Your favorite stimulator?

[TIVAndy]

MDT has great reps where I am in CA, but WC doesn’t cover SCS for FBSS; CA sucks

WC stim success rate is dismal. Avoid at all.costs

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[Ducttape]

my experience, limited tho it may be - out of the albeit limited number of implants I set up per year, 99% of those that get explanted are either Medicaid or WC.

s

 

[BobBarker]

I am explanting an ABT soon due to failure to be able to go in MRI mode

 

[deleted993114]

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 see procedures and meds to be on "parallel tracks". I tell patients that meds, procedures, or surgery is all a means to reduce pain so that patients can participate in core strengthening exercises and improve thier ADLs. The least invasive, lowest risk means of creating a pathway to improvement of ADLs is the goal.

I usually try to get someone there as cheaply and minimally invasive as possible. Sometimes, however, their best answer is simply surgery, which we arrange and then purse the physical medicine aspects after that.

I find it interesting, however, that when many providers say that they choose alternative, non narcotics meds primarily to treat their patients that the medicare published prescribing records tell the opposite story. It's all spelled out in black and white for providers- sometimes the truth hurts.

 

[deleted993114]

my experience, limited tho it may be - out of the albeit limited number of implants I set up per year, 99% of those that get explanted are either Medicaid or WC.

s

I would agree. I almost consider Medicaid and work comp to be absolute contra-indications to an implant.

 

[deleted880510]

how about auto injury patients? in the same category as WC when it comes to stim?

 

[deleted993114]

how about auto injury patients? in the same category as WC when it comes to stim?

I am not aware of data on that topic.

 

[Orin]

I am not aware of data on that topic.

The effect of workers’ compensation on outcome measurement methods after upper extremity surgery: A systematic review and meta-analysis

Patients who receive workers’ compensation (WC) often display worse surgical result such as prolonged pain or reduced functional ability. The outcomes of surgery can be assessed using a variety of surveys, assessments, and measurements. It is ...

www.ncbi.nlm.nih.gov

I don't mind the push back against WC's patients as there are data for a lot failing in the setting of a competing compensation claim.

The push back against Medicaid is more problematic for me to understand. I get that those patients have more comorbid disease and demographically are more likely to be lower-income. Colloquially I hear talk about them 'failing at life' as compared to the private insurer population. While the deck is stacked against them, I have not seen data suggesting they're more likely to fail a therapeutic avenue if they get access to it.

 

[Ferrismonk]

how about auto injury patients? in the same category as WC when it comes to stim?

In my area, stims only work in auto cases while the patient is concurrently being prescribed opiates and while the case is still open. When the case closes/settles, the stim stops working once they get placed on Medicaid and/or the opiates stop.

 

[deleted131481]

The effect of workers’ compensation on outcome measurement methods after upper extremity surgery: A systematic review and meta-analysis

Patients who receive workers’ compensation (WC) often display worse surgical result such as prolonged pain or reduced functional ability. The outcomes of surgery can be assessed using a variety of surveys, assessments, and measurements. It is ...

www.ncbi.nlm.nih.gov

The push back against Medicaid is more problematic for me to understand. I get that those patients have more comorbid disease and demographically are more likely to be lower-income. Colloquially I hear talk about them 'failing at life' as compared to the private insurer population. While the deck is stacked against them, I have not seen data suggesting they're more likely to fail a therapeutic avenue if they get access to it.

I see a high percent of Medicaid patients. It's not just being Medicaid per se, but the lower-income and comorbidities lead to higher rates of depression, anxiety, psych hx, obesity, smoking, alcohol, drug use/exposure, and less social support. All of these things lead to less responsiveness with interventions. There are certainly exceptions who don't have those issues, are hard on their luck, etc and I have seen plenty who respond very well to interventions. In my population though these are not the majority.

 

[Monterosso]

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.

Agree with the regional rep support, definitely a key factor.

 

[mja75]

I've had excellent outcomes with both Medtronic and Boston Scientific WW. Medtronic's latest IPG is excellent and so is their local rep support here.

 

[Green Grass]

I've had excellent outcomes with both Medtronic and Boston Scientific WW. Medtronic's latest IPG is excellent and so is their local rep support here.

You just unlocked the key to all of neuromodulation.

 

[PM&R90]

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.

Was that really necessary? You don’t have to be an dingus.