The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Best Practices for Cervical Neurostimulation.

INTRODUCTION: The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on the use of neurostimulation in the cervical region to improve outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for an often-overlooked area of neurostimulation practice. MATERIALS AND METHODS: Authors were chosen based upon 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 2017 (when NACC last published guidelines) to the present. Identified studies were graded using the US Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS: The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS: The NACC recommends best practices regarding the use of cervical neuromodulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be utilized as a guide to assist decision making when clinically appropriate.

Peripheral neuromodulation for pain.

The past decade (1999-2009) has witnessed a dramatic increase in the use of electrical stimulation to treat chronic, intractable pain. The implantation of electrodes in close proximity to peripheral nerves, known as peripheral nerve stimulation, has been enthusiastically adopted by neurosurgeons and interventional pain specialists. The most common conditions treated with this technique are headache and complex regional pain syndromes. The potential application of peripheral neuromodulation to relatively common and frequently disabling conditions such as migraine and lower back pain represents an exciting phase in the evolution of contemporary pain surgery. We review the available evidence relating to the use of peripheral nerve stimulation for the treatment of medically refractory, chronic non-cancer pain in a variety of clinical situations, highlight the absence of randomised controlled studies, and emphasise the need for scientifically sound research in this field.