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Catch up…spinal cord stimulators, opioid addiction test and settlement dollars, and electrical grid risks – oh my!

Stuff you may have missed…

Spinal cord stimulators...Don’t work.

More specifically, multiple high-quality studies found little evidence of pain reduction, no impact on disability, no impact on opioid use, and a relatively high risk of complications (about one in five patients required device revision or removal)

Just as bad, the SCS industry fought back with highly questionable tactics: this from JAMA reported in MedPageToday:

 “Industry-funded critics of independent studies often do not follow the usual route of scientific discourse…

Rather than respond to the journal where the original study was published, critics frequently publish in journals where they are the editors and can control the discourse (15 of 18 letters criticizing the independent studies cited in this article appeared in journals with industry-affiliated editors)…

The journal can then choose to paywall the subsequent response from the independent authors, giving critics the last word.”

and criticisms are typically narrow (but they didn’t look into the benefits for left handed red heads who speak Swahili!) and/or specious.

The net – science indicates the risks of SCS are high indeed, while the benefits of SCS are sketchy at best.

FDA approves test to assess opioid addiction risk

From the FDA

“The AvertD test is intended to be used before patients who are being considered for a 4- to 30-day prescription for acute pain (e.g., for a planned surgical procedure) are first exposed to oral opioids. It is not intended for patients being treated for chronic pain.”

Excellent news indeed!

The test is NOT yet available…check here for more info.

Net – get your Medical Director(s) on this post haste to determine coverage policies and reimbursement.

Opioid settlement dollars

are in high demand, with a bunch of companies coming up with very creative ways to stick their heads in the trough. Spiderman-type cord wraps for police, locking pill bottles, safe disposal envelopes are among the pitches governmental entities are getting for their opioid settlement dollars.

Two points – 

  1. addiction counseling, behavioral health, and other patient care is what is needed – and where dollars should go.
  2. illicit fentanyl is the big problem now – expensive locking pill bottles and disposal envelopes are marginally useful.

Texans may see rolling blackouts this winter, with implications for businesses, public safety employees, utility workers and essential workers.

In October ERCOT – the state’s power regulator, “… issued a request to increase [electricity producers] power capacity ahead of winter’s peak load season in Texas but canceled the request after it only found an additional 11 megawatts out of the 3,000 it was looking for.”

Power producers pointed to ERCOT’s request as too little, too late; University of Houston Energy Fellow Ed Hirs: “Just simply throwing some money out and hoping that people could bring a coal-fired power plant back out to operational capability within a period of weeks was really, ridiculously, ambitious.”

It’s not just Texas…with changing winter weather patterns driven by climate change other states are also at risk of similar blackouts.


3 thoughts on “Catch up…spinal cord stimulators, opioid addiction test and settlement dollars, and electrical grid risks – oh my!”

  1. My wife had pancreatitis and got a spinal stimulator. It did not work. The way they sell is is to do a trial of it first, and then if it seems like it will work, they do a final implant. But it’s all kind of a scam, because during the trial they leave it on continuously, and it did seem to help a little. Once it’s implanted, though, they tell you that it has to cycle on/off every 30 seconds. My wife noticed the cycling and they said if they leave it on all the time, your body gets used to it and it becomes ineffective. However, if they don’t turn it on all the time, it’s also ineffective. Fortunately, we got insurance to cover the $50k cost, after doing two appeals. The battery on it is rechargeable but after about six month it stopped taking a charge, so you need another surgery to replace it but we just gave up at that point. She eventually had her pancreas and spleen removed, and now she’s pain free, but still addicted to legally prescribed fentanyl unfortunately. The pain management is a whole other scam. They aren’t even attempting to wean her off opiates as they get their $500 for a 15 minute appointment every month.

    1. Jeff, thanks for the comment. So sorry to hear about your wife’s situation. Thanks for putting a face on the impact of the incredibly abusive practices by medical professionals who are supposed to take care of us. Very much. Hope your wife gets better. Be well, Joe.

      1. One thing I forgot to mention is that the pain management folks were not pushing the spinal implant. They know it doesn’t work and were telling us that. However, we were desperate. The fentanyl really quickly increases your tolerance to opiates and once you hit the legal limit for your weight they won’t increase the dose any higher. My wife was on oxy for three years at a very low does, around 20mg a day, but within three months of going to fentanyl she was at the legal limit of 50mcg a day, which is really high, like what they give to cancer patients. She ended up on fentanyl after another surgery that didn’t work and the hospital was giving her 200mg of oxy a day, which ruined her tolerance and that caused the switch to fentanyl. I will say the pain management people were also very reluctant to prescribe fentanyl. They know what will happen. You’ll get a tolerance to it and it will stop working. We were the ones pushing for any other solution to her pain and so I did the appeals for the insurance and we did the spinal implant. It’s desperation, pure and simple. That’s another reason it’s so terrible what the spinal implant folks are doing, they’re taking advantage of very desperate people.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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