A Message from the President
Dear all INS members,
The neuromodulation field is developing rapidly. Not only are manufacturers developing new technologies to better treat our patients but also is the health economy starting to turn. At the same time, INS is growing and so is the interactivity with members and the public.
The INS executive board will be meeting immediately prior to the North American Neuromodulation Society annual scientific meeting in Las Vegas this December 2013. The full INS board will meet in Montreal in May 2014. Our constitution means that each board should meet in person once a year. The full board meeting in Montreal allows ratification of various proposals and policies put to it by the executive board. The full board members also get to see the venue for our next biennial meeting in Montreal in June 2015. This allows time for chapter presidents to provide their input and promote this important international event to their membership.
Meanwhile the venue selection committee is working systematically on proposals for city candidacy for our 12th World Congress in 2017. We have narrowed this down to five cities and are now doing our due diligence.
The INS is continuing to work on two other new initiatives – the INS Endorsement Policy and INS Research Support Policy. Both of these will bring added value to INS membership, so please stay tuned to these developments.
INS President-Elect Dr. Timothy Deer and the Neuromodulation Appropriateness Consensus Committee (NACC) have been working hard to achieve publication of four major titles that we hope will help to bring us all up to the mark in terms of our understanding of appropriate application of neuromodulation in 2013 - 2014. The INS is extremely grateful to Tim and the NACC team for taking on this mammoth project. Much like Polyanalgesic Consensus Conference these titles are an evolving project over successive years. They will help each of you in your collective efforts to ensure there is patient access to these therapies. We also hope to try to raise standards of practice.
There is a danger that some colleagues (most likely not INS members) are over-prescribing neuromodulation trials (in particular peripheral nerve field stimulation, PNfS, and spinal cord stimulation, SCS) with low rates of conversion to full implant, or worse still, early explantation of devices after failed therapy. In some countries, reimbursement agencies are aware of this. As the leading professional education society, it is our responsibility to make sure that neuromodulation use is appropriate. We cannot tolerate restrictions on appropriate use but nor must we condone inappropriate use.
As well as the NACC there is a further INS initiative to support this. The INS has been promoting the use of national registries for neuromodulation. If co-operation can be achieved not only will a registry help safeguard patients but will also be an invaluable tool for clinical audit, observational outcome research and device tracking. Many of the manufacturers are introducing registries; although not a substitute for an independent national registry, they will if properly carried out and independently analysed and published provide some useful data on new technological developments.
2014 and 2015 will be exciting years for the fruits of research in our field. Several high quality research projects, which will have similar significance to Kumar et al. (2007) and North et al. (2005), in various new applications of therapy, will be published. The INS believes that research such as this is vital to the survival of neuromodulation.
Through our journal Neuromodulation: Technology at the Neural Interface, we continue to reinforce the central role of research in this developing field. Authors who submitted abstracts at INS Berlin 2013 have been asked by Neuromodulation Editor-in-Chief Dr. Robert Levy to contribute full-length articles to the journal for peer review. Select audio and slide presentations from INS Berlin are already available on the INS website. The proceedings from the INS congress will also be available in the online journal, thereby providing citation references.
Meanwhile in 2014 the journal will publish eight editions per year rather than the current six, an expansion made possible by mutual commitment of the publisher and editorial office. With a steady influx of manuscript submissions, this can be done and still maintain the all-important rejection rate that ensures our journal continues to climb in quality. As members of the INS, I hope you are proud of the direction in which your journal is progressing.
At this time of year many of the INS chapter societies will be having their scientific meeting. I recently attended the Neuromodulation Society of the United Kingdom and Ireland meeting in Oxford, UK. I was especially pleased to see so many younger members starting out in our field. The reimbursement landscape, for SCS at least, is becoming more secure and clinical fellowships in neuromodulation more abundant so allowing training of future neuromodulation specialists.
I am very much looking forward to attending both the North American Neuromodulation Society (NANS) in December and the Italian Neuromodulation Society in January that take place in Las Vegas and Venice, respectively. I hope to see many of you there.
Both the INS and NANS will be exhibiting at the Congress of Neurological Surgeons (CNS) meeting in San Francisco on 19th to 23rd October 2013. If you are going, please drop by booth 1055 to see INS Executive Director Tia Sofatzis and NANS Executive Director Chris Welber and encourage non-INS members to join our society. Current NANS President Dr. Ali Rezai is also president of CNS and current NANS Vice President Dr. Ashwini Sharan is chair of CNS scientific committee. With our mutually complementary interests, we wish the CNS and our colleagues there a successful meeting.
We have two great discussion forums in October and November 2013. Please use your membership privilege and take part in these active forum discussions.
From October 8th through 22nd we have Prof. Turo Nurmikko, MD, PhD of Walton Centre, Liverpool and Director of Pain Research Institute who is leading and moderating discussion on repetitive transcranial magnetic stimulation for chronic pain. Following that from October 27th to November 10th we will be having a lively discussion concerning the use of neurosurgically placed paddle leads and minimally invasively placed cylindrical leads. I am grateful to Dr. Konstantin Slavin for joining me as a co-moderator to make this a thought-provoking discussion.
The activities I have mentioned represent aspects of how we try to give added value to your membership. As we watch the case for appropriate use of neuromodulation becoming more and more compelling, the INS as a society is continuing in good health. I hope that you all do too, and that you continue to associate with our society since your collective efforts and support help to fulfill our shared mission. Best wishes to you all.
Dr. Simon Thomson, MBBS, FFPMRCA
President of INS
How to Participate in Engaging Pain-Oriented Expert Panels in October
From Oct. 8 – 22, the International Neuromodulation Society is holding online Expert Panel led by Prof. Turo Nurmikko, MD, PhD, professor in Pain Relief, The Walton Centre NHS Foundation Trust, and director of the Pain Research Institute on repetitive transcranial magnetic stimulation for neuropathic pain.
Following that, from Oct. 27 – Nov. 10, INS President Simon Thomson, MBBS, FRCA, FIPP, and INS Director-at-Large Konstantin Slavin, MD, are scheduled to lead a discussion for members on the comparative pros and cons of percutaneous or paddle leads. The discussion coincides with publication of “Outcomes of Percutaneous and Paddle Lead Implantation for Spinal Cord Stimulation: A Comparative Analysis of Complications, Reoperation Rates, and Health-Care Costs” by Duke University authors Ranjith Babu; Matthew A. Hazzard, MD; Kevin T. Huang; Beatrice Ugiliweneza, PhD; Chirag Patil, MD; Maxwell Boakye, MD; and Nandan Lad, MD, PhD in Neuromodulation: Technology at the Neural Interface.
Expert Panel discussions take place in the Members Only Section of the INS website, www.neuromodulation.com. Members may login following instructions found at http://www.neuromodulation.com/expert-panels.
Login button on home page
2) Choose the Global Disccusion Forum link from the Member Menu in the Members-Only Section
Menu on Members-Only Page
3) Navigate to the Global Discussion - Expert Panel Forum
Community Forum in Members Only Area
ABOUT THE PANEL LEADERS, Prof. Nurmikko leads several research projects involving the peripheral and central mechanisms of chronic and experimental pain. This research involves the use of a variety of techniques such as functional and structural brain imaging, non-invasive brain stimulation, quantitative sensory testing and electrophysiology. He is currently a lead investigator of a number of studies involving the role of transcranial magnetic and transcranial direct current stimulation of the brain in chronic pain.
Meanwhile, in the panel about leads, Dr. Thomson committed to advocate advantages of percutaneous leads, while Dr. Slavin agreed to advocate the advantages of paddle leads.
Dr. Thomson is a consultant in Anaesthesia and Pain Management services at Basildon and Thurrock University NHS Trust. He has a keen interest in spinal cord stimulation becoming a standard of practice for the management of refractory neuropathic, ischaemic and visceral pain. Indeed his efforts have been to ensure that there is high quality clinical evidence for the effectiveness and safety of this useful therapy at an affordable cost. Dr. Thomson has been using SCS for 21 years and has only personal experience at placing cylindrical placed leads. He has of course been involved in research, guideline writing, training, teaching and clinical audit.
“SCS has its origins with neurosurgery with open placed leads (paddles) but like with many other surgical techniques the drive is towards minimal intervention,” he noted. “The supposed advantages of paddle leads are being matched by cylindrical leads (percutaneous), multi-contact platforms, better anchors and robust leads. However the increased risk of major neurological harm, in-patient stay and patient morbidity relegates paddle lead placement to a secondary procedure if cylindrical lead therapy fails. At the very least patients should be fully informed that there is an alternative with a different risk/benefit profile.”
A professor of neurosurgery in the University of Illinois at Chicago, Dr. Slavin has treated hundreds of patients using SCS over the past 15 years. Among other publications, he co-authored “NANS Training Requirements for Spinal Cord Stimulation Devices: Selection, Implantation, and Follow-up” in Neuromodulation in 2009 and a recent paper on “Incidence and avoidance of neurologic complications with paddle type spinal cord stimulation leads”, published in Neuromodulation in 2011. Dr. Slavin has been selected to co-host this discussion because of his expertise in both percutaneous and laminectomy-type SCS electrodes..
Neuromodulation: Technology at the Neural Interface to publish two additional issues starting in 2014
The International Neuromodulation Society journal, Neuromodulation: Technology at the Neural Interface, will increase publication from six to eight times annually in 2014 to accommodate increasing submissions and interest in the field. With a growing rejection rate that has reached 60% and has markedly improved the journal’s quality, there still is a need to expand the editorial space available in each issue to publish high-caliber manuscripts.
Issues of Volume 17 in 2014 will be published in January, February, April, June, July, August, October, and December. INS members will receive the additional issues as part of their membership for no additional charge.
Neuromodulation fills a unique role by meeting the needs of a diverse readership for scientific and clinical peer-review articles that increase understanding of mechanisms of neuromodulation and evaluate existing and emerging applications. Studies published in the journal help to develop and refine indications and techniques for an ever-expanding field including pain, headache, movement disorders, spasticity, paralysis, psychiatric disorders, epilepsy, sensory deprivation, gastric dysfunction, obesity and incontinence.
By publishing international and national conference abstracts in the journal for open public access by non-subscribers, the society enables collaboration and communication. In addition, journal content is available free online within institutions in the developing world through participation of the publisher, Wiley-Blackwell, in the World Health Organization’s HINARI Initiative.
Since its creation in 1998, the journal has grown from four issues a year, to six in 2011 and now to eight in 2014, and has been indexed in PUBMED to retroactively include all articles published since its inception.
Find Presentations from the 11th World Congress Online
The online edition of the September/October 2013 issue of Neuromodulation: Technology at the Neural Interface featuresoral and poster abstracts from the International Neuromodulation Society 11th World Congress in Berlin. The International Neuromodulation Society and Wiley-Blackwell are enabling free download of the proceedings, making this leading-edge research more accessible to the public and to those who can benefit from it.
Oral and poster abstracts featured in the online version of Volume 16, Number 5, will be organized by the dates on which they were presented, and will have the following digital identifiers:
Meanwhile, selected audio and slide presentations about neuromodulation from the 11th World Congress have been posted for members to access in the Members Only Section by following the link to Previous Congress Proceedings.
Make Your Voice Heard Concerning Future Congress Preferences
In a forthcoming survey, International Neuromodulation Society members will have a chance to express preferences for content, focus, location and length – as well as to provide ideas and suggestions about what would be valuable to see offered.
We encourage you to fill out and return the survey. It will be sent by email, presented in a format that will provide an opportunity to rank options as well as write comments.
Once results are tallied, summaries will be presented in a future newsletter. Your contributions are appreciated as we continue to serve members and play a leading role in this interdisciplinary field.