Abstract
Introduction
The field of neurostimulation for the treatment of chronic pain is a rapidly developing
area of medicine. Although neurostimulation therapies have advanced significantly
as a result of technologic improvements, surgical planning, device placement, and
postoperative care are of equal importance to optimize outcomes. This Neurostimulation
Appropriateness Consensus Committee (NACC) project intends to provide evidence-based
guidance for these often-overlooked areas of neurostimulation practice.
Materials and Methods
Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed
literature, research productivity, and contributions to the neuromodulation literature.
Section leaders supervised literature searches of MEDLINE, BioMed Central, Current
Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science,
Google Scholar, and PubMed from the last NACC publication in 2017 to the present.
Identified studies were graded using the United States Preventive Services Task Force
criteria for evidence and certainty of net benefit. Recommendations are based on evidence
strength and consensus when evidence was scant.
Results
This NACC project provides guidance on preoperative assessment, intraoperative techniques,
and postoperative management in the form of consensus points with supportive evidence.
These results are based on grade of evidence, strength of consensus, and expert opinion.
Conclusions
The NACC has given guidance for a surgical plan that encompasses the patient journey
from the planning stage through the surgical experience and postoperative care. The
overall recommendations are designed to improve efficacy and the safety of patients
undergoing these neuromodulation procedures and are intended to apply throughout the
international community.
Keywords
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Article info
Publication history
Accepted:
October 6,
2021
Received in revised form:
September 21,
2021
Received:
April 11,
2021
Footnotes
Source(s) of financial support: This NACC publication was supported by the International Neuromodulation Society (INS) and no authors were paid for their contributions. Sarah Staples, MA, ELS, assisted with manuscript preparation as a part-time contractor for INS.
Conflict of Interest: The following authors reported no conflict of interest: Marc A. Russo, Jay S. Grider, Jonathan M. Hagedorn, Stana Bojanic, Alexander L. Green, N. Nick Knezevic, Stefan Schu, Jay M. Shah, Thomas P. Pittelkow, Asokumar Buvanendran, Kenneth Chapman, Jose Manuel Gonzalez, Navdeep Jassal, Peter Pahapill, Pankaj Mehta, Alessandro Dario, Fabian Piedimonte, and Robert M. Levy. Timothy R. Deer consults for Abbott, Axionics, Saluda, Mainstay, Nalu, Stimgenics, and Nevro; holds a patent with Abbott; is on the advisory boards of Abbott and Nalu; owns stock options from Axionics, Saluda, and Nalu; and has institutional research grants from Abbott, Saluda, and Mainstay. Jason Pope serves as a consultant, is on the advisory boards of, and conducts research for Ethos Labs, Flowonix, Saluda, PainTeq, Aurora Spine, Thermaquil, Abbott, Vertiflex, Vertos, and SPARK; owns stock in PainTeq, Aurora Spine, Thermaquil, Spine Thera, AGR, NIS, Vertos, Celeri Health, and SPARK; receives royalties from Aurora Spine; consults for Medtronic, Boston Scientific, and WISE; conducts research for Celeri Health and Boston Scientific; and serves on the advisory board of Spine Thera. Philippe Rigoard consults for Medtronic, Boston Scientific, Abbott, and Allergan, and his institution does clinical research for Medtronic and Boston Scientific. Ramana Naidu reports consulting fees from Abbott, Boston Scientific, and Nalu, outside the submitted work. Denis G. Patterson reports personal fees from Abbott Medical, Saluda, Nevro, Biotronik, and Nuvectra, outside the submitted work. Derron Wilson reports personal fees from Abbott and Boston Scientific, outside the submitted work. Timothy R. Lubenow reports consulting fees for Abbott, Medtronic, Nevro, Boston Scientific, and Vertiflex; payment or honoraria from Abbott, Vertiflex, and Medtronic; and payment for expert testimony as a plaintiff and defense expert. Samir J. Sheth reports personal fees from Medtronic and Boston Scientific, outside the submitted work. Rany Abdallah reports personal fees from Medtronic, Abbott, SPR Therapeutics, and Avanos during the conduct of the study. Harold Nijhuis reports grants and personal fees from Abbott and personal fees from Saluda, outside the submitted work. Ricardo Vallejo has conducted research for Avanos, and his startup company, Stimgenics, was recently acquired by Medtronic. No royalties or licenses are pending. Michael E. Harned received grants for fellowship education from Medtronic and Abbott and research funding from Nevro. Shachi Patel has received consulting fees from Abbott, outside of the submitted work. Natalie Strand consults for Abbott. Fabian Piedimonte received personal fees from Medtronic and Abbott, outside the submitted work. Robert M. Levy is an uncompensated consultant for Nalu, Saluda Medical, and Mainstay Medical and has stock options from Nalu and Saluda Medical obtained before 2019, and not exercisable through the duration of his term as INS president and editor-in-chief of the journal, Neuromodulation: Technology at the Neural Interface.
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