title: The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation Appropriateness Consensus Committee.
abstract: BACKGROUND
  The International Neuromodulation Society (INS) has determined that there is a need for guidance regarding safety and risk reduction for implantable neurostimulation devices. The INS convened an international committee of experts in the field to explore the evidence and clinical experience regarding safety, risks, and steps to risk reduction to improve outcomes.
  
  
  METHODS
  The Neuromodulation Appropriateness Consensus Committee (NACC) reviewed the world literature in English by searching MEDLINE, PubMed, and Google Scholar to evaluate the evidence for ways to reduce risks of neurostimulation therapies. This evidence, obtained from the relevant literature, and clinical experience obtained from the convened consensus panel were used to make final recommendations on improving safety and reducing risks.
  
  
  RESULTS
  The NACC determined that the ability to reduce risk associated with the use of neurostimulation devices is a valuable goal and possible with best practice. The NACC has recommended several practice modifications that will lead to improved care. The NACC also sets out the minimum training standards necessary to become an implanting physician.
  
  
  CONCLUSIONS
  The NACC has identified the possibility of improving patient care and safety through practice modification. We recommend that all implanting physicians review this guidance and consider adapting their practice accordingly.
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: David
authors.initials: D
authors.lastname: Provenzano
authors.forename: Jason
authors.initials: J
authors.lastname: Pope
authors.forename: Elliot
authors.initials: E
authors.lastname: Krames
authors.forename: Simon
authors.initials: S
authors.lastname: Thomson
authors.forename: Lou
authors.initials: L
authors.lastname: Raso
authors.forename: Allen
authors.initials: A
authors.lastname: Burton
authors.forename: Jose
authors.initials: J
authors.lastname: DeAndres
authors.forename: Eric
authors.initials: E
authors.lastname: Buchser
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.forename: Liong
authors.initials: L
authors.lastname: Liem
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: Syed
authors.initials: S
authors.lastname: Rizvi
authors.forename: Claudio
authors.initials: C
authors.lastname: Feler
authors.forename: David
authors.initials: D
authors.lastname: Abejon
authors.forename: Jack
authors.initials: J
authors.lastname: Anderson
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
authors.forename: Philip
authors.initials: P
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Leong
authors.forename: Salim
authors.initials: S
authors.lastname: Hayek
authors.forename: Gladstone
authors.initials: G
authors.lastname: McDowell
authors.forename: Lawrence
authors.initials: L
authors.lastname: Poree
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Brooks
authors.forename: Tory
authors.initials: T
authors.lastname: McJunkin
authors.forename: Paul
authors.initials: P
authors.lastname: Lynch
authors.forename: Leo
authors.initials: L
authors.lastname: Kapural
authors.forename: Robert D
authors.initials: RD
authors.lastname: Foreman
authors.forename: David
authors.initials: D
authors.lastname: Caraway
authors.forename: Ken
authors.initials: K
authors.lastname: Alo
authors.forename: Samer
authors.initials: S
authors.lastname: Narouze
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.forename: Richard
authors.initials: R
authors.lastname: North
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects; D004869:Equipment Safety; D019317:Evidence-Based Medicine; D006406:Hematoma / Q000209:etiology; D006801:Humans; D009493:Neurosurgery / Q000193:education; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010353:Patient Education as Topic; D018579:Patient Selection; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D040242:Risk Reduction Behavior; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014946:Wound Infection / Q000209:etiology / Q000517:prevention & control
keywords: Chronic pain; complications; guidance; neurostimulation; peripheral nerve stimulation; risk reduction; spinal cord stimulation