The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks

Timothy R. Deer, Jason E. Pope, Salim M. Hayek, Tim J. Lamer, Ilir Elias Veizi, Michael Erdek, Mark S. Wallace, Jay S. Grider, Robert M. Levy, Joshua Prager, Steven M. Rosen, Michael Saulino, Tony L. Yaksh, Jose A. De Andrés, David Abejon Gonzalez, Jan Vesper, Stefan Schu, Brian Simpson, Nagy Mekhail

Research output: Contribution to journalReview article

Abstract

Introduction: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. Methods: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. Results: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. Conclusion: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.

Original languageEnglish (US)
Pages (from-to)155-176
Number of pages22
JournalNeuromodulation
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2017

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Consensus
Safety
Pharmaceutical Preparations
Therapeutics
Pain
Expert Testimony
Advisory Committees
Practice Guidelines
PubMed
MEDLINE
Chronic Disease
Pharmacokinetics
Morbidity
Physicians
Mortality
Research

Keywords

  • Bupivacaine
  • chronic pain
  • clonidine
  • fixed rate pump
  • intrathecal drug delivery
  • intrathecal granuloma
  • neuropathic pain
  • nonmalignant pain
  • opioid
  • programmable pump
  • safety
  • ziconotide

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

The Polyanalgesic Consensus Conference (PACC) : Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. / Deer, Timothy R.; Pope, Jason E.; Hayek, Salim M.; Lamer, Tim J.; Veizi, Ilir Elias; Erdek, Michael; Wallace, Mark S.; Grider, Jay S.; Levy, Robert M.; Prager, Joshua; Rosen, Steven M.; Saulino, Michael; Yaksh, Tony L.; De Andrés, Jose A.; Abejon Gonzalez, David; Vesper, Jan; Schu, Stefan; Simpson, Brian; Mekhail, Nagy.

In: Neuromodulation, Vol. 20, No. 2, 01.02.2017, p. 155-176.

Research output: Contribution to journalReview article

Deer, TR, Pope, JE, Hayek, SM, Lamer, TJ, Veizi, IE, Erdek, M, Wallace, MS, Grider, JS, Levy, RM, Prager, J, Rosen, SM, Saulino, M, Yaksh, TL, De Andrés, JA, Abejon Gonzalez, D, Vesper, J, Schu, S, Simpson, B & Mekhail, N 2017, 'The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks', Neuromodulation, vol. 20, no. 2, pp. 155-176. https://doi.org/10.1111/ner.12579
Deer, Timothy R. ; Pope, Jason E. ; Hayek, Salim M. ; Lamer, Tim J. ; Veizi, Ilir Elias ; Erdek, Michael ; Wallace, Mark S. ; Grider, Jay S. ; Levy, Robert M. ; Prager, Joshua ; Rosen, Steven M. ; Saulino, Michael ; Yaksh, Tony L. ; De Andrés, Jose A. ; Abejon Gonzalez, David ; Vesper, Jan ; Schu, Stefan ; Simpson, Brian ; Mekhail, Nagy. / The Polyanalgesic Consensus Conference (PACC) : Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks. In: Neuromodulation. 2017 ; Vol. 20, No. 2. pp. 155-176.
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abstract = "Introduction: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. Methods: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. Results: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. Conclusion: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.",
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AU - Hayek, Salim M.

AU - Lamer, Tim J.

AU - Veizi, Ilir Elias

AU - Erdek, Michael

AU - Wallace, Mark S.

AU - Grider, Jay S.

AU - Levy, Robert M.

AU - Prager, Joshua

AU - Rosen, Steven M.

AU - Saulino, Michael

AU - Yaksh, Tony L.

AU - De Andrés, Jose A.

AU - Abejon Gonzalez, David

AU - Vesper, Jan

AU - Schu, Stefan

AU - Simpson, Brian

AU - Mekhail, Nagy

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N2 - Introduction: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. Methods: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. Results: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. Conclusion: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.

AB - Introduction: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. Methods: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. Results: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. Conclusion: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.

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