Pain from a lifestyle (pay, hours, etc.) stand point

[SSdoc33]

Centeno breaks it down for you today "old school." @lobelsteve @Ducttape

Why Aren't Interventional Pain Management Physicians Offering More Regenerative Solutions? - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.

regenexx.com

"There is nothing ever devised that you can place in the body that’s natural. Meaning if you place a piece of metal in the body, even if that’s placed in a less invasive way, that’s still a foreign object. We also know that these metals leech into the patient’s bloodstream and impact some patients more than others, with metal allergies now being a problem. Finally, that piece of metal or ceramic or plastic will eventually wear out, as it has no ability to repair and maintain itself.

This is perhaps the biggest growth area in IPM I have seen that concerns me. For example, we know from many studies that fusion is always a bad idea in that it leads to adjacent segment disease and abnormal motion. However, my colleagues are now placing SI joint fusion screws with wild abandon. Another problem is “interspinous spacers” which are used to treat spinal stenosis. These destroy the supra and interspinous ligaments with spine surgeons reporting that these devices are failing at an alarming rate, requiring their removal. Finally, placing implantable nerve stimulators to block pain signals is now a big thing. However, in the long run, my experience to date shows that these systems don’t last and often need to be removed or revised. In the end, none of these implantable solutions are as elegant as regenerating or helping maintain natural tissues."

thanks for posting this.

i can now print it out and use it daily. typically around 10 a.m. right after a few injections and my morning coffee. and bran muffin

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[drusso]

thanks for posting this.

i can now print it out and use it daily. typically around 10 a.m. right after a few injections and my morning coffee. and bran muffin

You don't like what he says, do you?

 

[lobelsteve]

You don't like what he says, do you?

You cannot make this stuff up....

Except. Centeno can, and does. He is so FOS. It is laughable.

 

[SSdoc33]

You don't like what he says, do you?

im no fan of surgery but saying "fusion is always a bad idea" immediately gives you zero credibility

 

[drusso]

You cannot make this stuff up....

Except. Centeno can, and does. He is so FOS. It is laughable.

The enemy of your enemy is not your friend.

 

[Ducttape]

i think you have yet to see me recommending fusions or spacers.

if anything, you do recognize that i am consistent - best evidence, less invasive, and as much self motivated treatment as possible.

 

[MitchLevi]

GTHO of here...

 

[lobelsteve]

The enemy of your enemy is not your friend.

I have no friends.

 

[oreosandsake]

GTHO of here...

View attachment 355637

stim is like having your hand on fire and me hiring someone to perform $e*ual favors on you. it distracts the brain for a little bit until you
it starts to get boring and you need to up the ante... more and more exotic wave forms and foramina

I think this schema makes sense... and if you ever speak to those KOLs about their own pain, you'll find out how many would put a minuteman, SIJ fusion, or stimulator in their own family member

 

[MitchLevi]

stim is like having your hand on fire and me hiring someone to perform $e*ual favors on you. it distracts the brain for a little bit until you
it starts to get boring and you need to up the ante... more and more exotic wave forms and foramina

I think this schema makes sense... and if you ever speak to those KOLs about their own pain, you'll find out how many would put a minuteman, SIJ fusion, or stimulator in their own family member

I'm as critical of stim as anyone alive, but the fact remains it works well for some people and that graph is absurd.

Ablation is second only to stim? Absurd.

 

[drusso]

stim is like having your hand on fire and me hiring someone to perform $e*ual favors on you. it distracts the brain for a little bit until you
it starts to get boring and you need to up the ante... more and more exotic wave forms and foramina

I think this schema makes sense... and if you ever speak to those KOLs about their own pain, you'll find out how many would put a minuteman, SIJ fusion, or stimulator in their own family member

I heard some KOLs talking about this very thing just the other day!

 

[ateria radicularis magna]

stim is like having your hand on fire and me hiring someone to perform $e*ual favors on you. it distracts the brain for a little bit until you
it starts to get boring and you need to up the ante... more and more exotic wave forms and foramina

I think this schema makes sense... and if you ever speak to those KOLs about their own pain, you'll find out how many would put a minuteman, SIJ fusion, or stimulator in their own family member

Lol!
So many questions…
Regarding KOLs and their families, one of their most predictable talking points is that they would do these new implant procedures on their mothers. What this talk track says about the KOLS, their family members or the implants is another matter.

 

[MitchLevi]

Regen heavy doctors are largely FoS. Please explain your treatment protocol for severe spinal stenosis with claudication. After you (like everyone else) refer that pt to a surgeon and they get a decompression (the indicated treatment), how are you managing chronic radiculitis in those unfortunate pts with persistent leg pain?

It's been 9 months and Mrs. Jones has a left leg that is screaming.

What is your next step assuming PT and meds are failing?

 

[drusso]

Regen heavy doctors are largely FoS. Please explain your treatment protocol for severe spinal stenosis with claudication. After you (like everyone else) refer that pt to a surgeon and they get a decompression (the indicated treatment), how are you managing chronic radiculitis in those unfortunate pts with persistent leg pain?

It's been 9 months and Mrs. Jones has a left leg that is screaming.

What is your next step assuming PT and meds are failing?

I'd stim that.

 

[MitchLevi]

I'd stim that.

You mean you wouldn't put PRP in the interspinous ligaments and multifidi?

Thanks for being honest, and I'd stim that too.

 

[drusso]

You mean you wouldn't put PRP in the interspinous ligaments and multifidi?

Thanks for being honest, and I'd stim that too.

I mean, it wouldn't be the stupidest thing I've seen done (at least PRP in multifidi) and I bet it's cheaper and safer than being implanted with a Reactiv8 system...first, do no harm...

Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease

Background: Lumbar multifidus muscle dysfunction and chronic low back pain are strongly correlated. There is no consensus regarding treatment of chronic LBP. The effect of platelet leukocyte rich plasma (PLRP) injections on atrophied lumbar multifidus ...

www.ncbi.nlm.nih.gov

 

[lobelsteve]

I mean, it wouldn't be the stupidest thing I've seen done (at least PRP in multifidi) and I bet it's cheaper and safer than being implanted with a Reactiv8 system...first, do no harm...

Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease

Background: Lumbar multifidus muscle dysfunction and chronic low back pain are strongly correlated. There is no consensus regarding treatment of chronic LBP. The effect of platelet leukocyte rich plasma (PLRP) injections on atrophied lumbar multifidus ...

www.ncbi.nlm.nih.gov

That’s not even a study.

 

[drusso]

That’s not even a study.

What? These data are compelling...

 

[Ducttape]

it is basically a case series. there was no control, no placebo group, no blinding, no randomization.

basically, if you have back pain and there isnt anything surgery can do, this doc will inject your back.

10% didnt complete the study. the average age was 30. noone over 55. 8% ended up having lumbar fusion even though they were seen by spine surgery and had fairly normal MRIs.

28.8% considered the procedure a failure.


do the study with a control group and a placebo group, in a not young patient population. do blinding. theres a lot that should be done to make this a valid study.

(and dont post pics saying how there is so much less atrophy but use different image intensity).

 

[MitchLevi]

During my regen course in Colorado, I had a great experience and it made me better at US and I took a lot from going out there. It was worthwhile. Learning the multifidi and interspinous + sacral ligament PRP was interesting, but it's also sort of ridiculous to think you'll open a canal with that or stabilize a spondy.

That isn't going to happen.

If I'm the pt I'd try it of course...Anything to prevent surgery, but I have to remember I'm a real life true baller and I can afford it. Many cannot.

 

[lobelsteve]

it is basically a case series. there was no control, no placebo group, no blinding, no randomization.

basically, if you have back pain and there isnt anything surgery can do, this doc will inject your back.

10% didnt complete the study. the average age was 30. noone over 55. 8% ended up having lumbar fusion even though they were seen by spine surgery and had fairly normal MRIs.

28.8% considered the procedure a failure.


do the study with a control group and a placebo group, in a not young patient population. do blinding. theres a lot that should be done to make this a valid study.

(and dont post pics saying how there is so much less atrophy but use different image intensity).

Did not control for other treatments in the time period.

 

[SeniorWrangler]

The Regenexx people are doing themselves no favors with this kind of hard sell approach.

 

[au bon pain]

Centeno breaks it down for you today "old school."

"There is nothing ever devised that you can place in the body that’s natural. Meaning if you place a piece of metal in the body, even if that’s placed in a less invasive way, that’s still a foreign object. We also know that these metals leech into the patient’s bloodstream and impact some patients more than others, with metal allergies now being a problem. Finally, that piece of metal or ceramic or plastic will eventually wear out, as it has no ability to repair and maintain itself.

Once somebody's sales pitch veers off into the weeds of "metal toxins"...the plausibility of said pitch lands somewhere in the hierarchy between QVC product and propriety GNC product.

 

[painballer27]

If you want to make over $750k you really have to choose a specialty with a high level of reimbursement. Pain is not that.

If pain is not a specialty with a high level of reimbursement, then what is? Seems based on discussions on here as well as MGMA data it pays fairly well

 

[hyperalgesia]

If pain is not a specialty with a high level of reimbursement, then what is? Seems based on discussions on here as well as MGMA data it pays fairly well

I think GI might be one that you can follow all recommended guidelines, practice ethically and conservatively, set up a super-efficient clinic, and work very hard and make a ton of money. Because the recommendations are that every human gets multiple colos in their life. I think the insurance auth must be a piece of cake, ie "patient is 50". Or "patient is 55 with prior h/o adenoma polyps".

 

[drusso]

If pain is not a specialty with a high level of reimbursement, then what is? Seems based on discussions on here as well as MGMA data it pays fairly well

It was the dream of the '90s...

 

[RoloTomassi]

I think GI might be one that you can follow all recommended guidelines, practice ethically and conservatively, set up a super-efficient clinic, and work very hard and make a ton of money. Because the recommendations are that every human gets multiple colos in their life. I think the insurance auth must be a piece of cake, ie "patient is 50". Or "patient is 55 with prior h/o adenoma polyps".

But if c-scopes get a reimbursement cut, they'll feel it hard, since they're not as diversified in what they offer.

 

[hyperalgesia]

But if c-scopes get a reimbursement cut, they'll feel it hard, since they're not as diversified in what they offer.

True that

 

[sloh]

I think GI might be one that you can follow all recommended guidelines, practice ethically and conservatively, set up a super-efficient clinic, and work very hard and make a ton of money. Because the recommendations are that every human gets multiple colos in their life. I think the insurance auth must be a piece of cake, ie "patient is 50". Or "patient is 55 with prior h/o adenoma polyps".

And that recommending screening age is likely going to be younger in the future

 

[Gauss]

Once somebody's sales pitch veers off into the weeds of "metal toxins"...the plausibility of said pitch lands somewhere in the hierarchy between QVC product and propriety GNC product.

God give me the confidence of a naturopath