ICDs, Occipital stimulation for Migraine and Treatment of Vertebral Fractures

10th May 2013 by Louise Hudman

Subcutaneous ICDs
The first guideline advises that subcutaneous ICDs can be used. Traditional ICDs have leads placed transvenously, which is more complicated and requires a GA. Subcutaneous ICDs seem to be safe and effective, though so far data is on short term use. A nice to know detail only!

Occipital Stimulation for Migraine
This guideline advises that occipital nerve stimulation can be used for intractable chronic migraine. There isn’t enough good data to be sure that it is effective, though some small studies suggest that it may be. A neurostimulator is placed subcutaneously and leads run to the level of the occipital nerve, so it doesn’t sound the simplest of procedures. Worth being aware of as patients may ask about it…

Percutaneous Vertebroplasty and Balloon Kyphoplasty for Vertebral Fractures
This guideline isn’t talking about new procedures, but they do seem to go in and out of fashion. These procedures do both work and also confer a mortality benefit. The main thing for us to be aware of is that the earlier these patients are treated, the better (ideally around the 6 week mark, when the pain should have settled if it’s going to, but before the fractures have fully healed). However, patients must already be on ‘optimal pain relief’, which is tricky to achieve by 6 weeks and my experience of these patients is that they often present quite late. As these procedures are normally organised by the pain clinic they’ll also have to wait about 3 months to get seen. So all in all, nice to know it works, but not very practical.

Read more

No credit card details needed – it takes two minutes.

Join free trial

Login

Already a member? Login to view this content.

Login

"I fell into a salaried role post-CCT, so faced with an unexpected relocation to a completely new area of the country the thought of GP locuming was incredibly daunting.

The assistance I have received from NASGP has been invaluable. I have received excellent and patient admin support when setting up my LocumDeck account. I have enjoyed the monthly chambers meetings I have attended: this made locuming feel far less isolating.

I have easily found plentiful work and am grateful for the invoicing and pension forms being taken care of – this gives me time to focus on the clinical work or make the most of precious days off.

With the support of NASGP Locum Chambers I have filled my diary working in a variety of practices in my new area, and have now joined one practice I enjoyed locuming at on a salaried basis while I continue to do some locum work on top using LocumDeck."

Dr Joanne Wright, Essex

See the full list of features within our NASGP membership plans

Membership