Expert Panel of Physicians and Neuroscientists Announce International Guidance on Using Neurostimulation for Chronic Pain

Newswise — BERLIN (June 10, 2013) -- 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.

About the Neuromodulation Appropriateness Consensus CommitteeThe NACC is comprised of internationally recognized physicians and surgeons who have deep experience in both patient care, and the conduct of peer-reviewed medical research. Committee members include:

Timothy R. Deer, M.D. (The Center for Pain Relief, Charleston, WV, USA) David Abejón, M.D., Ph.D. (Pain Unit of the University Hospital “Puerta de Hierro”, Madrid, Spain) Kenneth Alo, M.D. (Pain Management, The Methodist Hospital Research Institute, Houston, TX, USA)Jack Anderson, M.D. (Arizona Pain Specialists, Scottsdale, AZ, USA)Eric Buchser, M.D. (Center for Neuromodulation EHC, Morges, Switzerland)Allen W. Burton, M.D. (University of Texas M.D. Anderson Cancer Center, Houston, TX, USA) Asokumar Buvanendran, M.D. (Rush University Medical Center, Chicago, IL, USA)Kenneth Candido, M.D. (University of Illinois College of Medicine, Illinois Masonic Medical Center, Chicago, IL, USA)David Caraway, M.D., Ph.D. (The Center for Pain Relief Tri-State, Huntington, WV, USA)Michael Cousins, M.D. (Kolling Institute of Medical Research at the Royal North Shore Hospital Sydney, NSW, Australia Royal North Shore Hospital, Sydney, Australia)Jose De Andres, M.D., Ph.D., FIPP, EDRA (Anesthesia Division, Surgical Specialties Department, Valencia School of Medicine; Anesthesia Critical Care and Multidisciplinary Pain Management Department, Valencia University General Hospital, Valencia, Spain) Mike JL DeJongste, M.D., Ph.D., FESC (University Medical Center Groningen and University of Groningen, Groningen, Netherlands)Sudhir Diwan, M.D. (Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York NY, USA)Sam Eldabe, M.D. (The James Cook University Hospital in Middlesbrough, UK)Claudio Feler, M.D. (High Mountain Brain and Spinal Surgery, Glenwood Springs, CO, USA)Robert Foreman, Ph.D. (University of Oklahoma Health Sciences Center, School of Medicine, Oklahoma City, Oklahoma, USA)Felipe Fregni, M.D., Ph.D., M.P.H. (Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA)Kliment Gatzinsky, M.D., Ph.D. (Dept. of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden)Stanley Golovac, M.D. (Florida Pain Specialist, Merritt Island, Florida, USA)Salim Hayek, M.D., Ph.D. (Dept. of Anesthesiology, Case Western Reserve University; Div. of Pain Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA)Marc Huntoon, M.D. (Vanderbilt University, Nashville, TN, USA)Leo Kapural, M.D., Ph.D. (Wake Forest University Health Sciences Center Chronic Pain Center, Carolinas Pain Institute and Center for Clinical Research, NC, USA)Philip S. Kim, M.D. (Center for Interventional Pain Spine, Bryn Mawr PA and Newark DE USA) Thomas Kinfe, M.D. (Dept. of Neurosurgery, Heinrich Heine University, Dusseldorf, Germany)David Kloth, M.D. (President/Medical Director Connecticut Pain Care, Danbury, CT, USA)Elliot Krames, M.D., DABPM (Pacific Pain Treatment Centers, San Francisco, CA, USA)Krishna Kumar, M.D. (University of Saskatchewan, School of Medicine, Canada)Nandan Lad, M.D., Ph.D. (Duke University Medical Center, Durham, N.C., USA)Michael Leong, M.D. (Stanford University, Palo Alto, CA, USA)Robert M. Levy, M.D., Ph.D. (University of Florida, Jacksonvile, FL, USA) Liong Liem, M.D. (St. Antonius Hospital, Nieuwegein, Netherlands) Bengt Linderoth, M.D., Ph.D. (Karolinska Institute, Stockholm, Sweden)Paul Lynch, M.D. (Arizona Pain Specialists, Scottsdale, AZ, USA)Sean Mackey, M.D., Ph.D. (Division of Pain Medicine, Stanford University, Palo Alto, CA, USA) Gladstone McDowell II, M.D. (Integrated Pain Solutions, Columbus, OH, USA) Tory McJunkin, M.D. (Arizona Pain Specialists, Scottsdale, AZ, USA) Porter McRoberts, M.D. (Holy Cross Hospital, Fort Lauderdale Florida, USA) Nagy Mekhail, M.D., Ph.D. (Cleveland Clinic, Cleveland, Ohio, USA)Lotfi Merabet, O.D., Ph.D. (Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA)Samer Narouze, M.D., Ph.D. (Center For Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA) Richard North, M.D. (LifeBridge Health Brain & Spine Institute, Baltimore, MD, USA)Judith A. Paice, R.N., Ph.D. (Northwestern University Feinberg School of Medicine Chicago, IL, USA) Erika Petersen, M.D. (University of Arkansas for Medical Sciences, Little Rock, AR, USA)Jason Pope, M.D. (Center for Pain Relief Inc., Charleston, WV, USA)Lawrence Poree, M.D., Ph.D. (Pain Clinic of Monterey Bay, CA, USA)Joshua P. Prager, M.D., M.S. (Center for Rehabilitation of Pain Syndromes, Los Angeles, CA, USA) David Provenzano, M.D. (Institute for Pain Diagnostics and Care, Ohio Valley General Hospital, Pittsburgh, PA, USA)Lou Raso, M.D. (Jupiter Interventional Pain Management Corp., Jupiter, FL, USA)Richard Rauck, M.D. (The Center for Clinical Research, Winston-Salem, NC, USA)Marc Russo, M.D. (Hunter Pain Clinic, Newcastle, NSW, Australia)Michael Saulino, M.D., Ph.D. (Moss Rehab Thomas Jefferson Univ. Elkins Parks, PA, USA) Ashwini Sharan, M.D. (Thomas Jefferson University, Philadelphia, PA, USA)Brian Simpson, M.D. (Cardiff and Vale University Health Board, Cardiff, Wales, UK) B. Todd Sitzman, M.D., M.P.H. (Advanced Pain Therapy, Forrest General Cancer Ctr., Hattiesburg, MS, USA) Konstantin Slavin, M.D. (Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA)Peter Staats, M.D. M.B.A. (Premier Pain/American Pain Medicine, Colts Neck, NJ, Johns Hopkins University, Baltimore, MD, USA)Michael Stanton-Hicks, M.D. (Cleveland Clinic, Cleveland, OH, USA) Simon Thomson, M.D. (Basildon and Thurrock University NHS Trust, Basildon, Essex, UK)Jean Pierre Van Buyten, M.D. (AZ Nikolaas, Sint-Niklaas, Belgium)Paul Verrills, M.D. (Metro Spinal Clinic, Melbourne, Australia)Joshua Wellington, M.D. (Indiana University Medical Center, Indianapolis, IN, USA)Kayode Williams, M.D., M.B.A., FFARCSI (Johns Hopkins School of Medicine, Baltimore, MD, USA)

Note to editors: For details about the NACC recommendations, see today’s related news release, “Expert Panel of Physicians and Neuroscientists Announce International Guidance on Using Neurostimulation to Significantly Reduce the Need for Opioids in Chronic Pain”.

About the International Neuromodulation Society (INS)The INS is a nonprofit group of clinicians, scientists and engineers dedicated to scientific development and knowledge of neuromodulation, a rapidly growing family of therapies developed to help relieve pain or restore function by delivering electromagnetic stimulation or chemical agents to specific sites in the body. Founded in 1989 and based in San Francisco, Calif., the INS has 15 current and four forming chapters worldwide, and educates and promotes the field through meetings, its journal Neuromodulation: Technology at the Neural Interface, and chapter websites. For more information, please visit