The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for Spinal Cord Stimulation Long-Term Outcome Optimization and Salvage Therapy.

Introduction: The International Neuromodulation Society (INS) has recognized a need to establish best practices for optimizing implantable devices and salvage when ideal outcomes are not realized. This group has established the Neurostimulation Appropriateness Consensus Committee (NACC)® to offer guidance on matters needed for both our members and the broader community of those affected by neuromodulation devices.
Materials and Methods: The executive committee of the INS nominated faculty for this NACC® publication on the basis of expertise, publications, and career work on the issue. In addition, the faculty was chosen in consideration of diversity and inclusion of different career paths and demographic categories. Once chosen, the faculty was asked to grade current evidence and along with expert opinion create consensus recommendations to address the lapses in information on this topic.
Results: The NACC® group established informative and authoritative recommendations on the salvage and optimization of care for those with indwelling devices. The recommendations are based on evidence and expert opinion and will be expected to evolve as new data are generated for each topic.
Conclusions: NACC® guidance should be considered for any patient with less-than-optimal outcomes with a stimulation device implanted for treating chronic pain. Consideration should be given to these consensus points to salvage a potentially failed device before explant.
Competing Interests: Conflict of Interest Timothy R. Deer consults for Abbott, Saluda, Painteq, Cornorloc, Spinal Simplicity, Spinethera, Nervonik, Biotronik, and SPR Therapeutics. Dawood Sayed reports personal fees from Abbott, Medtronic, Flowonix, Nevro, and Boston Scientific, outside the submitted work. David M. Dickerson reports research support from SPR Therapeutics and Abbott; consulting fees from Abbott, Vertos, SPR, and Biotronik; speaker’s fees from Abbott, Vertos, Biotronik, and SPR Therapeutics; and meeting and travel support from Vertos, SPR, and Abbott. He is a committee chair for the North American Neuromodulation Society and the American Society of Anesthesiologists, and a board member of the Midwest Pain Society. He serves as a clinical advisory member for National Median Arcuate Ligament Syndrome Advisory and National Rx and Drug Abuse Summit. Erika A. Petersen reports research support from Mainstay, Medtronic, Nalu, Neuros Medical, Nevro Corp, ReNeuron, SPR, and Saluda, in addition to personal fees from Abbott Neuromodulation, Biotronik, Medtronic Neuromodulation, Nalu, Neuros Medical, Nevro, Presidio Medical, Saluda, and Vertos, outside the submitted work. She holds stock options from SynerFuse and neuro42. Michael A. Fishman reports honoraria from Abbott, Biotronik, Medtronic, and Mainstay Medical; consults and advises for Biowave, Biotronik, Medtronic, and Thermaquil; conducts funded research for Abbott, Biowave, Biotronik, and Medtronic; receives royalties/patent from Brixton Biosciences, Medtronic, and Vyrsa (acq Nevro); and has stock options from Brixton Biosciences and Thermaquil, an equity position in Celeri Health, and ownership in Brixton Biosciences. James Fitzgerald reports personal fees from Medtronic and Abbott, and grants from Abbott, outside the submitted work. Ganesan Baranidharan reports grants and personal fees from Nevro Corporation, Abbott, and Boston Scientific; and personal fees from Nalu Medical, outside the submitted work. Dirk De Ridder reports other from Abbott during the conduct of the study, and he has a patent pending with Abbott. Krishnan V. Chakravarthy reports other from Medtronic, Mainstay Medical, Vertos, NXTSTIM, Accufix Medical, Newrom Biomedical, and Douleur Therapeutics, outside the submitted work. Corey W. Hunter reports other from Saluda Medical Pty Ltd; grants, personal fees, and other from Abbott; and grants from Biotronik, outside the submitted work. Eric Buchser reports personal fees from Medtronic, Switzerland, outside the submitted work. Chris Gilligan reports other from Mainstay Medical and Sollis Therapeutics; and personal fees from Medtronic, Saluda, and Abbott, outside the submitted work. Simon Thomson reports consulting agreements with Boston Scientific Neuromodulation, Galvani Bioelectronics, Mainstay Medical, and Saluda Medical. Jessica Jameson reports personal fees from Nevro, Boston Scientific, and Abbott, outside the submitted work. Thomas T. Simopoulos reports personal consultant fees from Nevro Corp, outside the submitted work. Robert M. Levy is an uncompensated consultant for Nalu, Saluda Medical, and Mainstay Medical; and has stock options from Nalu and Saluda Medical obtained before 2019 and not exercisable through the duration of his term as International Neuromodulation Society president and editor-in-chief of the journal Neuromodulation: Technology at the Neural Interface. The remaining authors reported no conflict of interest.
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