North American Neuromodulation Society Research Articles

Best practices for interventional pain procedures in the setting of a local anesthetic shortage: A practice advisory from the Spine Intervention Society

Representatives from the Spine Intervention Society (SIS) Standards Division and Evidence Analysis Committee have developed the following best practice recommendations for the performance of interventional pain procedures in the setting of a local anesthetic shortage. The practice advisory has been endorsed by SIS, the American Academy of Pain Medicine, the American College of Radiology, the American Society of Neuroradiology, the American Society of Spine Radiology, the North American Neuromodulation Society, the North American Spine Society, and the Society of Interventional Radiology, who support the following best practice recommendations and statements for the performance of intra-articular, extra-articular, paraspinal, and epidural injections in the setting of a local anesthetic shortage.1.Use of preservative-containing local anesthetics is discouraged in the performance of neuraxial procedures where the injectate may enter the epidural (or intrathecal) spaces.2.When performing procedures with risk of arterial injection, ropivacaine should not be mixed with dexamethasone and injected due to the risk of crystallization and embolization.3.Physicians should not withdraw directly from vials of local anesthetic for multiple patients due to infection risk as per Centers for Disease Control and Prevention (CDC) and Joint Commission guidelines [1].4.Only pharmacists may repackage local anesthetic vials for multiple patients. This must be performed under strict, sterile conditions and only in times of critical need. In such situations, physicians must adhere to the beyond-use-date and storage conditions on the repackaged label [2,3].5.Joint, tendon, bursa, and/or ligament injections may be performed with local anesthetic with or without preservative.6.Interventional pain physicians should weigh the relative chondrotoxicity risks associated with each anesthetic when performing joint injections.7.Topical anesthetics, infiltration with diphenhydramine, and nonpharmacologic therapies (i.e., cognitive behavioral therapy, guided imagery, virtual reality, mechanodesensitization) may be used as alternatives to skin infiltration of local anesthetic for reducing procedural pain.8.Use of small-gauge needles (25 gauge or thinner) mitigates the need for local anesthetic prior to needle insertion.9.For local anesthetic infiltration prior to insertion of large bore needles or incision, 0.5% lidocaine may be as effective as 1%, and for that reason current supplies of lidocaine can be stretched by dilution with normal saline.10.If using an ester local anesthetic due to an amide local anesthetic shortage, interventional pain physicians should be aware (as always) of the potential for an allergic reaction and should be able to respond accordingly.11.Local anesthetic systemic toxicity (LAST) differs between the varying local anesthetics, and interventional pain physicians should be well acquainted with these differences when switching between local anesthetics.Physicians should carefully weigh the risks and benefits of performing procedures without local anesthetic or using an alternative agent in the context of each unique patient's situation and should involve patients in shared decision making before proceeding.Procedures should be performed following Spine Intervention Society Guidelines [4]. The physician should confirm placement of the needle in at least two imaging planes. Please refer to the SIS Practice Guidelines for the full details and standards related to each unique procedure [4].

Speaker Gender Representation at the North American Neuromodulation Society Annual Meeting (2017-2021): Have We Made Progress in Closing the Gender Gap?

BackgroundSpeaker gender representation at medical conferences is a significant site of gender disparity. Our primary objective was to quantify the proportion of female speakers and compare plenary session opportunities by gender at the North American Neuromodulation Society (NANS) Annual Conference.MethodsData from the 2017–2021 NANS Annual Conference presentations were abstracted. Primary outcomes included gender composition of speaker slots, gender composition of individual speakers, and comparison of plenary speaker slots by gender. Secondary outcomes included comparisons of session size, age, professional degree, and number of presentations per speaker based on gender.ResultsGender composition of annual speaker slots was (% slots presented by women): 2017:14.6%; 2018:20.5%; 2019:23.5%; 2020:21.0%; 2021:41.4%. Annual gender composition of individual speakers was (% women): 2017:18.7%; 2018:20.6%; 2019:24.6%; 2020:24.9%; 2021:33.8%. Of all speaker slots, the percentage of plenary slots did not differ based on gender, with 11.4% presented by female speakers versus 11.2% presented by male speakers (OR 1.0, 95% CI 0.7–1.5, P=0.893). Compared to male speaker slots, there was an association of lower age (43.9±5.6 vs 50.8±8.9, P<0.001), lower odds of holding a single doctorate degree (OR 0.3, 95% CI 0.2–0.5, P<0.001), and lower odds of holding a dual MD/PhD or DO/PhD degree (OR 0.3, 95% CI 0.1–0.5, P<0.001) in female speaker slots. Compared to male speakers, there was an association of higher number of presentations per female speaker at the 2021 NANS Annual Meeting (2.48±1.60 vs 1.79±1.30, P=0.008).ConclusionAlthough the volume of female speaker slots and individual speakers trailed behind their male counterparts, female speaker representation steadily increased at each subsequent annual NANS meeting. We identified no difference in plenary session slots based on gender.

ID:16253 NACC Infection Control Recommendations and NANS Members Practice Patterns

Surgical site infections (SSI) are the second most common healthcare-related infections with high annual cost (10 billion US$). However, SSI rates have not significantly declined despite more than a decade of infection control recommendations by both Centers for Disease Control & Prevention (CDC) and Surgical Care Improvement Project (SCIP). Particularly, SSI rates after spinal cord stimulator (SCS) implantation range from 1 to 10%, with large studies reporting rates of 3.4 to 4.6%. In 2017, Neuromodulation appropriateness consensus committee (NACC) under auspices of International Neuromodulation Society, published evidence-based recommendations for infection prevention and management during SCS implantation. We conducted a survey of North American Neuromodulation Society (NANS) members to evaluate their knowledge and adherence to these guidelines and if knowledge and adherence varied by members’ practice setting.

Abstracts from the North American Neuromodulation Society’s 2021 Virtual Meeting, January 15–16, 2021

Abstracts from the North American Neuromodulation Society’s 2021 Virtual Meeting, January 15–16, 2021

Radiation safety and knowledge: an international survey of 708 interventional pain physicians

IntroductionInterventional pain procedures have increased in complexity, often requiring longer radiation exposure times and subsequently higher doses. The practicing physician requires an in-depth knowledge and evidence-based knowledge of radiation safety...

Transcranial Magnetic Stimulation for Pain, Headache and co-morbid depression: INS-NANS Expert Consensus Panel Review and Recommendation

Background: Persistent Post-Traumatic Brain Injury (PTBI) Related Headache (PTBI-HA) is one of the most common debilitating chronic pain conditions in patients after a mild/moderate traumatic brain injury. Unfortunately, conventional pharmacological treatments for PTBI-HA have not been shown to be effective. Under the guidance of a steering committee composed of International Neuromodulation Society (INS) and the North American Neuromodulation Society (NANS) leadership, this expert panel provided TMS treatment recommendations for the PTBI-HA. Methods: Individual studies were first rated by the guideline established by American Academy of Neurology Classification of Evidence for Therapeutic Studies. The overall clinical evidence was then rated based on Type of Study Design and Level of Certainty, and recommendation was provided based on the US Preventive Service Task Force (USPSTF) and Centers for Disease Control and Prevention (CDC) criteria. Based on the existing clinical outcome evidence for the short-term efficacy (1-2 month) in alleviating PTBI-HA symptoms, the majority of the task group members rated the Study Design as I (Randomized Controlled Trials) for TMS at M1 or left LDLPFC, Level of Certainty in Evidence as High for PTBI-HA. Results/Conclusions: The task group also rated USPSTF recommendation as A (Extremely Recommendable) and CDC recommendation as IA (Strongly Recommended) for the clinical implementation of the rTMS at either M1 or left LDLPFC for mild PTBI-HA with the latter being considered as alternate treatment location for patients with PTBI-HA and co-morbid severe depression.

Implementation of the North American Neuromodulation Society Mentorship Program: Recommendations and Survey Results of Participants

Despite Accredited Counsel of Graduate Medical Education (ACGME) guidance and criteria, there remains variability in training both within each specialty and across the specialties involved in the delivery of neuromodulation. NANS advocates for the efficacious and safe the implementation of neuromodulation and therefore an educational mentoring program with a defined educational platform is needed. This is a structured, patient centered, and evidence-based approach mentorship program performed more than one year. Mentor/Mentee pairs started in 2015 and data collected were more than a five-year period. There was a 70%-86% response rate on each survey administered. All except one respondent reported that the mentorship program met their previously declared expectations. All the respondents self-reported at least a moderate increase in their knowledge in the field of neuromodulation while 54% of the respondents felt their knowledge in the field to have greatly increased. Most respondents reported an increase in the number of spinal cord stimulator trials and permanent implants performed after the mentorship program. The self-reporting of mentees competencies at the conclusion of the program was statistically significant for higher competency scores in all areas assessed. The NANs mentorship program met expectations and implementation goals by improving neuromodulation education including covering patient care, delivery, and training topics. The mentoring program provides a structured framework for extending formal physician neuromodulation education outside of direct fellowship training.

Abstracts from the North American Neuromodulation Society’s 23rd Annual Meeting, Las Vegas, NV, USA

Abstracts from the North American Neuromodulation Society’s 23rd Annual Meeting, Las Vegas, NV, USA

Abstracts from the 22nd Annual Meeting of the North American Neuromodulation Society

Abstracts from the 22nd Annual Meeting of the North American Neuromodulation Society

Abstracts from the 21st Annual Meeting of the North American Neuromodulation Society, Las Vegas, NV, USA January 11-14, 2018

Abstracts from the 21st Annual Meeting of the North American Neuromodulation Society, Las Vegas, NV, USA January 11-14, 2018

Abstracts from the 2016 Joint Meeting of the North American Neuromodulation Society and the Neural Interfaces Conference: “Where Science Meets Innovation”

Abstracts from the 2016 Joint Meeting of the North American Neuromodulation Society and the Neural Interfaces Conference: “Where Science Meets Innovation”

Abstracts from the 19th Annual North American Neuromodulation Society Meeting (NANS) Las Vegas, NV, USA December 10-13, 2015

Abstracts from the 19th Annual North American Neuromodulation Society Meeting (NANS) Las Vegas, NV, USA December 10-13, 2015

Abstracts From the 18th Annual Meeting of the North American Neuromodulation Society December 11-14, 2014 Las Vegas, NV, USA.

Abstracts From the 18th Annual Meeting of the North American Neuromodulation Society December 11-14, 2014 Las Vegas, NV, USA.

Neurotech report.

More than 1800 neurosurgeons, pain doctors, neural engineers, and neurotechnology researchers—a record number—attended the 17th annual meeting of the North American Neuromodulation Society in Las Vegas, NV in December.

Women in Neuromodulation

At the recent meeting of the North American Neuromodulation Society (NANS), I was struck by the discordance between the representation of women in the leadership of the neuromodulation device industry as compared with our professional organizations. Two of the three major neuromodulation device companies were represented at these board meetings by 50% or more women; women serve in major leadership roles of all three companies. By contrast, no women sit on the executive boards of the NANS or the International Neuromodulation Society (INS). What has industry learned that we have not? (Figure 1, Figure 2, Figure 3)