Why the study?
More than half of neuromodulation patients experience implantable pulse generator-related inconveniences, yet standardized guidelines to minimize or prevent these issues are lacking.
This expert consensus provides 26 practical recommendations to minimize and manage inconveniences related to implantable pulse generators in patients undergoing neuromodulation.
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IPG inconveniences lack guidelines; review recommendations leave open need for prospective validation before practice change.
PURPOSE: More than half of patients treated with neuromodulation experience inconveniences related to the implantable pulse generator (IPG). Despite their significance, there is an absence of standardized guidelines and recommendations minimizing and/or preventing these issues, reinforcing the continuous burden posed by IPG-related inconveniences. This study aims to provide evidence- and experience-based recommendations for preoperative counselling, implantation site, surgical technique, and management strategies, improving IPG-related inconveniences, by combining a comprehensive literature review with insights gathered from global expert meetings on the topic. METHODS: In this evidence-and experience-based consensus study, a literature analysis was performed using the PubMed, MEDLINE, and EMBASE databases. Experts’ insights on the topic were systematically collected during various expert-based meetings. Recommendations were developed through an integration of literature evidence and clinical expertise, with the aim of preventing and reducing IPG-related inconveniences. The level of evidence for each recommendation has been assessed using the GRADE system and the degree of consensus was evaluated using an independent expert-analysis. RESULTS: A total of 26 articles, published between 2001 and 2024, were included in the literature search. Twenty-six recommendations were formulated. Outcomes emphasized the importance of thorough preoperative counseling, strategic implant site selection, well-considered surgical technique, and tailored postoperative management in reducing the incidence and severity of IPG-related issues. The level of evidence was low to moderate, while the degree of consensus was high for most of the recommendations proposed in this study. CONCLUSIONS: Given the impact of IPG-related inconveniences, clear and practical recommendations are essential for consistent and effective neuromodulation practice.
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Kollenburg et al. (2026) studied this question.
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