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Spinal cord stimulation for Morton neuroma

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jun 18, 2011.

  1. NewsBot

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    Spinal cord stimulation for recurrent painful neuromas of the foot.
    Messina G, Nazzi V, Sinisi M, Dones I, Pollo B, Franzini A.
    Neurol Sci. 2011 Jun 16. [Epub ahead of print]
  2. WillTrekker

    WillTrekker Member

    If all other Clinical Measures have been exhausted, including:
    1. a series of Sclerosing Injections at 4-6% strength of sterile Alcohol in Marcaine or lo-o-ong acting local anesthetic -like the CRNA's get (keep it dark and NOT un-refrigerated for more than 24hrs). Would do this under light oral sedation or even bring in a CRNA if you have a particularly anxious, injection-phobic, or pt w/ any other supra-tentorial issues... the patient just does NOT need to see or feel this coming; that is, if valium & percocet or vicodin just doesn't cut it. Don't be afraid to pre-medicate, and never torture one's patient. I hate ending up with patients who've got these stories from previous under-trained, un-experienced providers who didn't have the confidence or whatever to do the right thing. Keep your nurse nearby, do some vitals monitoring, & consent them on a long form, and be confident... this works with great success. If no experience with this, and it's a complicated history, send this patient to someone with experience. Try this particular procedure, for starters on scar-nerve entrapment to gain your expereince, and after a series of injections on more than one patient, and you see your success, then go for the deeper lesions--like Morton's.
    2. Radical Revisional surgery (via a plantar approach) --which in expert hands should work on the right patient (carefully selected, I mean beware of supra-tentorial issues, otherwise no success to be had whatsoever!), for the right reasons, at the right time -that is. If doing recurrent revisional removal, then would recommend capping it, or for certain - implanting it into muscle belly, sometimes easy & sometimes not.
    3. Cryotherapy Procedure? No experience, so I plead the 5th. It's about the only one thing I haven't done. I've done EPF for toe webspace on small Morton's, and seen it relieve the symptoms; other high tech stuff - YES: trained & qualified & performed the TOPAZ RF procedure for various tendons, ligaments, & of course PF - NOT for M/N; and done the ESWT - all with awesome success. But not the Cryo puppy. So, just can't say... gotta get up to speed on that baby. Will input after taking a course, reading & researching, talking w/ some experts, & putting in some hands-on time.
    4. As for Spinal Cord Stim, or implanting an IPG - for the Refractory, Recurrent or non-responsive and most difficult Morton's Neuroma --THIS IS AN EXCELLENT OPTION. WORKS EXTREMELY WELL. BUT, ONE DRAWBACK: VERY EXPENSIVE, ONLY ABOUT $25K FOR THE DEVICE W/ ACCOMPANYING CHARGER, CONTROLLER, & support of the company -which only means that they'll replace the charger & controller (and your barely readable manual) if it breaks or you lose it. Requires patient commitment to charging it 2-3x/week minimum, has only a life of 10 years (IF they keep it charged properly). After the scar tissue sets up AFTER 6 months, make sure you refer them back to the Pain Doc to get the IPG/Implant Rep in to increase their levels of 'Controller' settings OR the patient will be MISERABLE! As scar tissue increases around the leads, so does impedance of electric (micro-amps) current -which translates to decreased pain relief! [That's what happened to me for my Lumbo-Sacral issues -as the company rep & pain doc/clinic 'forgot' about me, and never told me to get this INCREASE in settings done--and it wasn't in the manual!]
    That all being said, I can almost bet or guarantee that most health insurance companies will want you to have exhausted ALL other measures FIRST before they shell out... AND so will the patient, if they are reasonable & they have a high deductible, co-pay, & shallow pockets, etc. IPG/Pain Implant/Spinal Cord Stim = awesome choice for permanent therapeutic option and relief = happy patient. But, consider it and referral in a timely manner.
    Unfortunately, too many Pods are not yet familiar, nor are they employing this modern, high-tech, safe, effective & proven therapy for enough of it's potential indications. SPREAD THE WORD. IT IS INDEED GOOD NEWS, AND WAS A LIFESAVER FOR ME, MY LIFE, AND MY CAREER.
    {{The only flaw in the whole thing with Class III Medical Devices is, if they fail, which is rare, and your patient experiences severe "rebound pain" -they can sue but will NOT be successful, as these companies are, as of yet -like the casino's in Nevada, protected by the Law "because their device was approved by the FDA, and met the standards of testing." Even if it works intermittently, harms the patient, the charger or communicator goes out, and the company lies to you and is unresponsive, and you cannot get your doctors to prescribe high level pain meds 'cuz they 'think' you have a pain implant, even though it's going wonky & failing. Sorry, no pecuniary damages, and the judge will throw out the case--even if the FDA issued warnings against that one particular company for manufacturing it with sub-standard parts. S'posedly, this law may change soon. MY ARGUMENT IS THIS: HEY YOU CAN'T SUE ME: I WAS APPROVED FOR DOING YOUR BUNION SURGERY, AND THE STEPS ARE QUITE STNDARD; COMPLICATIONS CAN OCCUR AT ANY TIME, TO ANYONE, AND YOU WERE FINE WHEN I LEFT YOU. That's their argument w/ Class 3 Med devices, so why not with us pod sgn's too, heh.}}

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