![]() In addition, the APP should assess for the patient’s mental and physical capacity to operate a patient programmer for an SCS device and social support systems and potential challenges. Contraindications include uncontrolled psychiatric disorders, such as severe depression and untreated anxiety inability to adhere to therapy or poor compliance persistent systemic or local infection immunosuppression and inability to obtain clearance to cease anticoagulation therapy before, during, and after the SCS trial. The APP must be able to correctly identify these individuals as well. 8, 9, 10, 11 Proper inspection of the surgical site to evaluate for any signs of skin infection or skin breakdown is recommended.Īs critical as identifying appropriate candidates, determining poor candidates is of utmost importance. 6 However, SCS and DRGS have been proven effective for pain syndromes beyond the typical indications and should be considered for any patient who has failed to respond to conservative options and would otherwise be an appropriate stimulation candidate. 7 Dorsal root ganglion stimulation is indicated for complex regional pain syndrome and focal pain syndromes. 7 Spinal cord stimulation is indicated for failed back surgery syndrome with persistent axial low back pain or radicular pain, neuropathic pain syndromes affecting the upper or lower extremities, complex regional pain syndrome type 1 and type 2, and mixed neuropathic-vascular conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) recommends considering neuromodulation for patients who have failed to respond to conservative medical management or those who have experienced adverse effects from their treatment regimen. The initial step begins with the APP’s eliciting a comprehensive medical history and relevant physical examination. Proper selection of patients is vital in pursuing any therapy and particularly crucial in considering neuromodulatory techniques, such as SCS and DRGS. Throughout this paper, we aim to clarify the role of the APP in the care of patients with chronic pain by neuromodulatory techniques and offer a reference for these providers to safely manage neuromodulation patients.Īs APPs evaluate patients, they have the important role of correctly identifying appropriate neuromodulation candidates. To date, the role of the APP in the care of the neuromodulation patient has not been defined in the literature. 6 Together, these 2 advanced treatment modalities have helped countless patients live a better and more fulfilling life. 2, 3, 4, 5 A newer technology, DRGS, was shown to be more effective than SCS for certain patients. ![]() Multiple randomized controlled trials have proven SCS to produce more cost-effective and superior patient outcomes compared with repeated surgery or conventional medical management. One such therapy that has grown tremendously during the past 2 decades is neuromodulation, specifically spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS). ![]() This has allowed patients improved access to specialized evaluation and chronic pain treatment options. Given the expanding population of individuals with chronic pain, some practices have begun using APPs to properly care for increasing numbers of patients. Most states allow all APPs to have full or partial prescribing capabilities, including controlled substances. 1 Many APPs have become more specialized through APP residency programs or specific on-the-job training. Physician assistants train for an additional 2 years beyond a Bachelor of Arts or Science degree to earn a physician assistant degree. The nurse practitioner is an advanced practice registered nurse who has completed additional training and education, earning a master’s or doctoral degree. 1 The tasks of these individuals are often considered similar, and together they are known as advanced practice providers (APPs). Because of shortages in the US primary care workforce in the 1960s, the role of the nurse practitioner and physician assistant emerged. ![]()
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