HOW IT WORKS - CERTIFICATION - STUDIES - REIMBURSEMENT
How It Works: Axon-II Physiology
Conventional EMG (electrical muscle graph) cannot test the nerves causing pain, which is the reason why 40% of patients seek medical help. Only 2% of pain patients have motor nerve symptoms for which EMG is effective. Massachusetts General Hospital Handbook of Pain Management 2005 "EMG/NCV cannot test small pain fibers." "In MOST cases (over 50%) of neck and back pain the anatomic and physiologic diagnosis remains unclear." Neurological Text by Weiner & Goetz Lippinott 2005 "EMG/NCV in the absence of motor symptoms, such as muscle weakness, is costly, time consuming and seldom benefits the patient.
This is the reason 43% of pain patients become chronic and 50% to 80% of back surgeries end in failures. The medical literature does not support that symptoms, physical exams, EMG/NCV or MRI can detect which nerve is causing pain. Only the AXON-II tests pain fibers!
GUYTON & HALL EXPLAIN HOW PAIN IS REFERRED
At least 50% of patients misdirect doctors away from the source of pain due to referred symptoms. Over 90% of A-delta fibers reach the sensory cortex so they should allow the patient to exactly localization of the source of pain, but injury causes A-delta fiber to become numb. However, the poor localizing C-Type fiber keep functioning and can even up-regulate. The result is that 50% of patients are so confused they may even localize pain as coming from the opposite side. Guyton states: "It explains why patients often have serious difficulty in localizing the source of some types of chronic pain."
The AXON-II detects down-regulated A-delta function to locate injured nerve(s) with statistical sensitivity approaching 100%. The patented electrical signal selectively stimulates A-delta fibers. The highest amplitude causing an action potential indicates pathology. A potentiometer verifies firing by detecting the action potential. Since the patient is his own control, independent of age or gender and population variables, the sensitivity is as high as is possible. High potentiometer amplitudes have been reported to have a close correlation with high VAS ratings. The AXON-II can also test C and A-beta fibers, which is useful when RSD or sympathetically mediated pain syndrome is suspected.
Certification
AMA and Medicare guidelines support that any physician can perform and supervise electrodiagnostic examinations (EDX). The AANEM (N stands for 'neuromuscular') is limited to conventional EMG/NCV and NCS of the large motor and large, well myelinated, A-beta (light touch) fibers. Many do not realize the 'M' in EMG stands for Muscle/Motor, and not 'Myelin' (fatty nerve covering) or 'myelo' (spinal cord). Only the American Association of Sensory Electrodiagnostic Medicine (AASEM), a nationally recognized medical organization offering CME credit, represents physicians performing pain fiber nerve conduction studies (pf-NCS).
PainDX, Inc. encourages all physicians using the AXON-II to become certified. Contact the AASEM about certification in pf-NCS. Learn more about certification and reimbursement issues on the AASEM web site - www.sensorymedicine.org
Studies
Studies increasingly are being published and presented at scientific meetings. Recently, the Axon-II helped researchers detect a relationship between chronic prostatitis and vulvadynia with S1 radiculopathy. (Baddrodoja, Bush et al) See News & Events and Studies.
Reimbursement
The American Association of Sensory Electrodiagnostic Medicine (AASEM) is a nationally recognized medical organization offering CME credit. The AASEM Practice Guidelines and Consensus of pf-NCS certified physicians supports that code 95904 is appropriate.
Localizing Injury
In the spinal cord A-delta fibers synapse with motor neurons in the ventral motor pathway, so firing generates voltage directly from the A-delta fibers and sub-threshold voltage from the motor fibers. In minutes a nurse can test all the major nerves and their branches in a region - 18 (9 bilateral) in the cervical and 14 (7 bilateral) in the lumbar region. The nerve(s) requiring the highest voltage to fire identifies the injured nerve(s). Once the injured nerve is identified, testing proximal and distal to a suspected site of injury easily verifies the location.
For example; testing above and below both right and left medical elbows detects cubital tunnel entrapment. The non-symptomatic side acts as a control. Comparing median nerve branches in the fingers with the radial nerve (back of the hand) allows differentiation between carpal tunnel entrapment and nerve root pathology since the median and radial nerves originate from the same nerve roots, C6-7. The palmar branches of the median and ulnar nerve pass over the wrist, not through the carpal tunnel or Guyon's canal respectively, so palmar sites differentiate between proximal and wrist entrapments. The same differentiation is at works in the lower extremity where, like the cervical study, all the lumbosacral sites are proximal to sites of entrapment in the ankle. Any branch of a cutaneous nerve can be tested to map the dysfunctional area.
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