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requiem_aeternam, I would like your opinion please

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Posted 8/2/2011 6:34 AM (GMT -6)
Hello requiem, first let me say I am sorry I got a little testy with you yesterday concerning the battery pack.

I would like to know how you feel about the Neurostimulator, SCS, do you feel they are beneficial at all.  I myself did not have a good experience with mine.  I think though it is an individual thing, I have read some posts where some people have had good experience with the system.

I think I said yesterday, I never should have allowed myself to be talked into something that I was not all that excited about.  Maybe thats not true, I was excited at the thought of the amount of pain relief that could be gotten from this unit.

As I said, my trial did not go well, I should have stopped there.  When mine was first installed, the surgeon placed it to far in, so the battery could not find the unit to charge it.  I had surgery to correct this but the unit still could not be found and therefore could not be charged.  I will not have anymore surgery done until I decide to have the piece in my back removed.  By now there is scar tissue etc.

But that is my experience, I am wondering how do you feel, as a doctor, do you recommend the procedure, of course on a case by case.  But as a doctor what is your opinion of the stimulators in general.

Posted 8/2/2011 8:15 AM (GMT -6)
Hi Kathy,

I know that your question was directed to Requiem, but having been active on various CRPS forums over the years, I've come to know quite a few people with stimulators.

From talking to others, I think a big problem is that patients are not given an adequate trial period...I've heard of people having trials as short as three days...or even NO trial... then going ahead with a permanent implant. I had a week long trial. I had what I think was probably an optimal experience. My doctor conducted my trial with permanent leads...i.e. anchored into place. It meant a more invasive trial surgery, but meant that the problem of different positioning was avoided. I've come across a lot of people who've had their trial done, had the trial leads replaced and permanents implanted while they are under full GA, then when they are activated have stimulation in a completely different area to where they had during the trial.

I think doctors will sometimes push SCS onto patients. I've heard this complaint more than once, and I think too that some people choose to go ahead with a permanent implant out of desperation when they should be counselled against it. I believe that placebo effect also plays a role. Even the most grounded of us is so keen for pain relief that it's amazing what our brains can do.

Can they be beneficial? Certainly. I've had a lot of trouble with my unit as you know, but I wouldn't be without it. CRPS causes something called allodynia - where normal touch, or even something like a breeze on the skin causes intense pain. Except in the worst flares, my SCS has all but done away with that. Before I had my implant, I was in the middle of winter unable to put my foot to the ground, no sock or shoe, pants rolled to my thigh. A few weeks after, I was walking reasonably comfortably with crutches.

Just my two cents :)

Laura
Posted 8/2/2011 10:58 AM (GMT -6)
Of course doctors push these things on patients. They either get big money for them or it is in the name of stopping the use of those evil narcotic pain meds. I am not saying long term narcotic use is "good" for a person, only that I do not believe it is nearly as bad as some doctors try to make it out to be.
Posted 8/2/2011 11:59 AM (GMT -6)
Hello Laura, and Jim also.  Laura, I am so glad to here of your experience with SCS units, just as I thought, the trial period is inadequate, I know mine was.  But you and many others have benefited greatly from them.  I really think it is an individual person by person thing.  The benefits to you are priceless and for this I am truly grateful.

Jim, I do agree somewhat, but I am not so sure it is the  doctors and the representatives sent by these companies to sell to the doctors.  I believe most doctors want to do what is best for there patients.  This is not always easy.  They like everybody has big brother looking over there shoulders, DEA, heard of them?  Look the feds are going to want control of any and all things to do with the medicines we get, how much we get and so on.

These are just some facts that the doctors must answer to someone, and then so must we.  Sadly we are at the lower end of the food chain.  So of course we get punished first.  Then there are the posers out there that really make our lives difficult.  I wish as much as the DEA does that they would stay out of our lives.  But life goes on and so do we.

Take care, and thank you both for your valuable input, hope you are feeling well today.

Posted 8/2/2011 5:05 PM (GMT -6)
Thank you, that was very interesting and valuable opinion.  The uses you wrote as to who it works best for was very informative.  Although I believe I was a good candidate for the SCS unit, when it was first implanted, it was implanted to deep.  After I healed from that surgery, which by the way was minimal healing time and minimal pain, It was discovered that it had been implanted to deep. 

I will make a guess here and I think once it had been implanted to deep, it required another surgery to correct the first.  As I am sure you know, scar tissue is what I believe might have been the cause of the unit not ever being able to find the unit in my back, and therefore it could never be charged.

At this point, I have no interest in continuing on, I was told that another surgery could be performed, and of course the placement would be different.  If and when I have anymore surgery on this issue, it will be to remove the unusable unit already in my back.

As I have said, I know it is invaluable to many people, and for that I am grateful that this exists for the people who so badly need it.

Thank you for your opinion, I am sure others will read and also gain much knowlege from this.

Take care,

Kathy

Posted 8/2/2011 7:52 PM (GMT -6)
Requiem, when you are talking about generalized pain in joints, muscles or skin, are you talking about pain originating directly from those structures, or also neuropathic conditions causing problems in those areas? If the latter, I'd beg to differ. As I said, I know quite a number of people with SCS units for management of Complex Regional Pain Syndrome (CRPS). Not sure how familiar you are with the condition, but it causes a LOT of generalised muscle and skin pain, and the SCS is a lot of help with that.

It certainly is interesting to have a view from 'the other side' though, so thank you very much for being here and contributing.

Laura
Posted 8/3/2011 12:47 AM (GMT -6)
True, it is. But I'm talking CRPS with full-body involvement here.

Your point about problems recharging is a good one - also worth noting that having the unit too close to the skin can cause problems with charging too. I am a healthy weight at the moment, but I have a constant battle with gastroparesis (my doctors believe it to be autonomic dysfunction secondary to the CRPS, rather than primary due to my medications) and at one time weighed only 60lb. At that weight I couldn't charge the SCS without putting a significant amount of padding between my skin and the charging wand (I have an ANS unit), because placing the wand over my shirt did not give enough distance between the battery and wand for optimal charging. I had the same issue with programming - and also whenever my doctor would try to program my pump after a fill.
Posted 8/3/2011 3:06 AM (GMT -6)
Requim; While I agree with everything you have said here, what would you say to the patient that would do well with the SCS but has had 4 psych exams that say no this isn't a good idea? I don't even understand most of the questions on those tests and the fact that they lump us all together with a "national average" and say they are 80% accurate just doesn't mesh with me.

I have failed back syndrome from three failed back surgeries and have neuropathic pain radiating down both legs. I think that the SCS is a viable option for me and so do 4 doctors. However, everytime I go to do that stupid psych evaluation I fail to live up to what they consider "their standards." I have dealt with every last one of my depression issues, yet I am still told that the SCS will never be an option for me. All because of a stupid psych test???
Posted 8/3/2011 1:47 PM (GMT -6)
I believe that the Psychologist that I was seen, twice I might add, just might be the later of your post, Requim. Unfortunatly I am at the mercy of not only this psychologist, but too at the mercy of worker's comp in WY. In their opinion SCS devices do not work period! I have fought like heck to get them to see it differently, even showing them post after post from this site showing people with the same disability that I have being treated well with the SCS.

They see it as a matter of cost I believe. But, in the cost department is it more expensive to keep a patient on a very expensive narcotic like Kaidan for six years, or opt for an SCS where I could possibly be weaned off of the drug and not have to take such an expensive medication. I think the former would be more cost effective, if it worked.

But, I will never get the chance to try the SCS, as I have decided to forgo this route and just deal with the pain meds. I cannot tell you how heartbreaking it is to go through a year with a psychologist and be told that your just not a good candidate. I have done everything my PCP has asked of me. Even suggested things as I am an advocate for my own body. But, the heartbreak that goes with being told "no" is just to much to handle and after the last time, I just would prefer to not be disappointed any longer.

Maybe someday the SCS will be a more traditional modility for chronic pain.

Hugs

Scarred
Posted 8/3/2011 8:21 PM (GMT -6)
Do you know I completely forgot I had to get a psyc. doctor prior to being approved for the implant surgery.  I probably forgot because he spent no more than 5 minutes with, and I wish I was exaggerating, I am not.  Yes I totally forgot until I received his bill for service rendered.

Funny isnt it, some are held back due to there psyc. evaluations, and then there are people, might I add, this doctor has done all the psyc tests for the approval of the implant.  Makes you wonder doesnt it?

Now thinking back, the warning signs were all there, the friendly way the reps were with my doctor.  Another thing I have noticed, since about maybe 5-6 months ago, I realized there were not alot of phamlet for the Company selling the doctors and there patients this implant.  Last time I was there, I noticed alot of new phamplets for a new non-intrusive way to help people with carpal tunnel syndrome.  Yes they were everwhere.   Luckily that is one thing I do not suffer from.

Ok my 2cents again.

take care all, hope all are feeling well

Posted 8/4/2011 12:57 PM (GMT -6)
Hey Kathy, I too had a psych eval, but mine spent an hour with me talking to me, its was not an in & out like yours. I also had to take a written test that was done in two days. Boy, what a joke, I believe it was called an MMPI. The questions were so stupid, you cannot imagine. I know for a pain pump Medtronics requires psych evals on all potential pump patients. I had no problem visiting with the dr it was the written test that was a joke. But, this same dr also was the one that interpreted the MMPI I took too.

Unfortunately, things like the SCS units are so easily accessible for many if their health insurance will pay for them, its like the flavor of the month club with some drs on how they will push them on their patients. Kind of like when the rep comes into the drs office with all the sample of free medications and they have a new one for the dr to try on the patients, everyone gets that medication that month if they have the problem the medication is for. I aw this over & over in the clinic I use to go to. When I asked my PCP about it he agreed he did not deny it.
Posted 8/4/2011 2:14 PM (GMT -6)
Sadly the truth is medicine is big business.  Thats why there is such an uproar from the insurance co. and the doctors who are for the most part, paid by them.  What little they get from the co-pays would not be enough to pay for there first homes, let alone the vacation houses.

I sound (I cant spell the word) synical (ok thats the best I can do) because I am.  I am not sure what the answer is, I know in the UK, and Canada health care is for all, but from what I understand that comes at a price also, the price of waiting for surgeries, etc.  So although I am sure there is a way to make it possible for all the get good health care without suffering through waiting, or not being treated due to lack of insurance, I dont think in my time it will be resolved.

As long as greed is the major player in the business of insurance and health care there will be no changes.  I would go so far as to suggest that the pharmacutical companys are hand in hand with the above mentioned.

In any doctors office I have ever been in, (and I have benefited from this) pharmacutical personnel are everywhere.  My gp whom I went to for 20 years until he took another job (very sad day for me) gave me samples for everything I needed outside narcotic medicines and I really appreciated that, I used to leave there with large bags of medicine for my sinus infections.  It was great, and so was he.  I think I mentioned before, the man never ever let me pay my co pay, even when I had to go on medicare, and the price went up, he wrote off everything I owed to him.  And he did not do this just for me, he had many patients who were poor.  The man took his oath to "First, due no harm" very seriously.

Ok I have run on long enough, take care all, hope everyone is feeling well today.

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