Video Transcription
0:00
Hi, my name is Dr. Madi Schnur and I am here to talk to you today about patient selection for neuromodulation. So why is it important to have good patient selection?
0:16
One, we know that there is a certain population of patients whom we implant with permanent devices that experience inadequate relief.
0:25
For spinal cord stimulation, that's about 30 to 40% of patients, which is quite high.
0:31
With the right patient selection, we know that those numbers of patients who experience long-term relief can go up or down.
0:40
The other thing is that treatment failure, meaning the patient does not receive as much relief as they expect,
0:51
this is associated with patient dissatisfaction and inevitably dissatisfaction of the patient with you as a physician.
1:00
We also know that the expense to remove some of these devices, probably the majority of them, occur to both the patient as well as to society as a whole.
1:15
Patients need to take time off of work, they have spouses that need to take time off of work, which inevitably can lead to wages that are lost for them, for their family, etc., etc.
1:28
And in terms of the devices themselves, the cost benefit for many of them, such as spinal cord stimulation, exists really via the longevity of the device.
1:42
We know that this is also true for intrathecal pumps and probably some of the other devices we place, like peripheral nerve stimulators.
1:54
Some things to take into account. One, I would encourage you all to really place devices using FDA-approved indication.
Video Summary
Dr. Madi Schnur discusses the importance of patient selection for neuromodulation devices. She explains that selecting the right patients can improve long-term relief and reduce treatment failure rates. Treatment failure not only leads to patient dissatisfaction but also incurs additional costs for device removal. Dr. Schnur emphasizes the need to follow FDA-approved indications and ensure a positive response to a trial before placing a permanent device. Factors such as patient safety, pregnancy, and patient understanding of device operation should also be considered. Dr. Schnur provides examples of common indications for different devices, including spinal cord stimulation, dorsal root ganglion stimulation, intrathecal pain pumps, and peripheral nerve stimulation. Psychological risk factors, patient demographics like BMI and smoking, and medication use (such as opioids) should also be evaluated when selecting patients. Finally, Dr. Schnur discusses guidelines, such as the NAC guidelines and PAC guidelines, for infection prevention and management, as well as the importance of staying updated on current guidelines for device implantation.
Keywords
patient selection
neuromodulation devices
treatment failure rates
FDA-approved indications
device removal
spinal cord stimulation
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