title: The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation Appropriateness Consensus Committee.
abstract: BACKGROUND
  The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain.
  
  
  METHODS
  The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors.
  
  
  RESULTS
  The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational.
  
  
  CONCLUSIONS
  The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
authors.affiliation: Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
authors.forename: Erika
authors.initials: E
authors.lastname: Petersen
authors.forename: Elliot
authors.initials: E
authors.lastname: Krames
authors.forename: Peter
authors.initials: P
authors.lastname: Staats
authors.forename: Jason
authors.initials: J
authors.lastname: Pope
authors.forename: Youssef
authors.initials: Y
authors.lastname: Saweris
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Sudhir
authors.initials: S
authors.lastname: Diwan
authors.forename: Steven
authors.initials: S
authors.lastname: Falowski
authors.forename: Claudio
authors.initials: C
authors.lastname: Feler
authors.forename: Konstantin
authors.initials: K
authors.lastname: Slavin
authors.forename: Samer
authors.initials: S
authors.lastname: Narouze
authors.forename: Lotfi
authors.initials: L
authors.lastname: Merabet
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Joshua
authors.initials: J
authors.lastname: Wellington
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005157:Facial Pain / Q000628:therapy; D006261:Headache / Q000628:therapy; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans; D008881:Migraine Disorders / Q000628:therapy*; D009493:Neurosurgery / Q000193:education; D059408:Pain Management / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D018579:Patient Selection; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods; D018084:Ultrasonography, Interventional; D055536:Vagus Nerve Stimulation / Q000295:instrumentation / Q000379:methods
chemical_list: D000700:Analgesics; D000925:Anticoagulants
keywords: Cranial nerve stimulation; deep brain stimulation; migraine; motor cortex stimulation; neurostimulation; occipital nerve stimulation; peripheral nerve stimulation; trigeminal nerve stimulation; vagal nerve stimulation