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

Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason E.; Krames, Elliot S.; Leong, Michael S.; Levy, Robert M.; Abejón, David; Buchser, Eric; Burton, Allen W.; Buvanendran, Asokumar; Candido, Kenneth D.; Caraway, David; Cousins, Michael J.; DeJongste, Michael J. L.; Diwan, Sudhir; Eldabe, Sam; Gatzinsky, Kliment; Foreman, Robert D.; Hayek, Salim M.; Kim, Philip; Kinfe, Thomas M.; Kloth, David; Kumar, Krishna; Rizvi, Syed; Lad, Shivanand P.; Liem, Liong; Linderoth, Bengt; Mackey, Sean; McDowell, Gladstone; McRoberts, Porter; Poree, Lawrence; Prager, Joshua P.; Raso, Lou; Rauck, Richard; Russo, Marc; Simpson, Brian; Slavin, Konstantin V.; Staats, Peter S.; Stanton‐Hicks, Michael; Verrills, Paul; Wellington, Joshua; Williams, Kayode; North, Richard B.

doi:10.1111/ner.12208

Cited by 460 publications

(353 citation statements)

References 362 publications

(411 reference statements)

Supporting

Mentioning

333

Contrasting

Unclassified

Order By: Relevance

“…These conclusions are consistent with the recommendations for the Neuromodulation Appropriateness Consensus Committee (NACC) 18 which found high‐level or moderate‐level clinical evidence to recommend SCS for neuropathic pain (FBSS, radicular pain, complex regional pain syndrome) but found insufficient, low‐quality, or contradictory evidence for SCS use (including high frequency SCS) in patients with predominant low back pain.…”

Section: Introductionsupporting

confidence: 82%

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Deckers

Smedt

Mitchell³

et al. 2018

Neuromodulation: Technology at the Neural Interface

Self Cite

View full text Add to dashboard Cite

ObjectivesThe purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS).Materials and MethodsFifty‐three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2‐point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL; EQ‐5D).ResultsFor 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided satisfactory pain relief, the responder rate was 58%. The percentage of subjects at 90 days, six months, and one year with ≥MCID improvement in single day NRS was 63%, 61%, and 57%, respectively. Percentage of subjects with ≥MCID improvement in ODI was 52%, 57%, and 60% while those with ≥MCID improvement in EQ‐5D was 88%, 82%, and 81%. There were no unanticipated adverse events (AEs) or serious AEs related to the device, procedure, or therapy. The initial surgical approach led to a risk of lead fracture, which was mitigated by a modification to the surgical approach.ConclusionsElectrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP. Results demonstrate clinically important, statistically significant, and lasting improvement in pain, disability, and QoL.

show abstract

Section: Introductionsupporting

confidence: 82%

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Deckers

Smedt

Mitchell³

et al. 2018

Neuromodulation: Technology at the Neural Interface

Self Cite

View full text Add to dashboard Cite

show abstract

“…Несмотря на это, Международный согласительный комитет по целе-сообразности применения нейромодуляции (англ. The Neuromodulation Appropriateness Consensus Committee, NACC) пришел к выводу, что применение спинальной нейростимуляции, в сравнении с консерва-тивной терапией, способно снизить вероятность ампу-тации конечности и интенсивность болевого синдрома у пациентов с КИНК при недоступности реконструк-тивных хирургических вмешательств и невосприимчи-вости к консервативной терапии (класс доказательнос-ти B) [63]. В связи с этим при невозможности прямой реваскуляризации NACC рекомендует применение SCS перед планируемой симпатэктомией, несмотря на боль-шую доказательную базу последней (таблица).…”

Section: Reviewsunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

View full text Add to dashboard Cite

Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

show abstract

“…The NACC recommends that SCS be considered after conventional multidisciplinary management (usually 3-6 months) has failed in patients with neuropathic or mixed pain. 4,5 Patients should have a well-defined, non-cancer, physiological cause of pain. 4 Contra-indications should be excluded.…”

Section: Patient Selectionmentioning

confidence: 99%

“…These include systemic or local infection, coagulopathy, need for anticoagulant or antiplatelet therapy that cannot be temporarily stopped, and uncontrolled psychiatric/psychological problems. 5 Depression, anxiety, somatisation, and poor coping…”

Section: Patient Selectionmentioning

confidence: 99%

Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

2017

View full text Add to dashboard Cite

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

Cited by 460 publications

References 362 publications

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

Contact Info

Product

Resources

About