Jonathan D. Carlson

The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices

The Neurostimulation Appropriateness Consensus Committee (NACC) was formed by the International Neuromodulation Society (INS) in 2012 to evaluate the evidence to reduce the risk of complications and improve the efficacy of neurostimulation. The first series of papers, published in 2014, focused on the general principles of appropriate practice in the surgical implantation of neurostimulation devices. The NACC was reconvened in 2014 to address specific patient care issues, including bleeding and coagulation.

Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant

Spinal cord stimulation (SCS) devices are cost effective and improve function as well as quality of life. Despite the demonstrated benefits of SCS, some patients have the device explanted. We are interested in exploring the patient characteristics of those explanted.

Peripheral Nerve Stimulation for Pain in Extremities: An Update.

Pain in extremities may occur in a variety of central and peripheral neuropathic and nociceptive syndromes, some of which may respond to central neuromodulation procedures. Peripheral neuromodulation techniques, either as a stand-alone therapy or as an adjuvant to spinal cord stimulation, may be particularly effective when the pain is localized to a part of a single extremity or when the source of the pain is related to the malfunction of a known peripheral nerve. Further, peripheral neuromodulation is used to treat disorders in which central simulation fails to provide discrete therapeutic paresthesia. Despite the fact that there are only a few neuromodulatory devices designed specifically for the periphery, clinical experiences are growing, and here we provide a clinical update on use of peripheral nerve stimulation (PNS) in management of chronic pain in extremities. Historical PNS strategies and innovative methods are reviewed and highlighted in this chapter. With the upcoming technological advances and new stimulation paradigms, along with clear updated guidelines statements, the utilization of PNS will likely continue to increase and improve the management of chronic pain syndromes in the extremities. The potential success of the novel devices specifically designed to target the peripheral nervous system is expected to positively impact and promote the use of PNS in treatment of chronic pain.

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options.

Advanced Spinal Mapping: An Interventional Continuum for Axial, Radicular, and Dorsal Root Ganglion–Related Pain

The anatomy of the spine can undergo numerous changes that result in pain. Various forms of chronic pain, including pain of the neck, back, or extremities, may indicate one or more spinal pathologies. Differing treatments may be used depending on the pain generator, including radiofrequency neurotomy, corticosteroid injection, decompression, and neurostimulation. Utilizing an appropriate treatment may be challenging, given frequently comorbid spinal pathologies and potentially overlapping symptoms. Spinal mapping enables the identification and treatment of the appropriate pain generator. Spinal mapping and subsequent treatments can be used for a number of varying indications: Facet arthropathy Posterior disc herniation or extrusion Anterior disc herniation or extrusion Central canal stenosis Lateral canal stenosis Neuroforaminal stenosis Chemical disruption of the disc Intradiscal pressure Annular disc tear Dorsal root ganglion (DRG) mapping to optimize DRG stimulation

Permanent Percutaneous Spinal Cord Stimulator Implantation: Cervical/Lumbar

Spinal cord stimulation (SCS) has been an effective therapeutic treatment for many years in a wide variety of chronic pain conditions. Though there is well-established evidence for treatment of several diseases, but most of the key indications have been in neuropathic pain states. A physician using this treatment option should be familiar with the surgical anatomy, preoperative considerations, and operative techniques, including the instruments and tools needed. To properly care for patients, physician performing such procedures also must be vigilant in monitoring for postoperative complications.

Spinal Cord Stimulation for the Treatment of Failed Neck Surgery Syndrome: Outcome of a Prospective Case Series: SCS FOR THE TREATMENT OF FNSS

Spinal cord stimulation (SCS) is an accepted, cost‐effective treatment option for a variety of chronic pain syndromes, including failed back surgery syndrome (FBSS). The application of SCS in the cervical spine, particularly for pain after cervical spine surgery, has been drawn into question in recent years by payers due to a purported lack of clinical evidence. To challenge this claim, we analyzed data from a prospective registry to support the use of SCS in the cervical spine for pain after spine surgery.

DRG FOCUS: A Multicenter Study Evaluating Dorsal Root Ganglion Stimulation and Predictors for Trial Success: DRG FOCUS STUDY

Dorsal root ganglion stimulation (DRGS) is a powerful tool in the treatment of chronic, neuropathic pain. The premise of DRGS is similar to that of conventional spinal cord stimulation (cSCS), however, there is more variability in how it can be utilized. While it is this variability that likely gives it its versatility, DRGS is not as straightforward to implement as cSCS. The purpose of this study was to assess the efficacy of DRGS on a broad number of diagnoses, determine which dorsal root ganglia were associated with better outcomes for particular body parts/diagnoses, and evaluate what factors/parameters were associated with higher rates of trial success.

Spinal Cord Stimulation for the Treatment of Pain in the Rehabilitation Patient

The Gate Control Theory of pain proposed that electrical stimulation of the spinal cord or other nerve structures can produce pain relief. Therapies involving electrical stimulation of various nerve structures are now an option for chronic pain sufferers, particularly for neuropathic pain conditions. For many difficult-to-treat chronic pain conditions that are neuropathic in nature, including post-laminectomy syndrome and complex regional pain syndrome, it has shown to be the most effective treatment option available.

Opioid Medications for Chronic Noncancer Pain

Opioid medication for chronic noncancer pain has grown in popularity over the last few decades, despite the lack of compelling evidence for their efficacy. Opioids can be considered as a means of analgesia for chronic pain when other non-opioid pain medication and treatments have been exhausted. In contrast to the concurrent rise in opioid-related morbidity and mortality, provider vigilance with opioid prescribing is paramount. Opioids for chronic noncancer pain should only be prescribed if there is significant pathology, confirmed with history and physical exam as well as pertinent diagnostic testing. Because of the highly addicting nature of the medication and the increasing street value of prescription opioids, ruling out misuse, abuse, and contraindications is mandatory.