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The Neurostimulation Appropriateness Consensus Committee (NACC)®, The Neuromodulation Appropriateness Consensus Committee (NACC)®, and The Polyanalgesic Consensus Conference (PACC)®

Articles and Guidance

As part of its mission to improve patient care and outcomes of neuromodulation therapies, the International Neuromodulation Society (INS) convened The Neurostimulation Appropriateness Consensus Committee (NACC)®, The Neuromodulation Appropriateness Consensus Committee (NACC)®, and The Polyanalgesic Consensus Conference (PACC)®, a group of international, multidisciplinary experts, to develop evidence-based, consensus guidance on the safe and effective use of neuromodulation devices in patient-centered therapy. The guidelines have been routinely updated and extensively cited in the peer-review literature for the field, serving as a living document guiding treatment decisions by practitioners, based upon the best available evidence and expert opinion.

The International Neuromodulation Society's (INS) journal, Neuromodulation: Technology at the Neural Interface, has published these peer reviewed guidelines since 2007, making the articles freely available to members as a benefit of their society membership, and to nonmembers in the neuromodulation field through institutional or individual subscriptions.

The Neurostimulation Appropriateness Consensus Committee (NACC)®, and The Neuromodulation Appropriateness Consensus Committee (NACC)®

The Neurostimulation Appropriateness Committee (NACC)® and The Neuromodulation Appropriateness Consensus Committee (NACC)® are articles in the field of neuromodulation practice standards and guidelines, which are published in INS’s peer-reviewed journal Neuromodulation: Technology at the Neural Interface. These articles provide information about specific practices in the field, such as surgical techniques, that have been identified as critical for improving efficacy and/or safety. The Neurostimulation Appropriateness Committee (NACC)® and The Neuromodulation Appropriateness Consensus Committee (NACC)® articles were created by INS members who have demonstrated their clinical expertise and familiarity with peer reviewed literature, produced research in the field, and contributed to neuromodulation literature. These articles are offered in response to a need identified by INS leadership, namely, to better define the use of neuromodulation therapies. The Neurostimulation Appropriateness Committee (NACC)® and The Neuromodulation Appropriateness Consensus Committee (NACC)® articles are intended to help both newer and more-experienced practitioners make sense of the wide-ranging scientific literature in the field and are intended to be a living document, regularly evolving with updates and new information as they become available.

Articles by The Neurostimulation Appropriateness Committee (NACC)® and The Neuromodulation Appropriateness Consensus Committee (NACC)®

  1. Deer TR, Thomson S, Pope JE, et al. Guideline review of implantable neurostimulation devices. Neuromodulation. 2014;17:678-685. https://doi.org/10.1111/ner.12186
  2. Deer TR, Mekhail N, Provenzano D, et al. The appropriate use of neurostimulation: avoidance and treatment of complications of neurostimulation therapies for the treatment of chronic pain. Neuromodulation. 2014;17:571–598. https://doi.org/10.1111/ner.12206
  3. Deer TR, Krames E, Mekhail N, et al. The appropriate use of neurostimulation: new and evolving neurostimulation therapies and applicable treatment for chronic pain and selected disease states. Neuromodulation. 2014;17:599–615. https://doi.org/10.1111/ner.12204
  4. Deer TR, Mekhail N, Provenzano D, et al. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: The Neuromodulation Appropriateness Consensus Committee. Neuromodulation. 2014; 17:515–550. https://doi.org/10.1111/ner.12208
  5. Deer TR, Mekhail N, Petersen E, et al., The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain, Neuromodulation, 2014;17:551–70. https://doi.org/10.1111/ner.12215
  6. Deer TR, Provenzano DA, Hanes M, et al. The Neurostimulation Appropriateness Committee (NACC) Recommendations for infection prevention and management. Neuromodulation. 2017;20:31–50. https://doi.org/10.1111/ner.12565
  7. Deer TR, Lamer TJ, Pope JE, et al. The Neurostimulation Appropriateness Consensus Committee (NACC) Safety guidelines for the reduction of severe neurological injury. Neuromodulation.  2017;20:15–30. https://doi.org/10.1111/ner.12564
  8. Deer TR, Narouze S, Provenzano DA, et al. The Neurostimulation Appropriateness Committee (NACC): Recommendation on bleeding and coagulation management in neurostimulation devices. Neuromodulation. 2017;20:51–62. https://doi.org/10.1111/ner.12542
  9. Deer TR, Pope JE, Lamer TJ, et al. The Neuromodulation Appropriateness Consensus Committee on best practices for dorsal root ganglion stimulation. Neuromodulation. 2019;22:1–35. https://doi.org/10.1111/ner.12845
  10. Deer TR, Russo MA, Grider JS, et al. The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations for surgical technique for spinal cord stimulation. Neuromodulation, 2022;25:1–34. https://doi.org/10.1016/j.neurom.2021.10.015.
  11. Deer TR, Russo MA, Grider JS, et al. The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on best practices for cervical neurostimulation. Neuromodulation, 2022;25:35–52. https://doi.org/10.1016/j.neurom.2021.10.015.
  12. Deer TR, Russo M, Grider J, et al. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation. 2024 Jun 13:S1094-7159(24)00075-8. https://doi.org/10.1016/j.neurom.2024.04.004
  13. Deer TR, Russo M, Grider J, et al. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for Spinal Cord Stimulation Long-Term Outcome Optimization and Salvage Therapy. Neuromodulation. 2024 June 19. https://doi.org/10.1016/j.neurom.2024.04.006
  14. Deer TR, Russo MA, Sayed D, et al. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation. 2024 Aug;27(6):977-1007. https://doi.org/10.1016/j.neurom.2024.04.004

The Polyanalgesic Consensus Conference (PACC)®

The formation of The Neurostimulation Appropriateness Committee (NACC) and The Neuromodulation Appropriateness Consensus Committee (NACC) articles were modeled after The Polyanalgesic Consensus Conference (PACC) articles. The Polyanalgesic Consensus Conference (PACC) developed the guidelines under the auspices of the INS. The leadership of the INS and of its journal, Neuromodulation: Technology at the Neural Interface, convened this international, multidisciplinary consensus group, based on expertise of its members, in order to address the growing need for updated guidance to keep pace with emerging evidence, changes in patient care, and to fill current gaps in clinical practice. The goal of The Polyanalgesic Consensus Conference (PACC) is to continue to improve safety and efficacy of the global use of intrathecal therapy for the treatment of chronic pain. The Polyanalgesic Consensus Conference (PACC) authors have published multiple guidelines and updates on the use of intrathecal drug delivery systems for chronic pain conditions, including cancer pain. 

The Polyanalgesic Consensus Conference (PACC)® Mobile App

To offer practitioners anytime access to consensus recommendations and insights that were published in the 2017 update from The Polyanalgesic Consensus Conference (PACC), the INS produced the PACC Mobile app, making it easy to reference and integrate recommendations from The Polyanalgesic Consensus Conference (PACC) into practice. Along with algorithms, recommendations, and evidence-based guidance developed by The Polyanalgesic Consensus Conference (PACC), this mobile application provides audio feedback and translation of the evidence to help apply the concepts in practice.

Access the PACC App

Articles by The Polyanalgesic Consensus Conference (PACC)®
  1. Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation. 2017 Feb;20(2):96-132. https://doi.org/10.1111/ner.12538. Epub 2017 Jan 2. Erratum in: Neuromodulation. 2017 Jun;20(4):405-406.
  2. Deer TR, Hayek SM, Pope JE, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy. Neuromodulation. 2017 Feb;20(2):133-154. https://doi.org/10.1111/ner.12543.
  3. Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. Neuromodulation. 2017 Feb;20(2):155-176. https://doi.org/10.1111/ner.12579.
  4. Deer TR, Abd-Elsayed A, Falowski S, Hagedorn JM, Abejón D, Russo M, Engle A, Hah JM, Lamer TJ, Carayannopoulos AG, Hunter C, Steegers M, Pope J. Practice Choices in Targeted Intrathecal Drug Delivery: An Online Survey Conducted by the Polyanalgesic Consensus Committee. Neuromodulation. 2021 Oct;24(7):1139-1144. https://doi.org/10.1111/ner.13335.
  5. Deer TR, Hayek SM, Grider JS, Hagedorn JM, et al. The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain. Neuromodulation. 2024 May 13:S1094-7159(24)00066-7. https://doi.org/10.1016/j.neurom.2024.03.003.
  6. Deer TR, Hayek SM, Grider JS, Pope JE, et al. The Polyanalgesic Consensus Conference (PACC)®: Updates on Clinical Pharmacology and Comorbidity Management in Intrathecal Drug Delivery for Cancer Pain, Neuromodulation, 2024,
    https://doi.org/10.1016/j.neurom.2024.08.006.