Current Stim Preference

[Birdstrike]

I like the pain relief from Abbott, but have trouble getting MRIs on these patients despite conditional compatibility. I like that Medtronic claims complete MRI compatibility but haven't used their system (or the others) in a while because COVID crushed my stim numbers for about a year.

Who do you like right now? (If you work for a company, please disclose)

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[paindoc007]

Boston alpha is solid. Mri conditional. 32 contact options. Fast is fairly neat. I’ve been happy overall.

 

[Sooshi]

Currently conflicted between Medtronic (where I'm going) and Boston (which we largely use here). Both are great, but at least in my area, the customer service from Boston Scientific is just on another level - I don't know how they train these guys, but no other company has ever made my life this much easier or been so pleasant to work with. Results, anecdotally from my brief time doing this, are roughly equivalent.

The BS trial lead connectors are goofy though, that's my one beef.

 

[pmrmd]

BSC is best across the board, product and personnel. Medtronic is good product. Abbott I only use for DRG and that's rare. I've been down on Nevro for a while now.

 

[manowar rules]

Less important that the overall experience, but I feel like Boston has better patient education about stim. The materials that Abbott, Nevro, Medtronic use for patients look like they’re marketing towards a 30-year old engineer, which definitely ain’t my patients.
On the flip side, I can find the Boston reps to be overbearing (unsolicited texts, randomly showing up in my office to meet, etc) and I’ve heard the same thing from colleagues across the country about Boston.

 

[paindoc007]

BSC is best across the board, product and personnel. Medtronic is good product. Abbott I only use for DRG and that's rare. I've been down on Nevro for a while now.

I agree. I used to love nevro few years ago. I don’t know what happened, but results have been disappointing me.

 

[RoloTomassi]

Really liking Medtronic DTM. Good prices and service too.

 

[paindoctor2014]

Feel like Boston has a good product right now. Customer service to our patients is really good.

not to hijack the thread but are yall
1. Always one lead
2. Always 2
3. Place one, test, then possibly a second?

 

[nvrsumr]

Medtronic. Mri compatibility has been main advantage. Don’t do enough cases anymore to really mix it up.

 

[NJPAIN]

Full MRI compatibility without SAR limitations, etc is imminent for ABBOTT. I’m told that Medtronic will no longer have that advantage over Abbott.

 

[Agast]

Boston Scientific has some weird sort of direct to patient marketing thing going on. My patient showed up to her appointment with one of the reps. It was the most awkward thing because the rep sat in on her appointment to help her explain why she needed a stimulator trial. And I had to remind her she didn’t do any of the imaging I’ve ordered for her, she hasn’t had any procedures done because she has an active wound infection on IV antibiotics, and she’s a pulmonary cripple.

Later I took the rep aside and told her if I thought a patient was a good candidate for stim I would deal with it myself. Apparently they have some sort of online campaign and my patient says she didn’t know what she was clicking on, just that she had back problems, but they called her later.

 

[Laryngospasm]

Boston Scientific has some weird sort of direct to patient marketing thing going on. My patient showed up to her appointment with one of the reps. It was the most awkward thing because the rep sat in on her appointment to help her explain why she needed a stimulator trial. And I had to remind her she didn’t do any of the imaging I’ve ordered for her, she hasn’t had any procedures done because she has an active wound infection on IV antibiotics, and she’s a pulmonary cripple.

Later I took the rep aside and told her if I thought a patient was a good candidate for stim I would deal with it myself. Apparently they have some sort of online campaign and my patient says she didn’t know what she was clicking on, just that she had back problems, but they called her later.

Sounds like a total cluster.. I would telll them if that happened again I was done with them.

 

[NJPAIN]

I’m not at all looking to defend the behavior. However, this is a CRAZY competitive market with a very young and somewhat immature sales force. The more mature Managment (that should know better) pushes them to do stupid things to sell this incredibly profitable product.

 

[Orin]

Medtronic, Abbott, and then the others as needed/requested.

Been low on Nevro since the start. Love the data and research investment but haven't seen great results.

The Medtronic device is the only one you can have a broken system in and still get an MRI. Stimwave might be close second for MR-conditionality.

Agree that the local reps/patient support makes or breaks things.

 

[DOctorJay]

Used to be strongly abbott. Been working more with medtronic and happy with DTM as well as service. Used to reserve Nevro for the more back pain predominant patients but medtronic working for those as well. My surgeons seem to prefer implanting medtronic as well.

Our medtronic and abbott reps are equally great.

Oh and for the above poster I’m typically one lead unless when we test I’m not catching both legs or the entire area needed with one lead. Rarely happens but I’ve added a second trial lead a handful of times.

 

[gdub25]

How is this entire thread about opinion rather than evidence? We have several level 1 studies in the space over the last 3-5 years and yet we are still participating in these type of discussions!? Our specialty will continue to be overrun with illegitimate “pain doctors” trained at weekend courses unless we start producing good, sustainable outcomes and show training matters

If you think you used to have good successs with one company but lately they suck, what changed? Suddenly their electricity is different and ineffective?

If you think your rep for company x,y,z isn’t good, ask for a different one. A good rep is important yes, but a good rep with a crapy technology is simply a master at keeping the patient happy with a good bedside manner and a lot of attention while keeping the patient away from telling you the doctor they aren’t feeling much better.

“Their reps are better”, “their marketing and patients education is better”, “I like their leads”, “the anchoring works best”, “I think MY patients do best with…”, etc. None of these are reasons we should be basing a decision of therapy on in my opinion. “A recent randomized, multi center, prospective, Level 1 study showed a sustained success rate of greater than 50% pain relief out to 24 months utilizing this therapy” is something I would love to see our specialty starting to hold each other accountable to. It will improve our future as pain physicians.

A new thread with this exact same topic is started about every 4-5 months. I post the same reply in every one…

 

[Orin]

How is this entire thread about opinion rather than evidence? We have several level 1 studies in the space over the last 3-5 years and yet we are still participating in these type of discussions!?

Mainly because the evidence is still weak compared to other fields and based on a phenotype/outcome that is often subjective, even before you consider the real world applicability of the trials.

I'm looking forward to the results of this one if they ever publish them.

Multicentre, double-blind, randomised, sham-controlled trial of 10 khz high-frequency spinal cord stimulation for chronic neuropathic low back pain (MODULATE-LBP): a trial protocol - Trials

Introduction Chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. Evidence demonstrates that high-frequency 10 kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in...

trialsjournal.biomedcentral.com

 

[RoloTomassi]

Also, studies are limited. There's no HF10 vs DTM vs FAST vs DRG head to head. What about after 24 mo? I've seen HF10 drop off after that. Is it as much as others? I don't know. If we were EBM purists, everyone with little old ladies able to garden, cook, sleep because of 5 mg hydrocodone BID should wean them off, as the literature says opioids don't improve function.

Efficacy is one thing but MRI compatibility, infection/explant, lead durability, charging time, etc are important factors too, and not all well studied so I appreciate opinions.

I get your point though, and agree that reps, marketing, shouldn't have as much of an impact on decision making.

 

[NJPAIN]

Mainly because the evidence is still weak compared to other fields and based on a phenotype/outcome that is often subjective, even before you consider the real world applicability of the trials.

I'm looking forward to the results of this one if they ever publish them.

Multicentre, double-blind, randomised, sham-controlled trial of 10 khz high-frequency spinal cord stimulation for chronic neuropathic low back pain (MODULATE-LBP): a trial protocol - Trials

Introduction Chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. Evidence demonstrates that high-frequency 10 kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in...

trialsjournal.biomedcentral.com

Good point. The subjective nature of pain is a huge factor . VAS scores, Oswestry, opioid doses - how reliable are those and similar as ways to measure effectiveness of SCS? Attentive rep, user friendly patient interface , etc goes a long way. Heck, the first stim trial I ever did the patient reported complete relief before I turned the damn thing on. I would love to have reliable data and base decisions on that but we’re not measuring BP, bilirubin, tumor size or other objective factors.

With regards to asking for another rep if your rep sucks, that only works if you are a big client. Ive been through that twice in the last 25 years and each time they did little more that ask the rep to straighten up and fly right. Both times I just stopped using the product until the rep changed.

 

[bedrock]

I think gdub25 makes some good points.

However, with the competitive nature of stim, I wonder how many truly objective difference remain between the companies? All the major companies now use a version of burst, of tonic, of HF, etc, as they are all copying each other. The only thing that is truly off limits via a patent is HF10, and we have all noticed the clinical long term nevro results not fulfilling the promise of the early studies, so at this point who knows how much HF10 really matters?

Until someone publishes good head to head trial data, after more than a decade of practicing pain, I'm left with the feeling that all the stim companies are 95% similar except for some minor differences in MRI compatibility and IPG size.

So unfortunately it most often ultimately comes down to rep service.

I also have great service from Boston so I use them the most, with some Abbott, but mostly for DRG.
Service/reps here are terrible for Nevro/MDT and so I don't use them any longer.

 

[Sooshi]

How is this entire thread about opinion rather than evidence?...

“Their reps are better”, “their marketing and patients education is better”, “I like their leads”, “the anchoring works best”, “I think MY patients do best with…”, etc. None of these are reasons we should be basing a decision of therapy on in my opinion. “A recent randomized, multi center, prospective, Level 1 study showed a sustained success rate of greater than 50% pain relief out to 24 months utilizing this therapy” is something I would love to see our specialty starting to hold each other accountable to. It will improve our future as pain physicians.

As of right now, no such studies are available, and any studies suggesting superiority of one system over another are self-congratulatory industry-sponsored grab-ass. Until better studies - independent ones - actually exist, the way I'm choosing between the systems is: is it user-friendly, do I like dealing with the company, and does it make my life easier and my patient's life better?