The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation

Timothy R Deer; Jason E Pope; Tim J Lamer; Jay S Grider; David Provenzano; Timothy R Lubenow; James J FitzGerald; Corey Hunter; Steven Falowski; Dawood Sayed; Ganesan Baranidharan; Nikunj K Patel; Timothy Davis; Alex Green; Antonio Pajuelo; Lawrence J Epstein; Michael Harned; Liong Liem; Paul J Christo; Krishnan Chakravarthy; Christopher Gilmore; Frank Huygen; Eric Lee; Pankaj Metha; Harold Nijhuis; Denis G Patterson; Erika Petersen; Julie G Pilitsis; Jeffery J Rowe; Matthew P Rupert; Ioannis Skaribas; Jennifer Sweet; Paul Verrills; Derron Wilson; Robert M Levy; Nagy Mekhail

doi:10.1111/ner.12845

The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation

Neuromodulation. 2019 Jan;22(1):1-35. doi: 10.1111/ner.12845. Epub 2018 Sep 24.

Authors

Timothy R Deer¹, Jason E Pope², Tim J Lamer³, Jay S Grider⁴, David Provenzano⁵, Timothy R Lubenow⁶, James J FitzGerald^{7

8}, Corey Hunter⁹, Steven Falowski¹⁰, Dawood Sayed¹¹, Ganesan Baranidharan¹², Nikunj K Patel¹³, Timothy Davis¹⁴, Alex Green¹⁵, Antonio Pajuelo¹⁶, Lawrence J Epstein¹⁷, Michael Harned¹⁸, Liong Liem¹⁹, Paul J Christo²⁰, Krishnan Chakravarthy²¹, Christopher Gilmore²², Frank Huygen²³, Eric Lee²⁴, Pankaj Metha²⁵, Harold Nijhuis¹⁹, Denis G Patterson²⁶, Erika Petersen²⁷, Julie G Pilitsis²⁸, Jeffery J Rowe²⁹, Matthew P Rupert³⁰, Ioannis Skaribas³¹, Jennifer Sweet³², Paul Verrills³³, Derron Wilson³⁴, Robert M Levy³⁵, Nagy Mekhail³⁶

Affiliations

¹ Center for Pain Relief, Charleston, WV, USA.
² Evolve Restorative Center, Santa Rosa, CA, USA.
³ Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
⁴ UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
⁵ Pain Diagnostics and Interventional Care, Sewickley, PA, USA.
⁶ Rush University Medical Center, Chicago, IL, USA.
⁷ Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
⁸ Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
⁹ Ainsworth Institute of Pain Management, New York, NY, USA.
¹⁰ Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, PA, USA.
¹¹ University of Kansas Medical Center, Kansas City, KS, USA.
¹² St. James Hospital, Leeds, UK.
¹³ Institute of Clinical Neurosciences, Department of Neurosurgery, Southmead Hospital, University of Bristol, Bristol, UK.
¹⁴ Orthopedic Pain Specialists, Santa Monica, CA, USA.
¹⁵ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
¹⁶ Hospital Universitario Virgen del Rocio, Sevilla, Spain.
¹⁷ The Mount Sinai Hospital, New York, NY, USA.
¹⁸ Department of Anesthesiology, University of Kentucky, Lexington, KY, USA.
¹⁹ St. Antonius Hospital, Nieuwegein, The Netherlands.
²⁰ Johns Hopkins Medicine, Baltimore, MD, USA.
²¹ University of California, San Diego, CA, USA.
²² Center for Clinical Research, Winston-Salem, NC, USA.
²³ Erasmus University Hospital, Rotterdam, The Netherlands.
²⁴ Summit Pain Alliance, Santa Rosa, CA, USA.
²⁵ Pain Specialists of America, Austin, TX, USA.
²⁶ Nevada Advanced Pain Specialists, Reno, NV, USA.
²⁷ Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
²⁸ Neurosurgery and Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
²⁹ Main Line Spine, King of Prussia, PA, USA.
³⁰ Vertex Spine, Franklin, TN, USA.
³¹ US Anesthesia Partners, Houston, TX, USA.
³² Case Western Reserve University, Stereotactic & Functional Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
³³ Metro Spinal Clinic, Melbourne, VIC, Australia.
³⁴ Goodman Campbell Brain and Spine, Indiana University School of Medicine Department of Neurological Surgery, Indianapolis, IN, USA.
³⁵ Institute for Neuromodulation, Boca Raton, FL, USA.
³⁶ Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, OH, USA.

PMID: 30246899
DOI: 10.1111/ner.12845

Abstract

Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Through funding and organizational leadership by the International Neuromodulation Society (INS), the NACC reconvened to develop the best practices consensus document for the selection, implantation and use of DRG stimulation for the treatment of chronic pain syndromes.

Methods: The NACC performed a comprehensive literature search of articles about DRG published from 1995 through June, 2017. A total of 2538 article abstracts were then reviewed, and selected articles graded for strength of evidence based on scoring criteria established by the US Preventive Services Task Force. Graded evidence was considered along with clinical experience to create the best practices consensus and recommendations.

Results: The NACC achieved consensus based on peer-reviewed literature and experience to create consensus points to improve patient selection, guide surgical methods, improve post-operative care, and make recommendations for management of patients treated with DRG stimulation.

Conclusion: The NACC recommendations are intended to improve patient care in the use of this evolving therapy for chronic pain. Clinicians who choose to follow these recommendations may improve outcomes.

Keywords: chronic pain; complex regional pain syndrome; dorsal root ganglion; spinal stimulation.

Publication types

Practice Guideline
Review

MeSH terms

Electric Stimulation Therapy / methods*
Ganglia, Spinal*
Humans

Grants and funding

International Neuromodulation Society