Does SCS work for Painful Diabetic Neuropathy (PDN)? Chronic Back Pain? Update on my personal experiences! Unfiltered!

Does SCS (HFX) work for neuropathy? Back pain?

In July 2021, HFX was FDA-approved to treat painful diabetic neuropathy (PDN), making it the only medication-free treatment option for patients with PDN. According to The Journal of the American Medical Association, PDN patients experienced substantial pain relief and improved quality of life with HFX treatment.

As I mentioned previously in my article, "Never Give Up! Easy for me to say!"

"I have been working on scheduling the spinal cord stimulation procedure since November, 2021, (lot of unplanned delays)", the date of news release by UAMS Dec. 14, 2021 may help explain why I experienced delays.

My current health issues?

• Type 2 diabetes?Diabetic neuropathy can cause numbness or tingling in your fingers, toes, hands, and feet. Another symptom is a?burning, sharp, or aching pain?(diabetic nerve pain). The pain may be mild at first, but it can get worse over time and spread up your legs or arms. Can impact your ability to drive. I had a minor accident at a car wash, so I took the state driving test in Little Rock to assure myself and family that I was still a competent driver. I passed, many fail it, but I changed a few things to avoid feet numbness fatigue, while searching for a better permanent solution. Another was eliminating occasional double vision with prisms in eyeglasses after cataract surgery.
• Parkinson’s?- Rock Steady Boxing?is a boxing program designed for people with PD, based on exercises that are adapted from the world of boxing that emphasize agility, speed, endurance, accuracy, hand-eye coordination, footwork and strength. Recommended by my neurologist. Many more women participate locally than men. The social impact is by far my biggest takeaway. Everyone encourages, no one is negative, just realistic. There is not a cure for Parkinson's. Best audience yet for my subtle (sometimes dark) sense of humor.
• Atrial fibrillation (Afib) - found that I am constantly in it based on pacemaker readings? Where abnormal was normal for me.
• Pacemaker - Single chamber for atrial fibrillation. I drove to Fayetteville (80 miles), and back after pacemaker was implanted. No need for a driver. Used creative borrow a friend in Fayetteville.
• Removed cancerous (grade 2) tumor from kidney lining, no reoccurrence. My daughter takes credit for saving my life.?Found at NIH in DC, when she was there on a trial program /study for her birth defect. Oral-facial-digital syndrome type 1 (OFD1) is a rare disorder comprising malformations of the face, oral cavity, hands, and feet.?Polycystic kidney disease (PKD) is a more recently recognized feature of the syndrome.
• Had at least 6 epidural steroid injections to treat back pain caused by a herniated disc (slipped disc). Those were hit or miss (mainly miss). You are put to sleep for those as well. I was working in Little Rock at the time, so found creative ways to handle outpatient driver requirements.
• Numerous physical therapy sessions. All good, but prefer boxing.
• Lumbar discectomy and laminoforaminomy. Removal of L4-L5 disc with scar tissue replacement. Best immediate relief !
• Major back surgery fusion with titanium rod and screws./Unfortunate result was drop foot. Nerve damage from major surgery may be another reason to try spinal cord stimulator procedure first. I would recommend avoiding major back surgery as long as possible. Too many possibilities for nerve damage. Early stage undiagnosed Parkinson's another.
• High blood pressure controlled with meds. Also Warfarin for blood thinner to avoid strokes. "patients who were taking (newer anticoagulants) or warfarin were 35 to 44 percent less likely to experience severe stroke,?21 to 25 percent less likely to die, and 40 to 50 percent more likely to function independently after a stroke,”?Something my parents and brother failed to take as prescribed, probably leading to their untimely demise.
• Botox injections in feet ever 4 months - for nerve damage. Some might say a big waste of Botox. Spinal cord stimulation success might eliminate it? Appendix A
• Lasik in 1999. No eyeglass hassle for 23 years.
• Cataract surgery in 2022, also need for glasses (prism lenses) to correct double vision.
• Prior to spinal cord stimulator?surgery, insurance companies require a?psychological evaluation to helps identify your strengths, weaknesses, and motivation for surgery. The goal is to help identify good candidates for surgery and to increase your chances of success post-surgery.
• Another one of those tests, "do you really, really want to do this? Your decision or did someone force you to do it?" "Are you on drugs or an alcoholic?"
• Wow what a gauntlet!
• Finally spinal cord stimulator surgery,?Reached full cyborg status. I consider pacemaker only half status.
• Next? AI and closed loop! Whatever the next big thing is?

Note !!! After news release, I'll give some additional, updated, independent (unpaid), and unfiltered thoughts.

UAMS Neurosurgeon’s Study on Breakthrough Treatment for Painful Diabetic Neuropathy Published in Diabetes Care

By Linda Satter

Dec. 14, 2021 | Results of a 12-month multicenter randomized clinical trial led by Erika Petersen, M.D., a professor of neurosurgery at the University of Arkansas for Medical Sciences (UAMS), were published online Nov. 29 in Diabetes Care, highlighting the benefits of a breakthrough treatment for patients with painful diabetic neuropathy (PDN).

Petersen, director of Functional and Restorative Neurosurgery at UAMS, was the lead investigator in the study that involved 216 patients at 18 centers in the United States. Johnathan Goree, M.D., an associate professor in the UAMS Department of Anesthesiology and director of the Chronic Pain Division, is a co-investigator on the study.

The study, for which UAMS began enrolling participants in 2018, examined results of high-frequency spinal cord stimulation therapy for patients with PDN, a chronic neurological condition that manifests as burning, excruciating, stabbing or intractable pain, or tingling or numbness. Specifically, the study compared the 10 kHz treatment plus conventional medical management to results of the conventional treatment alone, and found that the high-frequency therapy results in significant pain relief and neurological improvements in patients with persistent PDN.

“Patients with painful diabetic neuropathy have no way to cure their condition, and many have trouble achieving relief from their pain,” Petersen said. “However, with high-frequency 10 kHz SCS, I’m seeing durable pain relief and potentially disease-modifying neurological improvements, which could be a game-changer when it comes to how we treat patients with impaired sensory function related to diabetic neuropathy.”

Durable pain relief means patients demonstrated pain reduction of 50% or more, which was maintained for 12 months. The trial follows patients for 24 months.

Nevro Corp., a global medical device company based in California that created the Senza spinal cord stimulation system that delivers the 10 kHz therapy, touted the findings of the landmark clinical trial, which was supported by the UAMS Translational Research Institute.

“No conventional, low-frequency SCS treatments have demonstrated such positive results in treating PDN patients,” said D. Keith Grossman, chairman, chief executive officer and president of Nevro.

Nevro’s system, called HFX, is the only SCS system approved by the FDA with a specific indication for painful diabetic neuropathy.

The high-frequency spinal stimulation is delivered through two thin, insulated wires inserted into the back, near the spinal cord, in a minimally invasive outpatient procedure. The wires are attached to a small implanted device that recharges wirelessly through the skin. The wires deliver mild electrical impulses directly to a processing center in the spinal cord, suppressing neural hyperactivity and reducing pain signals to the brain.

The method stimulates the inhibitory neurons without stimulating the excitatory neurons, reducing pain without paresthesia, a tingling sensation that can occur during traditional spinal cold stimulation.

The World Health Organization estimates there are 422 million adults with diabetes worldwide. About 20% of patients with diabetes will develop PDN, a progressive, potentially debilitating chronic neuropathic pain condition.

UAMS is the state's only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; a hospital; a main campus in Little Rock; a Northwest Arkansas regional campus in Fayetteville; a statewide network of regional campuses; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, Jackson T. Stephens Spine & Neurosciences Institute, Harvey & Bernice Jones Eye Institute, Psychiatric Research Institute, Donald W. Reynolds Institute on Aging, Translational Research Institute and Institute for Digital Health & Innovation. UAMS includes UAMS Health, a statewide health system that encompasses all of UAMS' clinical enterprise. UAMS is the only adult Level 1 trauma center in the state. U.S. News & World Report recognized UAMS Medical Center as a Best Hospital for 2021-22; ranked its ear, nose and throat program among the top 50 nationwide for the third year; and named five areas as high performing — colon cancer surgery, diabetes, hip replacement, knee replacement and stroke. UAMS has 3,047 students, 873 medical residents and fellows, and six dental residents. It is the state's largest public employer with more than 11,000 employees, including 1,200 physicians who provide care to patients at UAMS, its regional campuses, Arkansas Children's, the VA Medical Center and Baptist Health. Visit www.uams.edu or uamshealth.com

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Fun fact for marketers - nevro when spell checked on Word doc gives following optional words- nerve, Nero, never, nervy, nitro - Nero? Never? Really? I once worked with a cable software company with a system called Intelecable - spell check correction is intolerable.

My additional, independent (unpaid), and unfiltered thoughts.

• I have thoughts on changing role of GPs and other local "specialists" in rural locations.
• New technology overcoming the resistance of change (how and way we have always done it).
• Listening to customers (patients). Much easier said, then done.
• How my global business development travels eliminated any bias against other cultures and nationalities.

Baseline considerations

Evangelists

If you have read any of my articles on company and system start-ups, undoubtedly you have come across "evangelists". From nearly 6 years ago

Every Company Needs a Chief Evangelist

• Published on September 15, 2016 (nearly 6 years ago)

Excerpt -- "Unfortunately there are times when companies have a good idea, good management, and even are well capitalized; but then lack a real, inspiring story about their products and/or services.

Although many times we associate chief evangelists with large companies, they are also key for smaller and medium size companies.

In those cases it might be customers who express great passion and enthusiasm, openly giving analytics on revenue increases and cost cuts.?Having evangelists detached from the payroll are priceless.

Many companies use traditional methods for marketing and sales. They miss key elements of business development, excellent customer experience, and identifying evangelists.

Those companies use the “Field of Dreams” approach -- build and they will come. After a few years they become nightmares and wonder why?

Recently I worked with a company who was attempting to build sales. They had great prices and products, their missing piece was customer service, and evangelists.

Although they were telling customers they could meet schedules, they didn't. Unfortunately the delays were being poorly handled. Customer had no idea schedules were not being met, until deadlines came, and products weren’t there.

In order to turn the situation around, there had to be micromanaging of the process. Customer has to be kept in the loop with both bad news and good news. Managing those issues has and will develop customers into evangelists.

“Roles within Sales and Marketing has become much more complex amid the cacophony from social networks, the proliferations of mobile devices, and changing TV viewer habits.” Companies, such as Amazon and Apple get it, while many retail stores are being shuttered."

Disclosure - too early to determine if I will become a full fledged evangelist for spinal cord stimulation procedure, and medical devices. Just some really positive "first steps".

Latest:

Some additional basics

Teaching old dog new tricks.

Our dog Ozzie (12 years old, 84 human years), was recently trained to go get his best friend "Christy " , my daughter when I need something (or it's an emergency).

Click on https://www.youtube.com/watch?v=DMzvl2KfMNs&t=29s

easiest

or link below - more challenging via Linkedin, but more aesthetic.

Again old people vote for practicality.

Teaching new dogs. old (and new) tricks can be done as well.

Old people are in a hurry. For obvious reasons. We don't buy green bananas.

Avoid making old mistakes, learn from other people's experiences (mistakes).

Leave your egos at the door.

I have thoughts on changing role of GPs and other local "specialists" in rural locations.

• Growing up in a rural community, I recall a time that every medical situation was handled by my dad's cousin, Dr. Ross Fowler . He delivered me at home, and he was the only doctor I had any contact with until college. He would contact specialists to get questions answered.
• Frequent use of specialists have created a rural game changer.
• I'm a specialists in telecommunications, so I see parallels. We wouldn't have sold systems in over 50 countries, if there were confidence in local technologists to solve their problems. We had addressable interfaces to all the major set top box manufacturers, and had successfully completed an audit from a Fortune 500 company. Important if a foreign cable operator wanted to partner or sell to US companies.
• My GP handles lab tests for type 2 diabetes quarterly, and other health needs as necessary. including annual checkup. Prescribes medication.
• My local cardiologists handles tests, schedules pacemaker checks, and checks and manages my INR level. Prescribes medication. My pacemaker was embedded in Fayetteville. I go there when there are major needs.
• GP and other local rural doctors accepting role as facilitators, and not your destination doctor has its challenges.

University of Arkansas for Medical Sciences (UAMS) study (personal experience) -- Little Rock and Fayetteville Arkansas

Utilization of a neuroinformatics research platform to develop quantitative tools for clinical assessment and treatment of?Parkinson's disease patients in rural Arkansas

Purpose of study is to try to understand how Parkinson's disease affects movements and speech and how to measure these things

New technology overcoming the resistance of change (how and way we have always done it).

• "One study estimated the success rate for back surgeries to be?about 50%. This estimate is conservative, as most success rates depend on a wide variety of factors. Your health, specific surgery, source of pain and any surgery complications influence whether or not your procedure will be effective."
• I had foot drop after major back surgery -- "The most common cause of foot drop is?peroneal nerve?injury. The peroneal nerve is a branch of the sciatic nerve. It supplies movement and sensation to the lower leg, foot, and toes."?
• Everyone knows the difference between masking a problem, and fixing it.
• "After FDA approval in July 2021, spinal cord stimulation can be used in some situations to treat chronic pain from nerve damage associated with diabetic neuropathy, a diabetic condition that can cause disabling burning or stabbing pain, often in the legs or feet. This treatment is appropriate for patients whose condition and symptoms are not responding to other treatments, and who meet specific criteria including levels of red blood cells (hemoglobin), blood sugar (A1C), and body mass index."
• Reminder FDA approval is only 1 year old.
• So far efforts to fix my pain problems have not worked, and now there's one new issue Parkinson's
• Always told to fix the root of a problem, not the symptoms.
• The reality in healthcare and in technology business development fixing the root problem, may be impractical. e.g. Rural broadband fiber-to-home is cost prohibitive. Same for back surgery with its low percentage of success.

I was able to install PC based customer care and billing systems in over 50 countries prior to commercial Internet. The major US cable billing companies were all based on mainframes, impractical for international market. in the Again detailed in my story - Capitalizing on the Global Telecom Perfect Storm -- My True Story! https://www.dhirubhai.net/pulse/test-only-herb-lair/

• Whether it's the targeted procedure on The Voice and Today Show's Carson Daly's basivertebral nerve,?or the more general approach of the spinal cord stimulator; procedures to reduce, or even eliminate fake pain signals.

Basivertebral nerve (BVN) ablation is?a minimally invasive spinal procedure targeting the BVN, which is responsible for carrying nociceptive information from damaged vertebral endplates

Listening to customers (patients). Much easier said, then done.

• UAMS handled the medical part of the trial, and embedding medical device and wires. Everything went perfect.
• Nevro the medical device and training. Four people have been assigned and are available 24/7 for emergencies.
• Lot of YouTube training videos are available.
• With my medical history, and technology background very anxious to get started.
• After removing staples, and determining there were no infections, I was given some additional instructions by the Nevro representative. The most obvious was be patient and follow their proven model. I had already received a reprimand for moving ahead on my remote.
• I am now using SCS remote control, and determining optimum settings as instructed.
• Optimum would be using the least power to mask my pain. Battery will be charged less frequently.
• Although feet and toes are having little pain, it will take some effort to get my walking gait back. Over past 2-3 years i started stiff legged penguin steps to avoid falls. Hard habit to break.

OK stay tune for more updates

Cultures, nationalities, age, and sex never a problem.

• I have worked successfully with business owners' nationally and globally
• I have had the best patient treatment by UAMS, and Nevro
• Some are from India, great work ethics. I established lifelong friends when I traveled to New Delhi on business with a side trip to the Taj Mahal.
• Many are young women professionals

Young lady on my left in picture was invaluable associate - handling Mandarin and more importantly cultural acceptance - she knew I would be clumsy using chopsticks or?kuàizi (Chinese: 筷子) in food tasting sketch on Sunday night TV seen throughout mainland China - no pressure. She took charge and all I did was taste, playing perfectly the food illiterate American (better than being discovered as once working at the CIA - might still be there?).