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Article ; Online: Preoperative Antidepressant Prescriptions Are Associated With Increased Opioid Prescriptions and Health Care Use but Similar Rates of Secondary Surgery Following Primary Anterior Cruciate Ligament Reconstruction in a Young Adult Population.

Pahapill, Natalie K / Monahan, Peter F / Graefe, Steven B / Gallo, Robert A

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2024

Abstract: ... postoperatively (P <.0001 for each time point). Patients with ADP had greater rates of ED visits (ADP 9.7%, NADP 7 ... 1%, P < .0001, OR 1.39) and outpatient appointments (ADP 28.3%, NADP 21.8%) P < .0001, OR 1.42) at 3 ... months' postoperatively. Secondary surgery rates at 1 and 2 years were nonsignificant (P = .381 and P ...

Abstract	Purpose: To compare adverse events, postoperative opioid-prescribing patterns, health care use, and secondary anterior cruciate ligament reconstruction (ACLR) surgery rates of patients undergoing primary ACLR with a preoperative antidepressant prescription (ADP) against a propensity-matched group with no preoperative antidepressant prescription (NADP) using the TriNetX Diamond Network. Methods: Patients undergoing primary ACLR between ages 18 and 35 years of age were queried from the database using International Classification of Diseases, Tenth Revision/Current Procedural Terminology codes. Patients with an ADP were propensity matched in a 1:1 ratio to patients with NADP based on 11 patient characteristics. Postoperative rates of adverse events, emergency department (ED) visits, in-patient hospitalizations, outpatient services, physical therapy evaluations, postoperative opioid prescriptions, and secondary ACLR were compared at various time points. Results: In total, 3,736 patients with an ADP with an average age of 21.4 ± 4.5 years undergoing primary ACLR were propensity matched to patients with NADP. A significantly greater percentage of patients with an ADP received opioid prescriptions at 2 weeks (ADP 21%, NADP 11.3%, odds ratio [OR] 2.08), 6 weeks (ADP 25.5%, NADP 13.9%, OR 2.13), 3 months (ADP 27.6%, NADP 15.6%, OR 2.07), 6 months (ADP 30.5%, NADP 17.2%, OR 2.1), and 1 year (ADP 35.3%, NADP 20.2%, OR 2.16) postoperatively (P <.0001 for each time point). Patients with ADP had greater rates of ED visits (ADP 9.7%, NADP 7.1%, P < .0001, OR 1.39) and outpatient appointments (ADP 28.3%, NADP 21.8%) P < .0001, OR 1.42) at 3 months' postoperatively. Secondary surgery rates at 1 and 2 years were nonsignificant (P = .381 and P = .062, respectively). Conclusions: Following ACLR, patients with ADP had a significant increase in postoperative opioid prescriptions at all time points and used more ED resources and outpatient services compared with patients with NADP at 3 months' postoperatively. Thirty-day postoperative adverse events and both 1- and 2-year secondary ACL surgery rates demonstrated no significant differences between the groups. Level of evidence: Level III, retrospective comparative case series.
Language	English
Publishing date	2024-01-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2023.12.030
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Article ; Online: Deep Brain Stimulation for Chronic Cluster Headaches: A Systematic Review and Meta-Analysis.

Murray, Molly / Pahapill, Peter A / Awad, Ahmed J

Stereotactic and functional neurosurgery

2023 Volume 101, Issue 4, Page(s) 232–243

Abstract: ... difference in headache attack frequency and headache intensity after DBS were statistically significant (p ... improvement in headache intensity postoperatively (p = 0.006). The average overall follow-up period was 45.4 ...

Abstract	Background: Chronic cluster headache (CCH) is a severe and debilitating sub-type of trigeminal autonomic cephalalgia that can be resistant to medical management and associated with significant impairment in quality of life. Studies of deep brain stimulation (DBS) for CCH have provided promising results but have not been assessed in a comprehensive systematic review/meta-analysis. Objective: The objective was to perform a systematic literature review and meta-analysis of patients with CCH treated with DBS to provide insight on safety and efficacy. Methods: A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. 16 studies were included in final analysis. A random-effects model was used to meta-analyze data. Results: Sixteen studies reported 108 cases for data extraction and analysis. DBS was feasible in >99% of cases and was performed either awake or asleep. Meta-analysis revealed that the mean difference in headache attack frequency and headache intensity after DBS were statistically significant (p < 0.0001). Utilization of microelectrode recording was associated with statistically significant improvement in headache intensity postoperatively (p = 0.006). The average overall follow-up period was 45.4 months and ranged from 1 to 144 months. Death occurred in <1%. The rate of major complications was 16.67%. Conclusions: DBS for CCHs is a feasible surgical technique with a reasonable safety profile that can be successfully performed either awake or asleep. In carefully selected patients, approximately 70% of patients achieve excellent control of their headaches.
MeSH term(s)	Humans ; Cluster Headache/therapy ; Deep Brain Stimulation/methods ; Quality of Life ; Wakefulness ; Headache/etiology ; Treatment Outcome
Language	English
Publishing date	2023-05-26
Publishing country	Switzerland
Document type	Systematic Review ; Meta-Analysis
ZDB-ID	645069-6
ISSN	1423-0372 ; 1011-6125
ISSN (online)	1423-0372
ISSN	1011-6125
DOI	10.1159/000530508
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Article ; Online: Spinal Cord Stimulation Trial Electrodes Rapidly Produce Epidural Scarring, Impeding Surgical Paddle Lead Placement.

Treffy, Randall W / Morris, Justin / Koshy, Rahul / Coss, Dylan J / Pahapill, Peter A

Neuromodulation : journal of the International Neuromodulation Society

2024

Abstract: ... operative times in those with SPL placed after ten days (122.42 ± 10.72 minutes vs 140.75 ± 4.72 minutes; p = 0 ...

Abstract	Objectives: After a successful percutaneous cylindrical electrode five-to-seven-day trial of spinal cord stimulation, subsequent permanent surgical paddle lead (SPL) placement can be impeded by epidural scar induced by the trial leads (TLs). Our goal was to determine whether a delay between TL and subsequent SPL placement provokes enhanced epidural scarring with an increased need for laminotomy extension required for scar removal for optimal SPL placement. Materials and methods: Using a prospectively maintained data base, a single-facility/surgeon retrospective study identified 261 patients with newly placed thoracolumbar SPLs from June 2013 to November 2023. Data were obtained from the patients' charts, including, but not limited to, timing between TL and SPL, operative time, and need for extension of laminotomy. Results: We found that the need for laminotomy extension due to TL epidural scarring and longer operative times was not required in our patients if the SPL was placed within ten days of placement of the TL (0/26), leading to shorter operative times in those with SPL placed after ten days (122.42 ± 10.72 minutes vs 140.75 ± 4.72 minutes; p = 0.005). We found no association with other medical comorbidities that may be confounding factors leading to epidural scarring/extension of laminotomy or association with level of SPL placement, size of the spinal canal, or indication for SPL placement. Conclusions: TL placement leads to scarring in the epidural space that appears to mature after ten days of its placement. In approximately 34% of patients, this leads to prolonged operative time owing to the need for extension of laminotomy and subsequent clearing of epidural scar for optimal SPL placement.
Language	English
Publishing date	2024-03-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1500372-3
ISSN	1525-1403 ; 1094-7159
ISSN (online)	1525-1403
ISSN	1094-7159
DOI	10.1016/j.neurom.2024.01.004
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Article ; Online: Post-Traumatic Stress Disorder Is Associated With Increased Emergency Department Services and Similar Rates of Opioid Prescriptions Following Primary Total Hip Arthroplasty: A Propensity Matched Analysis.

Monahan, Peter F / Martinazzi, Brandon J / Pahapill, Natalie K / Graefe, Steven B / Jimenez, Andrew E / Mason, Mark W

The Journal of arthroplasty

2024

Abstract: ... postoperatively. Within 1 month postoperatively, cohorts were prescribed opioid analgesics at similar rates (P ... month (P = .022). Within 2 years postoperatively, rates of revision hip arthroplasty were comparable ... between cohorts (P = .912).: Conclusions: Patients who have PTSD experience similar rates of revision ...

Abstract	Background: There is a paucity of literature regarding patients who have post-traumatic stress disorder (PTSD) following primary total hip arthroplasty (THA). The purpose of this study was to compare the rates of postoperative complications, prescriptions, health care utilization, and revision arthroplasty of patients who had PTSD undergoing primary THA against a propensity matched control group of patients who did not have PTSD (NPTSD). Methods: The TriNetX database was queried to identify PTSD patients undergoing primary THA. Patients were then propensity matched in a 1:1 ratio based on twelve preoperative characteristics to a cohort of NPTSD patients. Postoperative prescriptions and rates of health care utilization were analyzed within 5 days, 14 days, and 1 month postoperatively. Complications were analyzed within one month. Revision arthroplasty rates were analyzed within 1 year and 2 years. Results: A total of 198,560 patients undergoing primary THA were identified. Ultimately, 1,310 PTSD patients were successfully propensity matched to a cohort of 1,310 NPTSD patients. Patients who have PTSD presented to the emergency department at significantly higher rates than NPTSD patients within 14 days and 1 month postoperatively. Within 1 month postoperatively, cohorts were prescribed opioid analgesics at similar rates (P = .709). Patients who had PTSD received more prescriptions per patient compared to NPTSD patients. Patients who had PTSD were also found to have a higher number of total complications per person within 1 month (P = .022). Within 2 years postoperatively, rates of revision hip arthroplasty were comparable between cohorts (P = .912). Conclusions: Patients who have PTSD experience similar rates of revision hip arthroplasty and opioid prescribing compared to NPTSD patients following primary THA; however, within 1 month postoperatively, emergency department visits were greater in PTSD patients. These findings can help delineate early postoperative education and expectations for patients who have PTSD in contrast to other psychiatric diagnoses.
Language	English
Publishing date	2024-03-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2024.03.012
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Article ; Online: Prior Diagnosis of Opioid-Related Disorder Is Associated With Higher Medical Resource Utilization Following Primary Hip Arthroscopy: A National Database Study.

Monahan, Peter F / Surucu, Serkan / Pahapill, Natalie K / Jimenez, Andrew E / Taylor, Kenneth F

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2023

Abstract: ... were similar between groups (P = .693). Rates of revision arthroscopy were also similar for both ORD (9 ... 3%) and NORD (8.0%) cohorts (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.83-1.66; P ... opioid (OR, 2.66; 95% CI, 2.17-3.26; P < .0001) and antidepressant prescriptions (OR, 1.58; 95% CI, 1.26 ...

Abstract	Purpose: To compare adverse events, medical resource utilization, prescribing patterns, and revision surgery rates of patients with opioid-related disorders (ORDs) undergoing primary hip arthroscopy against a propensity-matched group with no opioid-related disorders (NORDs). Methods: The TriNetX database was queried between January 2015 and December 2020 using International Classification of Diseases, 10th Revision and Current Procedural Terminology codes to identify patients undergoing primary hip arthroscopy between ages 18 and 70 years. The ORD cohort was propensity matched in a 1:1 ratio to NORD patients based on age, sex, alcohol-related disorders, heart disease, hypertension, metabolic disorders, anxiety disorders, major depressive disorder, diabetes mellitus, and antidepressant prescriptions. Postoperative rates of adverse events and medical resources were compared within 90 days of procedure, prescriptions were compared within 1 year, and revision surgery was compared within 2 years. Results: A total of 809 ORD patients were propensity matched in a 1:1 ratio to NORD patients. Postoperative adverse events were similar between groups (P = .693). Rates of revision arthroscopy were also similar for both ORD (9.3%) and NORD (8.0%) cohorts (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.83-1.66; P = .377). ORD patients received care from the emergency department, inpatient admission, outpatient visit, and physical therapy evaluations at higher rates. The ORD cohort received a greater amount of new opioid (OR, 2.66; 95% CI, 2.17-3.26; P < .0001) and antidepressant prescriptions (OR, 1.58; 95% CI, 1.26-1.97; P < .0001) compared to NORD patients within 1 year of surgery. Conclusions: ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity-matched group of NORD patients undergoing primary hip arthroscopy. However, ORD patients experienced increased rates of emergency department visits and hospitalizations and were prescribed higher rates of opioid and antidepressant prescriptions. Level of evidence: Level III, cohort study.
Language	English
Publishing date	2023-12-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2023.12.008
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Article: Distinct Functional Connectivity Patterns for Intermittent Vs Constant Neuropathic Pain Phenotypes in Persistent Spinal Pain Syndrome Type 2 Patients.

Pahapill, Peter A / Arocho-Quinones, Elsa V / Chen, Guangyu / Swearingen, Brad / Tomas, Carissa W / Koch, Kevin M / Nencka, Andrew Scott

Journal of pain research

2024 Volume 17, Page(s) 1453–1460

Abstract: ... significantly lower than controls in all patients, regardless of pain phenotype (P < 0.003). Pain levels were ...

Abstract	Background: Chronic low back pain (cLBP) has been associated with alterations in brain functional connectivity (FC) but based upon heterogeneous populations and single network analyses. Our goal is to study a more homogeneous cLBP population and focus on multiple cross-network (CN) connectivity analysis. We hypothesize that within this population: 1) altered CN FC, involving emotion and reward/aversion functions are related to their pain levels and 2) altered relationships are dependent upon pain phenotype (constant neuropathic vs intermittent pain). Methods: In this case series, resting state fcMRI scans were obtained over a study duration of 60 months from 23 patients (13 constant neuropathic and 10 intermittent pain) with Persistent Spinal Pain Syndrome (PSPS Type 2) being considered for spinal cord stimulation (SCS) therapy at a single academic center. Images were acquired using a Discovery MR750 GE scanner. During the resting state acquisitions, they were asked to close their eyes and relax. The CN analysis was performed on 7 brain networks and compared to age-matched controls. Linear regression was used to test the correlation between CN connectivity and pain scores. Results: CN FC involving emotion networks (STM: striatum network index) was significantly lower than controls in all patients, regardless of pain phenotype (P < 0.003). Pain levels were positively correlated with emotional FC for intermittent pain but negatively correlated for constant pain. Conclusion: This is the first report of 1) altered CN FC involving emotion/reward brain circuitry in 2) a homogeneous population of cLBP patients with 3) two different pain phenotypes (constant vs intermittent) in PSPS Type 2 patients being considered for SCS. FC patterns were altered in cLBP patients as compared to controls and were characteristic for each pain phenotype. These data support fcMRI as a potential and objective tool in assessing pain levels in cLBP patients with different pain phenotypes.
Language	English
Publishing date	2024-04-12
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2495284-9
ISSN	1178-7090
ISSN	1178-7090
DOI	10.2147/JPR.S426640
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Article ; Online: Calcaneus fracture pattern and severity: Role of local trabecular bone density.

Chirvi, Sajal / Pahapill, Natalie / Yoganandan, Narayan / Curry, William / Stemper, Brian / Kleinberger, Michael / Pintar, Frank A

Journal of the mechanical behavior of biomedical materials

2022 Volume 134, Page(s) 105332

Abstract: ... of the posterior region. The BMD ratio between anterior and posterior was significant (p = 0.02) between anterior ...

Abstract	Calcaneus fracture is the most common tarsal bone fracture and is associated with external loads resulting from vehicle crashes, under body blasts, or sports. Almost 50% of weight bearing by the foot occurs through the calcaneus and its surgical fixation remains a challenging procedure. Postmortem human subjects were used to measure the regional trabecular BMD of the calcaneus. Mean age, height and weight of the included 14 specimens was 69 years, 177 cm and 80 kg respectively. Using a custom mode within Quantitative Computed Tomography clinical software; calcaneal trabecular BMD in the anterior and posterior regions was quantified. Tolerance data and calcaneus fracture patterns were also available for these specimens from previous tests. The posterior region of the calcaneus had a higher mean BMD (114 mg/cc) than the anterior region (81 mg/cc). These BMD differences also paralleled injury outcome of specimens from axial loading with 50% of specimens resulting in high severity anterior region calcaneal fractures and 36% of specimens resulting in low severity posterior calcaneal fractures. These findings may be reflective of the lower BMD in the anterior region, although the load was uniformly distributed across the plantar surface of the foot. Severity of fracture was greater (intraarticular/crush) in the anterior region as compared to fractures of the posterior region. The BMD ratio between anterior and posterior was significant (p = 0.02) between anterior region fractures and posterior region fractures. The ratio parameter may indicate that the disparity in trabecular BMD between anterior and posterior calcaneus regions is more important in predicting injury outcome than the absolute BMD value of each region.
MeSH term(s)	Aged ; Ankle Injuries ; Bone Density ; Calcaneus/diagnostic imaging ; Cancellous Bone/diagnostic imaging ; Foot Injuries ; Fractures, Bone/diagnostic imaging ; Humans
Language	English
Publishing date	2022-06-22
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2378381-3
ISSN	1878-0180 ; 1751-6161
ISSN (online)	1878-0180
ISSN	1751-6161
DOI	10.1016/j.jmbbm.2022.105332
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Article ; Online: Functional connectivity and structural analysis of trial spinal cord stimulation responders in failed back surgery syndrome.

Pahapill, Peter A / Chen, Guangyu / Arocho-Quinones, Elsa V / Nencka, Andrew S / Li, Shi-Jiang

PloS one

2020 Volume 15, Issue 2, Page(s) e0228306

Abstract: ... p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear ... relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC ...

Abstract	Background: Chronic pain has been associated with alterations in brain structure and function that appear dependent on pain phenotype. Functional connectivity (FC) data on chronic back pain (CBP) is limited and based on heterogeneous pain populations. We hypothesize that failed back surgery syndrome (FBSS) patients being considered for spinal cord stimulation (SCS) therapy have altered resting state (RS) FC cross-network patterns that 1) specifically involve emotion and reward/aversion functions and 2) are related to pain scores. Methods: RS functional MRI (fMRI) scans were obtained for 10 FBSS patients who are being considered for but who have not yet undergone implantation of a permanent SCS device and 12 healthy age-matched controls. Seven RS networks were analyzed including the striatum (STM). The Wilcoxon signed-rank test evaluated differences in cross-network FC strength (FCS). Differences in periaqueductal grey (PAG) FC were assessed with seed-based analysis. Results: Cross-network FCS was decreased (p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC with network elements and amygdala but increased FC with the sensorimotor cortex and cingulate gyrus. Conclusions: Decreased FC between STM and other RS networks in FBSS has not been previously reported. This STMFCS index may represent a more objective measure of chronic pain specific to FBSS which may help guide patient selection for SCS and subsequent management.
MeSH term(s)	Adult ; Aged ; Brain/diagnostic imaging ; Case-Control Studies ; Chronic Pain/complications ; Chronic Pain/pathology ; Failed Back Surgery Syndrome/complications ; Failed Back Surgery Syndrome/therapy ; Female ; Gyrus Cinguli/physiology ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neural Pathways ; Periaqueductal Gray ; Sensorimotor Cortex/physiology ; Spinal Cord Stimulation
Language	English
Publishing date	2020-02-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0228306
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Article ; Online: Functional connectivity and structural analysis of trial spinal cord stimulation responders in failed back surgery syndrome.

Peter A Pahapill / Guangyu Chen / Elsa V Arocho-Quinones / Andrew S Nencka / Shi-Jiang Li

PLoS ONE, Vol 15, Iss 2, p e

2020 Volume 0228306

Abstract: ... in periaqueductal grey (PAG) FC were assessed with seed-based analysis. RESULTS:Cross-network FCS was decreased (p<0 ... relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC ...

Abstract	BACKGROUND:Chronic pain has been associated with alterations in brain structure and function that appear dependent on pain phenotype. Functional connectivity (FC) data on chronic back pain (CBP) is limited and based on heterogeneous pain populations. We hypothesize that failed back surgery syndrome (FBSS) patients being considered for spinal cord stimulation (SCS) therapy have altered resting state (RS) FC cross-network patterns that 1) specifically involve emotion and reward/aversion functions and 2) are related to pain scores. METHODS:RS functional MRI (fMRI) scans were obtained for 10 FBSS patients who are being considered for but who have not yet undergone implantation of a permanent SCS device and 12 healthy age-matched controls. Seven RS networks were analyzed including the striatum (STM). The Wilcoxon signed-rank test evaluated differences in cross-network FC strength (FCS). Differences in periaqueductal grey (PAG) FC were assessed with seed-based analysis. RESULTS:Cross-network FCS was decreased (p<0.05) between the STM and all other networks in these FBSS patients. There was a negative linear relationship (R2 = 0.76, p<0.0022) between STMFCS index and pain scores. The PAG showed decreased FC with network elements and amygdala but increased FC with the sensorimotor cortex and cingulate gyrus. CONCLUSIONS:Decreased FC between STM and other RS networks in FBSS has not been previously reported. This STMFCS index may represent a more objective measure of chronic pain specific to FBSS which may help guide patient selection for SCS and subsequent management.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for Surgical Technique for Spinal Cord Stimulation.

Deer, Timothy R / Russo, Marc A / Grider, Jay S / Pope, Jason / Rigoard, Philippe / Hagedorn, Jonathan M / Naidu, Ramana / Patterson, Denis G / Wilson, Derron / Lubenow, Timothy R / Buvanendran, Asokumar / Sheth, Samir J / Abdallah, Rany / Knezevic, N Nick / Schu, Stefan / Nijhuis, Harold / Mehta, Pankaj / Vallejo, Ricardo / Shah, Jay M /

Harned, Michael E / Jassal, Navdeep / Gonzalez, Jose Manuel / Pittelkow, Thomas P / Patel, Shachi / Bojanic, Stana / Chapman, Kenneth / Strand, Natalie / Green, Alexander L / Pahapill, Peter / Dario, Alessandro / Piedimonte, Fabian / Levy, Robert M

Neuromodulation : journal of the International Neuromodulation Society

2022 Volume 25, Issue 1, Page(s) 1–34

Abstract: Introduction: The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device ... ...

Abstract	Introduction: The field of neurostimulation for the treatment of chronic pain is a rapidly developing area of medicine. Although neurostimulation therapies have advanced significantly as a result of technologic improvements, surgical planning, device placement, and postoperative care are of equal importance to optimize outcomes. This Neurostimulation Appropriateness Consensus Committee (NACC) project intends to provide evidence-based guidance for these often-overlooked areas of neurostimulation practice. Materials and methods: Authors were chosen based on their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from the last NACC publication in 2017 to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on evidence strength and consensus when evidence was scant. Results: This NACC project provides guidance on preoperative assessment, intraoperative techniques, and postoperative management in the form of consensus points with supportive evidence. These results are based on grade of evidence, strength of consensus, and expert opinion. Conclusions: The NACC has given guidance for a surgical plan that encompasses the patient journey from the planning stage through the surgical experience and postoperative care. The overall recommendations are designed to improve efficacy and the safety of patients undergoing these neuromodulation procedures and are intended to apply throughout the international community.
MeSH term(s)	Chronic Pain/therapy ; Consensus ; Humans ; Spinal Cord Stimulation
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1500372-3
ISSN	1525-1403 ; 1094-7159
ISSN (online)	1525-1403
ISSN	1094-7159
DOI	10.1016/j.neurom.2021.10.015
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