title: The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee.
abstract: BACKGROUND
  The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications.
  
  
  METHODS
  The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar.
  
  
  RESULTS
  Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated.
  
  
  CONCLUSIONS
  Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.
authors.affiliation: Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
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authors.lastname: Mekhail
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authors.lastname: Provenzano
authors.forename: Jason
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authors.initials: RM
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authors.forename: Robert D
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authors.forename: Thomas
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authors.lastname: Kinfe
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authors.lastname: Kloth
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authors.forename: Syed
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authors.lastname: Rizvi
authors.forename: Shivanand P
authors.initials: SP
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authors.lastname: Liem
authors.forename: Bengt
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authors.lastname: Linderoth
authors.forename: Sean
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authors.lastname: Mackey
authors.forename: Gladstone
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authors.lastname: McDowell
authors.forename: Porter
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authors.forename: Lawrence
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authors.lastname: Poree
authors.forename: Joshua
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authors.lastname: Prager
authors.forename: Lou
authors.initials: L
authors.lastname: Raso
authors.forename: Richard
authors.initials: R
authors.lastname: Rauck
authors.forename: Marc
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authors.lastname: Russo
authors.forename: Brian
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authors.lastname: Simpson
authors.forename: Konstantin
authors.initials: K
authors.lastname: Slavin
authors.forename: Peter
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authors.lastname: Staats
authors.forename: Michael
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authors.lastname: Stanton-Hicks
authors.forename: Paul
authors.initials: P
authors.lastname: Verrills
authors.forename: Joshua
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mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000787:Angina Pectoris / Q000628:therapy; D000925:Anticoagulants / Q000627:therapeutic use; D057189:Checklist; D059350:Chronic Pain / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D059408:Pain Management / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D010525:Peripheral Nerves / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D062187:Spinal Cord Stimulation
chemical_list: D000700:Analgesics; D000925:Anticoagulants
keywords: Angina pectoris; Reynaud's syndrome; chronic pain; complex regional pain syndrome; failed back surgery syndrome; high-frequency electrical stimulation; ischemic pain; neuropathic pain; nociceptive pain; phantom limb pain; postherpetic neuralgia; spinal cord stimulation