I had a discussion on another forum about
the push from doctors and the push from patients in getting a spinal cord stimulator or a pain pump instead of fixing the mechanical problem.
We all came to the conclusion that the fault lies with the sales representatives, with the doctors who either threaten patients, misrepresent what the units can do, or sell them to patients as a means to avoid surgery, which is the current trend and finally with the patients who are too eager for a quick fix, rather than repairing the actual problem, want to circumvent surgery altogether to their detriment.
Some PM doctors are pushing the units onto patients who are weeks out of a surgery or as a means to avoid surgery altogether. Some are threatening patients that if they don't go ahead with a trial and implant, they will not prescribe pain medications any longer. If a patient is threatened with that, they need to file a report with their county's medical board. It's unethical for any physician to do that. They make a lot of money from doing both the trial and the permanent implant, as well as any revisions that might be done, and battery changes, etc.
Not all of the units fail, for the right patient, selected with the right criteria, at the right time in the protocals for spine injury, they are a good treatment option.
But for someone looking to avoid having surgery when there is a structural problem, it is not going to work, in the short term or the long term. For someone who is taking a ton of medication and is looking for a means to stop taking pain medications, it probably isn't going to work, and for someone who gets less than the standard of 50% relief in their daily pain levels, it isn't going to work. And that will result in a bunch of failed stimulator implants, which in the long term can destroy the efficacy studies of scs, and result in insurance companies not wanting to pay for them, as we are seeing already in some cases.
The company reps are in it for the money- plain and simple. It's how they make their income- selling those units and servicing them. They will tell the patient who is looking into a scs as many lies as they feel they need to to get you to trial a unit. Once you trial it, even if it does not meet the standard of care- 50% or greater reduction in your daily pain levels- they will tell you that once the permanent leads are placed, you will get better relief, when that doesn't work, they will tell you once the leads are scarred in, it will be better, they will tell a patient who has greater back pain than nerve pain that it will cover their low back pain and it is not approved for that. In fact, in most instances it will not cover low back pain......period. If someone happens to get some stimulation in the low back, it is because of the patients anatomy, the position of the leads and the program, not because the unit is designed for that to happen. It is rare for low back pain to be covered with a spinal cord stimulator.
There is a standard of care when it comes to spine patients, and it is there for a reason.
First, you try PT for several weeks, then anti inflammatory medications and more PT, then exams and consults with surgeons, to rule in or out mechanical problems. Followed by imaging studies as necessary, emgs and test injections to see if they can relieve some of the pain, if not all, low dose oral pain medications and nerve pain medications....then surgery enters the picture......followed by more PT/rehab, long acting pain medications, and breakthrough if needed, more nerve pain medications, and when you are reach high doses or the meds are no longer effective, then the scs should enter the picture, not before and finally the pain pump.
Skipping any of those steps, except in emergencies, is going to result in a failure, either because the mechanical issue isn't fixed, and / failure to use the right treatment at the right time.
I learned a hard lesson in my own pain journey. When I first injured my back, I thought that I knew what a 10 on the pain scale was- and I did, it was my worst imaginable pain (at that time in my life), then each time my back went out again, I learned a new 10, when my discs herniated, I learned yet again another new 10- that one had me crying in my sleep, then post op from my first back surgery, I developed a whole new appreciation for a 10 on the pain scale- that one I thought would kill me, literally......since then, I have developed a few other new appreciations for 10 .
What I am saying by all of this, is that as our conditions deteriorate, we learn what we once believed whole heartedly was a 10 is now a 5, or less because that 10 - the worst pain imaginable has evolved while our conditions are worsening.
I look at pain management as a journey, not a destination- I want to save the big guns, scs and pain pumps for when my 10's evolve yet again, as I'm sure they will in the next 10 years or so....