International experts formulate guidance for neuromodulation practitioners

An international panel of experts has formulated guidance for neuromodulation practitioners that reflects increasing recognition of the value of this growing field. The inaugural Neuromodulation Appropriateness Consensus Committee (NACC) unites more than 60 leading physicians and medical researchers in articulating patient selection criteria, training recommendations, technique considerations, and therapeutic goals. The guidance was announced at the start of the 11th World Congress of the International Neuromodulation Society (INS) in Berlin.

"Neuromodulation provides pain physicians an established therapeutic alternative to long-term opioid use when treating appropriately selected chronic pain patients," said Dr. Timothy Deer, INS president-elect and director of the Center for Pain Relief in Charleston, W. Va., who spearheaded the initiative. "These 'digital drugs' provide programmable, adjustable, and reversible treatment."

Rather than rely on pills, tablets, or injections, neuromodulation employs advanced medical devices to deliver electrical stimulation or chemical agents to precise locations in the body. Neuromodulation therapies address a range of conditions, controlling chronic pain or the tremor and stiffness of movement disorder, or helping to restore function, such as with the cochlear implant.

Often the systems use minimally invasive techniques, can be trialed in advance, allow patients to choose between settings with a remote control, and are powered with batteries similar to the power supply of a cardiac pacemaker. Developed over the last 45 years, neuromodulation systems continue to become more sophisticated and diverse as practitioners influence development of approaches and devices that augment patient care. Since first becoming commonly available in the 1980s, spinal cord stimulators, for instance, are now implanted in an estimated 4,000 patients a year in the United States.

"Neuromodulation devices are a unique paradigm in medicine, and clinical experience has been growing quickly among a number of specialties, from pain interventionists to urologists, neurocardiologists, and cancer specialists. The NACC guidance gathers our best evidence based upon both clinical research trials and experts' informed, direct clinical experience," Deer said.

The NACC guidance is being submitted for peer-reviewed to the INS journal Neuromodulation: Technology at the Neural Interface.

Neuromodulation for chronic pain has allowed many patients to live more comfortably and resume more activities. For instance, a large proportion of patients with failed back surgery syndrome, sciatica, radiculopathy, or complex regional pain syndrome have found relief through this method.

As the population ages and lives longer with chronic disease, the need is expected to grow. A multi-country survey reported in 2013 shows that one out of five Europeans suffers from chronic non-cancer pain, and chronic pain costs the European healthcare system as much as €300 billion a year in medical treatment and lost productivity. Throughout the developed world, 20 percent of people live with chronic non-cancer pain, according to the WHO. In 2011, the Institute of Medicine reported that more than 100 million Americans live with pain, at a cost of up to $635 billion a year.

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