Functional Anaesthetic Discography™ Procedure

[Discipher]

The proprietary Discyphor™ Catheter allows the physician to isolate the source of lower back pain by selectively anesthetizing suspected disc(s) while the patient performs activities that typically generate pain.

Study Of Disc Anaesthesia For The Preoperative Diagnosis Of Chronic Lower Back Pain - Full Text View - ClinicalTrials.gov

[mmglobal]

Originally Posted by Sent via private message:

Dear Discyphor:

Welcome to iSpine. Functional anesthtic discography is very interesting. I know several doctors who have been doing them for years. It's an exciting new concept and I hope it's not just a FAD.

Your 2 posts to date, both about FAD seem quite like marketing. We welcome the data here, but we prefer that it come from participating members of the communiy instead of posters who may hit and run with marketing shots. I hope that you are a new member and will be participating in the community. If you have an insterest in FAD other than as a patient or spine researcher, post about here. As I said, we like the data, but also want transparency.

It is often too difficult or dangerous for anyone involved with a product to post with transparency. If that is the case, we still want the data, but I would ask you to approach me or another prolific poster here and if we think the topic is for the benifit of the community, we'll post it for you.

Again, I hope you'll explain and join the discussion. If there is nothing to explain... accept my apology and still join the community!

All the best,

Mark

Looking for a reply...

[Discipher]

Derby R, Baker R, Wolfer L and Depalma M. Analgesic Discography: Can analgesic testing identify a painful disc? SpineLine. North American Spine Society. 2008 Nov/Dec:17-24.

http://www.spinaldiagnostics.com/sdx...Dec%202008.pdf

[Kathy]

Mark,
Thank you for calling this out to our attention. It looks like you hit the nail on the head, as far as being a solicitor. The user name, is actually a brand name. I went to the profile and there was nothing other than a website link. I followed the link and there was the brand name, which is being used as the user name here. I totally agree with transparency. I'm all about knowledge, but definitely need to consider the source. It's just like when a dr discloses that they have financial intrest in a hospital, a disc, or any other product, facility, or company. That lets us know that there could be a conflict of intrest, we then can decide if we want to take it or leave it.
Thanks for pointing this out,
Kathy

[mmglobal]

Originally Posted by another private message to Discyphor

You have posted again without responding to my prior message. I'll say again... we like the data, but don't like the appearance that your sole purpose here is marketing. All we ask for is transparency. Explain... you can either do it publicly, or confidentially if you'll contact me directly.

Also, please answer my question on your thread about multi-level relief from FAD.

Mark

Question about FAD: If you get a positive response from multi-level FAD, how do you know which discs are responding to the anesthetic? Could be one... could be both...

[Discipher]

Originally Posted by mmglobal

Question about FAD: If you get a positive response from multi-level FAD, how do you know which discs are responding to the anesthetic? Could be one... could be both...

To all readers...I am a medical represenative and am merely providing support for questions regarding product and procedure.

Each level is independently tested. The patient is asked to rate his her pain prior to procedure and at conclusion of catheter placement for a baseline. This pain scale used is the Visual Analog Pain Scale (VAS) or the Numeric Pain Rating Scale (NPRS). Patient’s range of motion is also noted or those specific activites that create patient's pain on set (i.e sitting, standing, flexion, "it hurts when i do this"). Patient is then injected with 0.5 - 0.7 cc of anesthetic, and upon anesthetic onset, asked again to rate his or her pain level (and applicable range of motion). Comparison pain scores and range of motion are measured for anesthetic disc improvement and additional valuable information for consideration of treatment options of discogenic back pain. A two point drop or greater in pain score would indicate that the disc level is a pain generator.

To test if the test is still anesthetized most physicians use saline and test range of motion or their pain generating activites.

[Discipher]

Originally Posted by Discyphor

To all readers...I am a medical represenative and am merely providing support for questions regarding product and procedure.

Each level is independently tested. The patient is asked to rate his her pain prior to procedure and at conclusion of catheter placement for a baseline. This pain scale used is the Visual Analog Pain Scale (VAS) or the Numeric Pain Rating Scale (NPRS). Patient’s range of motion is also noted or those specific activites that create patient's pain on set (i.e sitting, standing, flexion, "it hurts when i do this"). Patient is then injected with 0.5 - 0.7 cc of anesthetic, and upon anesthetic onset, asked again to rate his or her pain level (and applicable range of motion). Comparison pain scores and range of motion are measured for anesthetic disc improvement and additional valuable information for consideration of treatment options of discogenic back pain. A two point drop or greater in pain score would indicate that the disc level is a pain generator.

To test if the test is still anesthetized most physicians use saline and test range of motion or their pain generating activites.

7cc to 1cc of lidocaine typically takes 10 to 20 min to onset so the patient is tested and measured at that level at 5, 10, 15, and 20 min intervals. Once information is collected at that level the next level is injected with .7cc to 1cc of lidiocaine. Most physicians will go from least suspected disk to most suspected disk.

In my experience the average levels tested would be 2-3 most often L3/4-L5-S1.

[mmglobal]

Greetings from Straubing!

I just had a wonderful conversation with discyphor. I was correct in that he's too close to the industry and medical practices to be able to 'come out'. I believe that he posted with the best of intentions and I'm happy to be able to let all the information stand. I invited him to post and participate if he'd like, but in order to do so, he's going to have to say who he works for and what he does. If he can't do that... he'll send me info that he thinks will be useful to the community and I'll post it for him.

We spoke for a long while about FAD and he answered all my questions about potential issues. Two of the principal users/developers of these techniques are doctors that I know well and have the greatest respect for.... Richard Derby is largely thought of as the father of discography. Kevin Pauza is on the forefront of intradiscal therapies that will hopefully be the future of treatments for those of us who catch the problems before they turn into huge structural problems. (I would have been perfect... when I was first disabled by 2-level discogenic pain, I still have very tall discs that looked pretty good on MRI in spite of some minor bulging.)

IMHO, FAD will not be the definitive test that we wish we could have, but it certainly looks like it has the potential to add more useful information to the mix. I'll bet that we'll still get ambiguous results at times, but hopefully, this additional data will allow us to have more information, possibly taking some tests from ambiguous to more determinative.

One interesting note is that FAD started as an adjunct to provocative discography and many users still do it this way. However, as some practitioners get more comfortable with FAD, they are frequently using it INSTEAD of provocative discography. Won't that be nice to not be tortured by testing over and over... "Yes, that's a 10/10, but is it your pain? And please stop screaming, you are scaring the other victims in the waiting room!"

I've changed the posters username to something other than the trademarked test name. I thank discyphor for the info and for taking the time to talk to me today and look forward to more info from him/her/it/them.

All the best,

Mark

[mmglobal]

This is interesting stuff. From our friendly medical representative, here is some literature on FAD.... FDA documentation, sample reports, etc...

For you technology geeks.... enjoy...

FDA Letter

Procedure Overview

Sample OP Report

Scoresheet

Thanks Discipher!

Mark