“It depends how much patients want to be treated. Some patients get better and decide they don’t need to take medication anymore. Sometimes it’s because of side effects, sometimes cost, and sometimes people just have an aversion to taking medication.
What I normally do is take it to the next step. If they’re noncompliant with medications, I offer them PTNS. That basically takes side effects out of the equation, but does require patient time commitments—coming into the office once a week for 3 months, then monthly after that. Some patients find it refreshing; they don’t have side effects or the cost, and it’s similar to acupuncture so in a way, it's sort of natural.
Then there’s Botox and the patient doesn’t have to see you in the office or take a medication for several months. The downside is they need an injection every 4 to 6 months, but they avoid side effects.
Sometimes patients who like PTNS don’t like coming into the office, or can’t, because of transportation or other issues. I tell them to go on Amazon and buy a TENS unit. It works like PTNS, but patients can do it themselves. They put the stickers on their ankle and stimulate themselves while watching TV. People are more open to treating themselves at home and it helps with symptoms.
The downside is we’re not there to monitor to make sure they’re doing it correctly and getting the results they should be getting. But it sometimes works for patients whose insurance doesn’t cover PTNS.”
Shahrad Aynehchi, MD