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OR Business
proving their pain control
and their quality of life.
This includes their ability
to function, sleep, and
gain back aspects of
their life that had been
limited.
Spinal cord stimulation
requires two proceAllen
Burton,
MD
dures to test and implant the device.
Electrodes are placed between the spinal
cord and the vertebrae in the epidural
space. Side effects include infection,
bleeding, and device migration.
Dorsal root ganglion stimulation. This
treatment can be used to help reduce
the effects of problems such as complex
regional pain syndrome, post-amputation
pain, failed back surgery pain, and
chronic pain in the lower body, such as
the foot, knee, hip, or groin.
It involves the implantation of a nonrechargeable
stimulation device over
the dorsal root ganglion bundle of sensory
nerves. It is similar to spinal cord
stimulators in that they both change
the way the brain perceives pain, but
the target is more specific. Although a
relatively safe procedure, some complications
such as infection at the site of
incision, hardware malfunctioning, or
pain at the surgical site can occur.
Sacroiliac joint stabilization and fusion
procedures. The sacroiliac joints
link the pelvis and lower spine. These
two joints are made up of the bony
structure above the tailbone-the sacrum-and
the top part of the pelvis,
known as the ilium. According to Dr
Narain, the pain originating from this
area is commonly underdiagnosed or
even misdiagnosed as coming from the
lumbar spine.
" We perform minimally invasive
surgical procedures that typically take
about an hour overall to make a major
structural change to the joints. These
are stabilization or fusion procedures
that decrease the pain from this area, "
says Dr Narain. The procedures involve
placing titanium implants and bone
www.ormanager.com
Leading vendors in pain treatment
Pacira, the provider of Exparel- a local anesthetic
administered at the time of surgery
to control pain and reduce or eliminate the
use of opioids for acute postsurgical pain-
is leading player in this space. " Pacira is a
single product company; its success is tied
to the performance of Exparel, " says Wang
Lushun, MD, senior consultant orthopedic
surgeon at Arete Orthopaedic Centre, Singapore.
Medtronic,
Stryker, Halyard Health, Boston
Scientific, and Abbott Laboratories are
also known for their expertise in pain management
and nerve-related treatment.
In the neuromodulation space, specifically,
Abbott, Boston Scientific, and
Medtronic are considered major contributors.
Abbott's proprietary BurstDR™ waveform
technology, for instance, does not
grafts to stabilize the joint and promote
bone growth. The patient may go home
on the same day or the following day
and will have to use crutches for support
for several weeks postoperatively.
A disadvantage of the procedure is
that not all insurance companies cover
it. Other disadvantages include wound
infection and nonunion (ie, failure of the
bone to heal).
Costs
The costs associated with these pain
treatment therapies can be higher than
traditional methods of physical therapy
and over-the-counter drugs because of
the specialized equipment and training
required, as well as use of an inpatient
or outpatient OR. Whether these treatments
can be profitable for ASCs or
hospital ORs depends on a variety of
factors, including the specific costs and
reimbursement rates for each therapy.
While these treatments can be expensive,
they can also provide significant
benefits in terms of patient comfort
and recovery time, which can offset
the higher upfront costs. Patient experience
with these treatments has been
cause a " tingling " feeling that some patients
find uncomfortable. " With BurstDR,
very few patients are able to tell the device
is operating aside from the pain relief they
feel and the fact that their controller alerts
them to its use, " says Allen Burton, MD,
divisional vice president and chief medical
officer at Abbott Laboratories, Chicago.
Boston Scientific also offers interventional
therapies approved by the Food and
Drug Administration such as spinal cord
stimulation, which works by interrupting
pain signals before they reach the brain.
" Additionally, Boston Scientific offers cryoablation
solutions to treat nerve-related
pain through a process called cryoneurolysis
via our ICE cryoablation platform, " says
Nilesh Patel, MD, MBA, vice president of
medical affairs at Boston Scientific.
generally positive; however, these treatments
may not apply to every patient,
and they also can be expensive for patients
if their insurance companies do
not cover them.
They are not out of reach, however.
By negotiating favorable pricing with
suppliers, maximizing resource use,
and performing cost-benefit studies to
evaluate their long-term effects on patient
outcomes and healthcare costs,
these treatments can prove profitable
for healthcare organizations. ORM
-David Cotriss is a healthcare
freelance writer based in California.
References
Complex regional pain syndrome.
Mayo Clinic.
Hear what people say about Abbott's
neurostimulation therapies. Abbott
Klintberg I H, Larson M E H. Shall we
use cryotherapy in the treatment in
surgical procedures, in acute pain
or injury, or in long term pain or
dysfunction? A systematic review.
Journal of Bodywork and Movement
Therapies. 2021;27:368-387.
OR Manager | Nov/Dec 2023 35
https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/symptoms-causes/syc-20371151 https://www.neuromodulation.abbott/us/en/chronic-pain/hear-what-people-say.html https://www.sciencedirect.com/science/article/abs/pii/S1360859221000528 http://www.ormanager.com
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