The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation Appropriateness Consensus Committee

Neuromodulation. 2014 Aug;17(6):571-97; discussion 597-8. doi: 10.1111/ner.12206.


Introduction: The International Neuromodulation Society (INS) has determined that there is a need for guidance regarding safety and risk reduction for implantable neurostimulation devices. The INS convened an international committee of experts in the field to explore the evidence and clinical experience regarding safety, risks, and steps to risk reduction to improve outcomes.

Methods: The Neuromodulation Appropriateness Consensus Committee (NACC) reviewed the world literature in English by searching MEDLINE, PubMed, and Google Scholar to evaluate the evidence for ways to reduce risks of neurostimulation therapies. This evidence, obtained from the relevant literature, and clinical experience obtained from the convened consensus panel were used to make final recommendations on improving safety and reducing risks.

Results: The NACC determined that the ability to reduce risk associated with the use of neurostimulation devices is a valuable goal and possible with best practice. The NACC has recommended several practice modifications that will lead to improved care. The NACC also sets out the minimum training standards necessary to become an implanting physician.

Conclusions: The NACC has identified the possibility of improving patient care and safety through practice modification. We recommend that all implanting physicians review this guidance and consider adapting their practice accordingly.

Keywords: Chronic pain; complications; guidance; neurostimulation; peripheral nerve stimulation; risk reduction; spinal cord stimulation.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chronic Pain / therapy*
  • Electric Stimulation Therapy / adverse effects*
  • Electric Stimulation Therapy / instrumentation
  • Electric Stimulation Therapy / methods
  • Electrodes, Implanted / adverse effects
  • Equipment Safety
  • Evidence-Based Medicine
  • Hematoma / etiology
  • Humans
  • Neurosurgery / education
  • Pain Management / adverse effects
  • Pain Management / methods*
  • Patient Education as Topic
  • Patient Selection
  • Peripheral Nerve Injuries / etiology
  • Peripheral Nerve Injuries / prevention & control
  • Risk Reduction Behavior
  • Spinal Cord Injuries / etiology
  • Spinal Cord Injuries / prevention & control
  • Spinal Cord Stimulation / adverse effects
  • Spinal Cord Stimulation / instrumentation
  • Spinal Cord Stimulation / methods
  • Wound Infection / etiology
  • Wound Infection / prevention & control