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

Scott G Pritzlaff; Johnathan H Goree; Jonathan M Hagedorn; David W Lee; Kenneth B Chapman; Sandy Christiansen; Andrew Dudas; Alexander Escobar; Christopher J Gilligan; Maged Guirguis; Amitabh Gulati; Jessica Jameson; Christopher J Mallard; Melissa Z Murphy; Kiran V Patel; Raj G Patel; Samir J Sheth; Stephanie Vanterpool; Vinita Singh; Gregory Smith; Natalie H Strand; Chau M Vu; Tolga Suvar; Krishnan Chakravarthy; Leonardo Kapural; Michael S Leong; Timothy R Lubenow; Alaa Abd-Elsayed; Jason E Pope; Dawood Sayed; Timothy R Deer

doi:10.2147/JPR.S424589

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

J Pain Res. 2023 Sep 13:16:3101-3117. doi: 10.2147/JPR.S424589. eCollection 2023.

Authors

Scott G Pritzlaff¹, Johnathan H Goree², Jonathan M Hagedorn³, David W Lee⁴, Kenneth B Chapman⁵, Sandy Christiansen⁶, Andrew Dudas⁷, Alexander Escobar⁸, Christopher J Gilligan⁹, Maged Guirguis¹⁰, Amitabh Gulati¹¹, Jessica Jameson¹², Christopher J Mallard¹³, Melissa Z Murphy¹⁴, Kiran V Patel¹⁵, Raj G Patel¹⁶, Samir J Sheth¹⁷, Stephanie Vanterpool¹⁸, Vinita Singh¹⁹, Gregory Smith², Natalie H Strand²⁰, Chau M Vu²¹, Tolga Suvar²², Krishnan Chakravarthy²³, Leonardo Kapural²⁴, Michael S Leong²⁵, Timothy R Lubenow²², Alaa Abd-Elsayed²⁶, Jason E Pope²¹, Dawood Sayed²⁷, Timothy R Deer²⁸

Affiliations

¹ Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA.
² Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
³ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Mayo Clinic, Rochester, MN, USA.
⁴ Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA.
⁵ The Spine & Pain Institute of New York, New York, NY, USA.
⁶ Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
⁷ Mays & Schnapp Neurospine and Pain, Memphis, TN, USA.
⁸ Department of Anesthesiology, University of Toledo, Toledo, OH, USA.
⁹ Division of Pain Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA.
¹⁰ Division of Pain Management, Ochsner Health, New Orleans, LA, USA.
¹¹ Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
¹² Axis Spine Center, Coeur D'Alene, ID, USA.
¹³ Department of Anesthesiology, University of Kentucky, Lexington, KY, USA.
¹⁴ North Texas Orthopedics and Spine Center, Grapevine, TX, USA.
¹⁵ Department of Anesthesiology and Pain Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA.
¹⁶ Capitol Pain Institute, Austin, TX, USA.
¹⁷ Interventional Pain Management, Sutter Health, Roseville, CA, USA.
¹⁸ Department of Anesthesiology, University of Tennessee, Knoxville, TN, USA.
¹⁹ Department of Anesthesiology, Emory University, Atlanta, GA, USA.
²⁰ Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA.
²¹ Evolve Restorative Center, Santa Rosa, CA, USA.
²² Department of Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, IL, USA.
²³ Coastal Pain and Spinal Diagnostics Medical Group, San Diego, CA, USA.
²⁴ Carolinas Pain Institute, Winston-Salem, NC, USA.
²⁵ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA.
²⁶ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
²⁷ Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas, Kansas City, KS, USA.
²⁸ The Spine and Nerve Center of the Virginias, Charleston, WV, USA.

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: dorsal root ganglion stimulation; fellowship training; neuromodulation; pain education; peripheral nerve stimulation; spinal cord stimulation.