Polyanalgesic consensus conference-2012: Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses)

Timothy R. Deer, Joshua Prager, Robert Levy, James Rathmell, Eric Buchser, Allen Burton, David Caraway, Michael Cousins, José De Andrés, Sudhir Diwan, Michael Erdek, Eric Grigsby, Marc Huntoon, Marilyn S. Jacobs, Philip Kim, Krishna Kumar, Michael Leong, Liong Liem, Gladstone C. McDowell, Sunil PanchalRichard Rauck, Michael Saulino, B. Todd Sitzman, Peter Staats, Michael Stanton-Hicks, Lisa Stearns, Mark Wallace, K. Dean Willis, William Witt, Tony Yaksh, Nagy Mekhail

Research output: Contribution to journalArticle

Abstract

Introduction: Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications. Methods: The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas. Results: The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas. Conclusion: The use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.

Original languageEnglish (US)
Pages (from-to)483-495
Number of pages13
JournalNeuromodulation
Volume15
Issue number5
DOIs
StatePublished - Sep 2012

Fingerprint

Granuloma
Consensus
Catheters
Chronic Pain
Opioid Analgesics
Nervous System
Intractable Pain
Group Processes
Standard of Care
Therapeutics
Drug Therapy
Pharmaceutical Preparations

Keywords

  • Chronic pain
  • consensus
  • granuloma
  • inflammatory mass
  • intrathecal

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Polyanalgesic consensus conference-2012 : Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). / Deer, Timothy R.; Prager, Joshua; Levy, Robert; Rathmell, James; Buchser, Eric; Burton, Allen; Caraway, David; Cousins, Michael; De Andrés, José; Diwan, Sudhir; Erdek, Michael; Grigsby, Eric; Huntoon, Marc; Jacobs, Marilyn S.; Kim, Philip; Kumar, Krishna; Leong, Michael; Liem, Liong; McDowell, Gladstone C.; Panchal, Sunil; Rauck, Richard; Saulino, Michael; Todd Sitzman, B.; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Wallace, Mark; Willis, K. Dean; Witt, William; Yaksh, Tony; Mekhail, Nagy.

In: Neuromodulation, Vol. 15, No. 5, 09.2012, p. 483-495.

Research output: Contribution to journalArticle

Deer, TR, Prager, J, Levy, R, Rathmell, J, Buchser, E, Burton, A, Caraway, D, Cousins, M, De Andrés, J, Diwan, S, Erdek, M, Grigsby, E, Huntoon, M, Jacobs, MS, Kim, P, Kumar, K, Leong, M, Liem, L, McDowell, GC, Panchal, S, Rauck, R, Saulino, M, Todd Sitzman, B, Staats, P, Stanton-Hicks, M, Stearns, L, Wallace, M, Willis, KD, Witt, W, Yaksh, T & Mekhail, N 2012, 'Polyanalgesic consensus conference-2012: Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses)', Neuromodulation, vol. 15, no. 5, pp. 483-495. https://doi.org/10.1111/j.1525-1403.2012.00449.x
Deer, Timothy R. ; Prager, Joshua ; Levy, Robert ; Rathmell, James ; Buchser, Eric ; Burton, Allen ; Caraway, David ; Cousins, Michael ; De Andrés, José ; Diwan, Sudhir ; Erdek, Michael ; Grigsby, Eric ; Huntoon, Marc ; Jacobs, Marilyn S. ; Kim, Philip ; Kumar, Krishna ; Leong, Michael ; Liem, Liong ; McDowell, Gladstone C. ; Panchal, Sunil ; Rauck, Richard ; Saulino, Michael ; Todd Sitzman, B. ; Staats, Peter ; Stanton-Hicks, Michael ; Stearns, Lisa ; Wallace, Mark ; Willis, K. Dean ; Witt, William ; Yaksh, Tony ; Mekhail, Nagy. / Polyanalgesic consensus conference-2012 : Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses). In: Neuromodulation. 2012 ; Vol. 15, No. 5. pp. 483-495.
@article{4e649d2c77584aa3839ee4ba5a1ec7d9,
title = "Polyanalgesic consensus conference-2012: Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses)",
abstract = "Introduction: Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications. Methods: The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas. Results: The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas. Conclusion: The use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.",
keywords = "Chronic pain, consensus, granuloma, inflammatory mass, intrathecal",
author = "Deer, {Timothy R.} and Joshua Prager and Robert Levy and James Rathmell and Eric Buchser and Allen Burton and David Caraway and Michael Cousins and {De Andr{\'e}s}, Jos{\'e} and Sudhir Diwan and Michael Erdek and Eric Grigsby and Marc Huntoon and Jacobs, {Marilyn S.} and Philip Kim and Krishna Kumar and Michael Leong and Liong Liem and McDowell, {Gladstone C.} and Sunil Panchal and Richard Rauck and Michael Saulino and {Todd Sitzman}, B. and Peter Staats and Michael Stanton-Hicks and Lisa Stearns and Mark Wallace and Willis, {K. Dean} and William Witt and Tony Yaksh and Nagy Mekhail",
year = "2012",
month = "9",
doi = "10.1111/j.1525-1403.2012.00449.x",
language = "English (US)",
volume = "15",
pages = "483--495",
journal = "Neuromodulation",
issn = "1094-7159",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Polyanalgesic consensus conference-2012

T2 - Consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses)

AU - Deer, Timothy R.

AU - Prager, Joshua

AU - Levy, Robert

AU - Rathmell, James

AU - Buchser, Eric

AU - Burton, Allen

AU - Caraway, David

AU - Cousins, Michael

AU - De Andrés, José

AU - Diwan, Sudhir

AU - Erdek, Michael

AU - Grigsby, Eric

AU - Huntoon, Marc

AU - Jacobs, Marilyn S.

AU - Kim, Philip

AU - Kumar, Krishna

AU - Leong, Michael

AU - Liem, Liong

AU - McDowell, Gladstone C.

AU - Panchal, Sunil

AU - Rauck, Richard

AU - Saulino, Michael

AU - Todd Sitzman, B.

AU - Staats, Peter

AU - Stanton-Hicks, Michael

AU - Stearns, Lisa

AU - Wallace, Mark

AU - Willis, K. Dean

AU - Witt, William

AU - Yaksh, Tony

AU - Mekhail, Nagy

PY - 2012/9

Y1 - 2012/9

N2 - Introduction: Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications. Methods: The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas. Results: The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas. Conclusion: The use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.

AB - Introduction: Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications. Methods: The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas. Results: The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas. Conclusion: The use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.

KW - Chronic pain

KW - consensus

KW - granuloma

KW - inflammatory mass

KW - intrathecal

UR - http://www.scopus.com/inward/record.url?scp=84867574475&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867574475&partnerID=8YFLogxK

U2 - 10.1111/j.1525-1403.2012.00449.x

DO - 10.1111/j.1525-1403.2012.00449.x

M3 - Article

C2 - 22494332

AN - SCOPUS:84867574475

VL - 15

SP - 483

EP - 495

JO - Neuromodulation

JF - Neuromodulation

SN - 1094-7159

IS - 5

ER -