Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation: A Proposal for Standardization in Fellowship and Training Programs

Abstract

The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation.

Keywords:

• neuromodulation
• pain education
• spinal cord stimulation
• dorsal root ganglion stimulation
• peripheral nerve stimulation
• fellowship training

Acknowledgments

The American Society of Pain and Neuroscience (ASPN) would like to thank the PEAK Committee and its members for supporting this project and improving pain education worldwide.

Disclosure

Alaa Abd-Elsayed, MD, MPH, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Medtronic, Curonix, Avanos, Averitas, SPR Therapeutics. Krishnan Chakravarthy, MD, PhD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Vertos Medical, Medtronic, Mainstay Medical; Stock Options: Neuronoff, Higgs Boson Health, Rune Labs; Owner: NXTSTIM INC., Accufix Medical. Kenneth B. Chapman, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Research: Abbott. Sandy Christiansen, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Research: Sorrento, GLG, Pacific Spine and Pain Society. Timothy R. Deer, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Vertos, SpineThera, Saluda, Nalu, CornerLoc, Ethos, SPR Therapeutics, Medtronic, Boston Scientific, PainTEQ, Tissue Tech, Spinal Simplicity, Biotronik; Advisory Board: Biotronik, Abbott, Nalu, SPR Therapeutics, Tissue Tech; Stock Options: Vertos, SpineThera, Ethos, Saluda, Nalu, CornerLoc, SPR Therapeutics, PainTeq, Spinal Simplicity; Pending Patent: Abbott; Research: Abbott, Vertos, Saluda, Mainstay, SPR Therapeutics, Boston Scientific, PainTEQ, Avanos. Alexander Escobar, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific Vertiflex, PainTEQ; Advisory Board: Medtronic, Nevro, Vertos Medical; Speaker’s Bureau: Medtronic, Nevro. Christopher J. Gilligan, MD, has had a financial agreement or affiliation with the following commercial interests in the form of consultant: Mainstay Medical, Saluda, Persica, Iliad Lifesciences. Johnathan H. Goree, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Saluda Medical, Stratus Medical. Maged Guirguis, MD, has had a financial agreement or affiliation with the following commercial interests in the form of consultant: Nevro, Boston Scientific, Abbott, Avertis pharmaceutical, Saluda, Avanos, Omnia, SPR Therapeutics; Research: Nevro, Boston Scientific, Saluda, Avanos. Amitabh Gulati, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Medtronic, Inc., SPR Therapeutics, Nalu Medical, Averitas Medical; Advisory Board: AIS Healthcare, Hinge Health, Tersera Medical, Neurovasis. Jonathan M. Hagedorn, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific, Nevro Corp, Saluda Medical. Jessica Jameson MD, FASA, has had a financial agreement or affiliation with the following commercial interests in the form of Research/Consultant: Nevro, Abbott, SPR, Vertos, SI Bone, Boston Scientific, Medtronic, Saluda Medical. Leonardo Kapural, MD, PhD, has had a financial agreement or affiliation with the following commercial interests in the form of Advisory Board: Avanos, Biotronik, Gimer, Medtronic, Neuralace, Neuros, PainTEQ, Nevro, Presidio; Research: Avanos, Neuros, Nevro, FUS Mobile, Nalu, Saluda. David W. Lee, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Medtronic, Mainstay Medical, Biotronik, Boston Scientific, Petal Surgical. Michael S. Leong, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Sorrento Therapeutics; Research: Wex Pharmaceuticals. Timothy R. Lubenow, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Abbott, Boston Scientific, Nevro, Medtronic, PainTEQ, PenTec. Chris J. Mallard, MD, has had a financial agreement of affiliation with the following commercial interest in the form of consultant: Zavation. Melissa Z Murphy, MD, MPH, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Medtronic, Relievant; Researcher: Medtronic; Advisor/Speaker: Medtronic. Kiran V. Patel, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Abbott Neuromodulation. Jason E. Pope, MD, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Abbott, Medtronic, Saluda, Flowonix, SpineThera, Painteq, Vertos, Vertiflex, SPR Therapeutics, Tersera, Aurora, Spark, Ethos, Biotronik, Mainstay, WISE, Boston Scientific, Thermaquil; Grant/Research Support: Abbott, Flowonix, Saluda, Aurora, Painteq, Ethos, Muse, Boston Scientific, SPR Therapeutics, Mainstay, Vertos, AIS, Thermaquil; Shareholder: Painteq, Vertos, SPR Therapeutics, Aurora, Spark, Celeri Health, Neural Integrative Solutions (NIS), Pacific Research Institute, Saluda, Thermaquil and Anesthetic Gas Reclamation. In addition, he also has a patent Neuro monitoring DRG issued to NIS. Scott G. Pritzlaff, MD, CIPS, FIPP, has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Bioness, Bioventus, SPR Therapeutics, Nalu Medical, EBT Medical; Royalties: Oxford University Press, Wolters Kluwer; Research Grants; Medtronic, Nevro Corp, Abbott. Dawood Sayed, MD, has had an agreement or affiliation with the following commercial interests in the form of Consultant: PainTEQ, Saluda, Abbott, Nevro, Vertos, Surgentec. Samir J Sheth, MD has had a financial agreement or affiliation with the following commercial interest in the form of Consultant: Boston Scientific, Medtronic, Nevro, SPR Therapeutics, Vertos. Vinita Singh, MD, has no financial relationships to disclose. Tolga Suvar, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant: Nalu, Medtronic, Nevro. Chau M. Vu, MD, has had a financial agreement or affiliation with the following commercial interests in the form of Consultant/Research: Saluda Medical, PainTEQ. The authors report no other conflicts of interest in this work.