Friday, January 15, 2010

Pain Management: A Brave New World?

As more people look for alternative treatments to the back pain, one topic that has not received much attention is pain management. There are a myriad of diagnoses that are in order to identify what is the primary, secondary or tertiary reason someone needs medical care for back pain. Since it is human nature to seek conservative treatment before opting for surgery, the spine industry has seen an influx of new therapies and entrants. No longer is the orthopedic and neurosurgeon the primary gatekeeper, today we see more and more anesthesiologist (aka pain managers) and interventional radiologist participating in the patient's modality of treatment. With new markets come new opportunities. Why? Because physicians look for newer and potentially better ways of addressing pain, along with newer avenues to supplement their income. No different than you and I. Yes, readers while the Wall Street analysts focus on the legacy companies, 2010 can become the year of Pain Management.

Pain Management has evolved from hot and cold therapies, the advent of TENS units, electrical bone stimulators, and chiropractic care. Even in today's world we see more and more physicians aligning themselves with chiropractic care in their offices or centers. These are only a few modalities that aide patients in alleviating pain. We have more invasive procedures being performed by interventional radiologists and anesthesiologists in some cases with the assistance of orthopedic and neurosurgeons. As this dynamic unfolded, we have more and more physicians looking to perform surgical procedures in twenty-three hour stay ambulatory surgery centers or pain management centers.

Recently, TSB wrote a blog entitled; "Is it Nu, Is it Tru, does it Loc and does it Fuse?" The blog centered on the introduction of facet fusion dowels and a rectangular wedge that had been exhibited at NASS. The reader response was overwhelming. Some intelligent, some adversarial, some beyond the sublime. But regardless of your personal opinions about people involved in this market, it seems that these little companies are picking up more and more traction in today's uncertain healthcare environment. These companies included NuTech, TruFuse, VertiLoc, Facet Fusion Technologies and even Bacterin has entered the fray (I believe they were involved with the original NuTech). In addition, word on the street has been that even NuVasive is looking at this market.

There is much controversy surrounding this modality of treatment. These allografts are manufactured out of cortical bone since it is very difficult to machine cancellous bone due to its spongy nature. In addition, most of us continue to obsess about fusion. If it doesn't fuse the facet, it's not doing its job. Along with these companies we have seen US Spine, Trans1 and Facet Solutions offer alternatives to facet pain management. So the question must be asked of our readers, are these companies going away? Or, are they taking advantage of an entirely new market that has the potential to grow regardless of how in-the-box many of us are in our thought process.

Considering that the facet has features similar to other joints in our body, is the only alternative fusion, or are we looking at this in the wrong way? The company that comes up with the best access instrumentation for percutaneous implantation and implant design could be the winner in a race that none of us know what the final outcome will be. TSB wants to know what our readers think?


  1. Great article, great food for thought. I carry a facet fusion device in the midwest and must come to the conclusion that the use of the device in pain management is all dependent on hospital credentialing systems. I have had countless pain management physicians contact me about using the product as a huge asset to their practice. However, it has been nearly two years and I have yet to do a case with any pain management physicians. Hospitals- at least in my area- are simply not allowing/credentialing the device to be utilized by these physicians. Essentially, it depends on hospital control.

    Perhaps the more difficult task is regulating the politics that occur between the pain management physician and the spine surgeon. In my experience few surgeons don't care, most have a big issue with it, and frankly some surgeons look at it as an opportunity for more revision cases. However, I believe these devices have their place in the market....with the proper patient selection. It just depends on where the cases are being done and how much push back there is from the spine surgeon community.

  2. I too sell a facet fusion device, and am now looking for independant distributors who can carry our new facet systems in Houston, Austin and San Antonio...if anyone knows a hungry agent or distributor let me know! You an call me the "Spine Specialy Consultant"

  3. I might be able to help out in austin. Please send some info

  4. The real question is going to be whether payers continue to reimburse the procedure??

    Idet is a perfect example. The industry didn't invest in showing that the treatment is better than the gold standard which is conservative treatment. Furthermore they couldn't prove that the procedure was better than placebo. Patient criteria and pathology wasn't properly utilized other than a study from the Cleveland Clinic which was designed well.

    What we need is a legit study to show that the percutaneous facet fusion works as well as a standard pedicle screw fusion or just works in general.

  5. Thanks for the great and useful post/article on Pain Management

  6. I am a pain management interventionalist currently performing TruFuse facet fusions. I solved the credentialing problem at my hospital simply...I bypassed them. Most pain specialists have access to ASCs, that's where I perform these procedure. When I can't, due to insurance reasons, I continue more conservative therapy.

    I do not see much of a conflict between surgeons and my performance of this procedure, as this patient population is not interested or have already been precluded as surgical candidates. They are culled from within my practice, many who have been referred by surgeons.

    There are several issues that pain management specialists need to contend with regarding this modality, the first is growing balls and standing up to their surgical colleagues. The idea that we are stealing patients from a more established therapy, or have no business using a hammer is ridiculous. No one complains when I implant pumps or stimulators. Facet fusion is not a new concept. What is new is the burgeoning self-awareness of my specialty which allows us to think and make decisions based on experience within our field.

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  8. Thank you for sharing this post and giving more idea about pain management and also Lower Back Pain Treatment

  9. I am so happy to read your article here. Very refreshing and new to me!keep going.

    Dr. Carl Balog

  10. Very informative post. Thanks for taking the time to share your view with us.
    San Antonio Spine Clinic

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