepted by radiology centers. It is also the smallest IPG, and has a 9 year warranty because the novel battery technology has less than 5% fade at 9 years.

Abbott requires MRI mode but can’t enter if there are any contacts with high impedance.

Boston curiously made their latest and greatest wave writer system to have a weird introducer and not be MRI conditional. Silly.

The results from the DTM-SCS study with Medtronic has made DTM the first line therapy in my practice for a patient suitable for a rechargeable. 80% of patients had >50% back pain relief and 63% of patients had >80% back pain relief. Average back pain relief per VAS was 74% and leg pain 72%.

For those of you not familiar with DTM and the rational design of the waveform to target the neuro-glial interaction should do some reading (substantiated by basic science preclinical work with transcriptomics describing a phenotype change in ). There are some upcoming webinars going through this science and it is wildly different than any other explanation of SCS mechanism that I have seen from any company. It is also not a black box, any doctor can see their programming.

The next webinar is 4/28. If anyone needs the link to register it is here:


Relevant disclosures: I am a consultant and investigator for Abbott, Medtronic, and Nevro, among others.


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How does one company feel about you whoring for other companies?

When I see multiple disclosures, i ignore any clinical content from that person. Their bias makes me not believe a word they say.
 
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I have no bias and no whoring. But thank you for the classic Lobel response that goes ahead and discounts anything anyone says who isn’t you. I shared data, not bias.

Remember you are the one who still has “HF10 therapy” on your website as its own category, .

I disclose these conflicts to patients and let them choose therapy from all available after a discussion of the most recent data.

As a consultant I tell them my opinion, not what rhetoric they want to hear. And I certainly don’t put them on my website.

As an investigator, I do research. Unbiased research.


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I am not paid by anyone. But the fda superiority claim stands on its own.
Paid by 3 stim companies at same time?

yawn.

as you are anonymous it is nothing personal. I have worked alongside and lectured with most everybody back in the day. I know the dirty nature of the industry and I am a reformed ho.
 
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I have implanted all systems and routinely do about 60% medtronic, 30% abbott, remainder grab bag.

Used to do a lot of Nevro and my results were not Senza-like, my facility couldn’t afford Senza 2 batteries and senza 1 was just so big patients didn’t like it. They don’t like abbot proclaim 7 either fwiw. Abbott has a 5 year warranty on their Proclaim XR; but that is really just a new logo on Proclaim 5 and the bold XR settings to make it last 5 years are clinically unlikely, to be nice about it. I’ve had more than a few burn out in less than 2 years. The back pain responder rate is not published in the SUNBURST study but I is in the package insert and was about 39% so I would not use this for back pain.

Medtronic Intellis has best in class full body MRI conditionality. Mri can be performed w fractured leads, IPG doesn’t have to be fully charged, and in general is most accepted by radiology centers. It is also the smallest IPG, and has a 9 year warranty because the novel battery technology has less than 5% fade at 9 years.

Abbott requires MRI mode but can’t enter if there are any contacts with high impedance.

Boston curiously made their latest and greatest wave writer system to have a weird introducer and not be MRI conditional. Silly.

The results from the DTM-SCS study with Medtronic has made DTM the first line therapy in my practice for a patient suitable for a rechargeable. 80% of patients had >50% back pain relief and 63% of patients had >80% back pain relief. Average back pain relief per VAS was 74% and leg pain 72%.

For those of you not familiar with DTM and the rational design of the waveform to target the neuro-glial interaction should do some reading (substantiated by basic science preclinical work with transcriptomics describing a phenotype change in ). There are some upcoming webinars going through this science and it is wildly different than any other explanation of SCS mechanism that I have seen from any company. It is also not a black box, any doctor can see their programming.

The next webinar is 4/28. If anyone needs the link to register it is here:


Relevant disclosures: I am a consultant and investigator for Abbott, Medtronic, and Nevro, among others.


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Ugh, dtm and the “proprietary” nature of it. The rep keeps trying to come to my office weekly and sell me it, but can’t tell me the specifics of the programming when I ask. Mdt has no respect for physicians. No wonder their market share sucks
 
Not true. They will show you the programming.


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Yes, I am currently using MDT, Nevro, ABT. MDT is going to gain market share. Best IPG, best MRI compatibility, now if DTM has legs it will be hard to compete against.
 
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I have pictures of the programming from the webinar. Do the webinar this week and take your own pictures.
 
Interesting, I was told “this is a proprietary algorithm which we can’t disclose the specifics of the programming”

I’ll do more research on it. Thanks
 
FWIW, if you say you have no bias, that's shenanigans. I'm biased for Medtronic because I have good relationships there.

Medtronic's DTM programming is a bit more of a black box, but you can get it explained to you. The conventional and HD programming is something you can do. I do often reprogram my devices, but it's not worth the time/effort, and I do ask the SCS reps to circle back behind me to make sure I didn't blow it up.

I can't say any of the other device companies allow you to reprogram your SCS yourself.
 
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The regional managers say their technology is the best, until they get a pay raise from their competitors...

Also, you can do research while not being on the payroll. That’s pure science
 
Interesting, I was told “this is a proprietary algorithm which we can’t disclose the specifics of the programming”

I’ll do more research on it. Thanks

Likely the rep was talking it up before they were trained. The algorithm is proprietary, but any patient of yours you can have the programming.

Medtronic is the only company that in my practice gives doctors clinician programmers so that we can program without the rep. The matrix for programming DTM is complicated so I wouldn’t do that myself, but like Orin I do program my patients often.

We have about 15 active studies in our practice now, about 1/3 are investigator-initiated.


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fwiw i do like using boston and mdt. i recently salvaged a medtronic scs pt who was reprogrammed to DTM. his opioid usage decreased and function improved
 
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I’m not familiar with the MDT DTM study. Can someone provide a link?

I gave up on MDT several years ago because they were so far behind Abbott and Nevro. Always happy to reconsider if there is new statistically significant data.
 
it is genius to give doctors the programmer. that way the rep doesn't have to waste time going to doctors offices to reprogram patients that they get nothing from.


please post the study. it is hypocrisy to tout a study as being so positive yet not post a link to that particular study.
 
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oh nm. I found the study.

impressive...
I mean the 3 month study objective.


the study primary endpoint is at 3 months. data suggests benefit, but if you are going to use an endpoint of 3 months, why not compare it to, say. using the SCS and doing a TF with NS or making nonexistent changes to programming?

id like to see what the data shows at 6 and 12 months, which are secondary endpoints.

Unfortunately, I tell patients these devices remained implanted, for, over 6 to 12 years...
 
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we posted at the same time, sorry bout duplication.
thanks for posting that, a lot more info than the webpage.

fwiw the other concerns I have with the study are:
1. inclusion criteria state patients with back pain and moderate to severe leg pain. leg pain benefit does not appear as robust as back pain. not tested on patients with primary back pain, but the conclusions discuss primary back pain benefit....
2. does the phrase "conventional stimulation" include high frequency? my impression of "conventional" would be standard low frequency stim.
3. again, the time of 3 months seems awfully short to tout as beneficial for something such as SCS...
 
I’ve done almost exclusively Nevro due to the studies - I’d say I have seen outcomes comparable to their studies. I’ve even done some recently for peripheral neuropathy with excellent results. I’m very selective about who I implant though - very rarely do I even trial smokers, or those on high dose opioids, or those with seemingly mechanical back pain.
The other stim companies’ reps, especially BoSci, have been very eagerly telling me they are seeing amazing results with their technology and it’s the best thing ever, but I ask for the studies and those still largely seem to show the usual 50% responder rate. Not even that for Abbott with the SunBurst trial.
I’m intrigued by this DTM - will be interesting to see the 12 and 24 month results but I may give it a try. Maybe in a skinny patient - MDT certainly has the sleekest battery. Do patients feel paresthesia with DTM? Any other feedback from those who have used it?
 
Standard laminectomy and fusion with ongoing radicular pain, leg more than back. What's your go-to, and is it MRI compatible? Is Abbott the only one with a non-rechargeable battery that is MRI compatible? All the IPGs look nice and small now. I figure enough time has passed since the last thread for people to have more thoughts.

It may seem strange, but whichever system has the best support setup with reps. This stim isn't worth much if the reps ignore the patient.

MRI compatibility, high freq, and burst capabilities are a plus. However, if someone has primarily a radic with mostly leg pain, you can cover that with most any system. Keep in mind that we covered those patients with ancient Quad Plus leads.
 
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I’m very selective about who I implant though - very rarely do I even trial smokers, or those on high dose opioids, or those with seemingly mechanical back pain.
...
Do patients feel paresthesia with DTM? Any other feedback from those who have used it?
I am the opposite as I'm in an ivory tower setting. I work primarily with Medicaid/Medicare train wrecks that have complex comorbidities, need interventions as a carrot to get off drugs, and have already been worked over by multiple surgeons and interventionalists. My patient population does not qualify for most studies. In my patient's, Nevro has been dismal. These folks mostly prefer some tonic/paresthesia based feedback in the region of their pain, even if their primary program is something else.

With regards to mechanical vs spontaneous pain, I haven't had anyone respond great to SCS or DRG with mechanical or exertion/position inducible pain. I have had patients with these pain patterns respond to PNS in some extremity cases, but generally that was with high frequency PNS or systems that throw in some TENS like coverage of a region plus PNS.

DTM is programmed for sub-paresthesia, but you can get paresthesias if you turn it up high enough similarly to what you'll get with Nevro at a high enough amplitude. I'm too early on with it to tell you anything the above poster's/papers haven't. It works great so far, but then so does Nevro for the early part.

I agree with Hawkeye though. Go with the team you know/trust. There's very few differentiating technologies here.
 
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You can get a good outcome with any system. Patient selection and setting realistic expectations are important.


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This hasn't been mentioned, but Abbott is only MRI conditional with leads between T7-T12. Outside of that area, the patient is not even MRI conditional. Medtronic has the best MRI conditionality overall. It's worth noting that Nevro is the only company that has 3T MRI conditionality.
 
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If the patient is likely to need MRI, then you can not really use ABT. It won’t go into MRI mode consistently.
 
oh nm. I found the study.

impressive...
I mean the 3 month study objective.


the study primary endpoint is at 3 months. data suggests benefit, but if you are going to use an endpoint of 3 months, why not compare it to, say. using the SCS and doing a TF with NS or making nonexistent changes to programming?

id like to see what the data shows at 6 and 12 months, which are secondary endpoints.

Unfortunately, I tell patients these devices remained implanted, for, over 6 to 12 years...
Would be great to have independently funded/academic/private head-to-head waveform studies or a comprehensive meta analysis (domestic/international) of all these weak , small, RCTs to gain further understanding/power of current programming techniques.
Right now it’s conjecture on forums and with pushy office reps...
 
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I am the opposite as I'm in an ivory tower setting. I work primarily with Medicaid/Medicare train wrecks that have complex comorbidities, need interventions as a carrot to get off drugs, and have already been worked over by multiple surgeons and interventionalists. My patient population does not qualify for most studies. In my patient's, Nevro has been dismal. These folks mostly prefer some tonic/paresthesia based feedback in the region of their pain, even if their primary program is something else.

With regards to mechanical vs spontaneous pain, I haven't had anyone respond great to SCS or DRG with mechanical or exertion/position inducible pain. I have had patients with these pain patterns respond to PNS in some extremity cases, but generally that was with high frequency PNS or systems that throw in some TENS like coverage of a region plus PNS.

DTM is programmed for sub-paresthesia, but you can get paresthesias if you turn it up high enough similarly to what you'll get with Nevro at a high enough amplitude. I'm too early on with it to tell you anything the above poster's/papers haven't. It works great so far, but then so does Nevro for the early part.

I agree with Hawkeye though. Go with the team you know/trust. There's very few differentiating technologies here.


I agree. I too, work with more "train wrecks" in a not for profit Catholic hospital (kind of nice- Bible passages plastered all over the walls in the hallways- it works for me, but of course is not for everyone). So the patients we see tend to be higher risk for about everything. Some patients prefer tonic stim, some high freq, some burst; you really have to find what an individual patient prefers, as it can be all over the map for preferences.

Mechanical pain is the "holy grail" of stim. We have had some decent success with lateral stim in an effort to stim the SVN and GRC which innervates the disc. Still collecting patients and learning from the process. That particular technique is best suited for Nevro, given that the stim must be high freq only. I have had some decent successes with peripheral "field stim", but that is experimental and, from a physiological standpoint, I still cannot understand how it works. No one does that anymore (insurance approval), but it seemed to work for "postcard" sized areas of pain.

The systems are more alike than they are different, thus the service of the reps is the most important aspect in my opinion.
 
I am the opposite as I'm in an ivory tower setting. I work primarily with Medicaid/Medicare train wrecks that have complex comorbidities, need interventions as a carrot to get off drugs, and have already been worked over by multiple surgeons and interventionalists. My patient population does not qualify for most studies. In my patient's, Nevro has been dismal. These folks mostly prefer some tonic/paresthesia based feedback in the region of their pain, even if their primary program is something else.

With regards to mechanical vs spontaneous pain, I haven't had anyone respond great to SCS or DRG with mechanical or exertion/position inducible pain. I have had patients with these pain patterns respond to PNS in some extremity cases, but generally that was with high frequency PNS or systems that throw in some TENS like coverage of a region plus PNS.

DTM is programmed for sub-paresthesia, but you can get paresthesias if you turn it up high enough similarly to what you'll get with Nevro at a high enough amplitude. I'm too early on with it to tell you anything the above poster's/papers haven't. It works great so far, but then so does Nevro for the early part.

I agree with Hawkeye though. Go with the team you know/trust. There's very few differentiating technologies here.
your patient population is best not served with SCS or ITP.

fwiw, a significant portion of that population with "go along" with you with regards to interventions, if only in the mistaken assumption that they will "wear you down" or their PCP in to agreeing that lifelong medication management (opioids, benzos, soma) is the only true option. don't be amazed when someone agrees to a stim then has zero success with the implanted device.
 
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your patient population is best not served with SCS or ITP.

fwiw, a significant portion of that population with "go along" with you with regards to interventions, if only in the mistaken assumption that they will "wear you down" or their PCP in to agreeing that lifelong medication management (opioids, benzos, soma) is the only true option. don't be amazed when someone agrees to a stim then has zero success with the implanted device.

I unfortunately have to agree. I quickly stopped connecting procedures to medication weaning, etc. I tell them the procedures may or may not help but they have to come off. I am in an academic setting, high # Medicaid, Medicare with multiple comorbidities. I perform much fewer SCS than I'd like, but often patients who would be potential candidates also have lots of other concerning psycho-social issues and I'm not comfortable implanting.
 
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Regarding DTM - I just listened to DTM webinar and poster above. Will be interested to see 3-6 month data.

However - would have liked to see opioid consumption decrease. Also, Intellis is supposed to have Snapshot feature with activity level. I have not used it but would really have liked this to see actual objective activity level changes.

In general much less difference from conventional SCS than the SENZA HF studies.
 
your patient population is best not served with SCS or ITP.
...
don't be amazed when someone agrees to a stim then has zero success with the implanted device.

I quickly stopped connecting procedures to medication weaning, etc. I tell them the procedures may or may not help but they have to come off.
...
often patients who would be potential candidates also have lots of other concerning psycho-social issues and I'm not comfortable implanting.

I'm not looking for a pills for poke model or cuts for weaning. Either way, they come off if indicated.

The system I'm in incentivizes me to try, but failure is an option and I'm happy to explant a device.

I just feel it's inappropriate to remove treatments from a treatment algorithm because it's too hard or scary for me, but I agree, I don't see as many clean wins as you might. I sleep better knowing I'm trying, but it is wearing me down.

If it's safe, testable, and approved by insurance, lets kick the tires and light the fires big daddy
 
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Ugh, dtm and the “proprietary” nature of it. The rep keeps trying to come to my office weekly and sell me it, but can’t tell me the specifics of the programming when I ask. Mdt has no respect for physicians. No wonder their market share sucks
Lol so true. Our reps can barely spell DTM and have no clue what it means.
 
I'm not looking for a pills for poke model or cuts for weaning. Either way, they come off if indicated.

The system I'm in incentivizes me to try, but failure is an option and I'm happy to explant a device.

I just feel it's inappropriate to remove treatments from a treatment algorithm because it's too hard or scary for me, but I agree, I don't see as many clean wins as you might. I sleep better knowing I'm trying, but it is wearing me down.

If it's safe, testable, and approved by insurance, lets kick the tires and light the fires big daddy
I’m in private practice but we have a great contract with our local Medicaid (it’s a privately managed subcontractor) that actually pays quite nicely for stim. That said I’ve only done a couple on that group due to the psychosocial baggage that makes many of them poor candidates. I’m straight fee for service and do implants at an ASC so I’m highly incentivized to “kick the tires” on anything that pays but I have no desire to tie myself to those patients permanently, or have them going out into the community telling everyone I implanted them and told them that was the end of the line when it didn’t help.
 
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I do quite a bit of Medicaid scs and lots of Medicaid pain interventions. Maybe 10-15 scs/year. They are good patients and I am happy to help them.
 
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MDT has great reps where I am in CA, but WC doesn’t cover SCS for FBSS; CA sucks
 
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