posted by : Dr. Barnetton: 23 January, 2019
Algorithmic approaches are the mainstay of most medical decisions and treatments. This one published in ASRA and Pain Medicine 2012, outlines the decision making process in applying Medtronic’s intrathecal drug delivery system to patients with and without cancer. Similarities exist in my practice, as I make my decisions for implantation of Spinal Cord Stimulators.
Referred to as Advanced Pain Therapies, these devices often separate a comprehensive pain treatment practice from a “hobby” practice of part time “epidural docs”.As noted in the chart, diagnosis is key, followed by exhaustion of more basic or conservative therapies. Once a patient has climbed the “therapeutic ladder” of treatment methods, he or she may be a candidate for either a Medication pump or a Spinal Cord Stimulator, (SCS) also known as Dorsal Column Stimulator, (SCS). These systems have numerous FDA approved applications, with numerous “off label” or non FDA approved uses available in certain circumstances and certain countries. In my practice, the general rule is that Stimulators are excellent tools for neuropathic pain treatment. The most common diagnosis is Failed Back Surgery with persistent Sciatica, but neuropathic conditions like RSD, Complex Regional Pain Syndrome, or Diabetic neuropathy that often present treatment challenges are often treated.