Timothy R Deer1, Jason E Pope2, Salim M Hayek3, Anjum Bux4, Eric Buchser5, Sam Eldabe6, Jose A De Andrés7, Michael Erdek8, Dennis Patin9, Jay S Grider10, Daniel M Doleys11, Marilyn S Jacobs12, Tony L Yaksh13, Lawrence Poree14, Mark S Wallace15, Joshua Prager16, Richard Rauck17, Oscar DeLeon18, Sudhir Diwan19, Steven M Falowski20, Helena M Gazelka21, Philip Kim22,23, Michael Leong24, Robert M Levy25, Gladstone McDowell26, Porter McRoberts27, Ramana Naidu28, Samir Narouze29, Christophe Perruchoud30, Steven M Rosen31, William S Rosenberg32, Michael Saulino33, Peter Staats34,35, Lisa J Stearns36, Dean Willis37, Elliot Krames38, Marc Huntoon39, Nagy Mekhail40. 1. Center for Pain Relief, Charleston, WV, USA. 2. Summit Pain Alliance, Santa Rosa, CA, USA. 3. Case Western Reserve University, Cleveland, OH, USA. 4. Anesthesia and Chronic Pain Management, Ephraim McDowell Regional Medical Center, Danville, KY, USA. 5. Anaesthesia and Pain Management Department, EHC Hosptial, Morges, and CHUV University Hospital, Lausanne, Switzerland. 6. The James Cook University Hospital, Middlesbrough, UK. 7. Valencia School of Medicine, Hospital General Universitario, Valencia, Spain. 8. Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 9. University of Miami Health System, Miami, FL, USA. 10. University of Kentucky College of Medicine, UK HealthCare Pain Services, Lexington, KY, USA. 11. Doleys Clinic, Birmingham, AL, USA. 12. California Pain Medicine Center, Los Angeles, CA, USA. 13. Anesthesiology and Pharmacology, University of California, San Diego, CA, USA. 14. Pain Clinic of Monterey Bay, University of California at San Francisco, San Francisco, CA, USA. 15. Department of Anesthesia, UC San Diego, San Diego, CA, USA. 16. Center for the Rehabilitation Pain Syndromes (CRPS) at UCLA Medical Plaza, Los Angeles, CA, USA. 17. Carolina Pain Institute, Wake Forest Baptist Health, Winston-Salem, NC, USA. 18. Roswell Park Cancer Institute, SUNY, Buffalo, NY, USA. 19. Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, NY, USA. 20. St. Luke's University Health Network, Bethlehem, PA, USA. 21. Mayo Clinic, Rochester, MN, USA. 22. Bryn Mawr Hospital, Bryn Mawr, PA, USA. 23. Christiana Hospital, Newark, DE, USA. 24. Stanford University, Palo Alto, CA, USA. 25. Marcus Neuroscience Institute, Boca Raton, FL, USA. 26. Integrated Pain Solutions, Columbus, OH, USA. 27. Holy Cross Hospital, Fort Lauderdale, Florida, USA. 28. San Francisco Medical Center, University of California, San Francisco, CA, USA. 29. Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA. 30. Hôpital de Zone Morges, Morges, Switzerland. 31. Fox Chase Pain Management Associates PC, Doylestown, PA, USA. 32. Center for Relief of Pain, Kansas City, MO, USA. 33. MossRehab, Elkins Park, PA, USA. 34. Premier Pain Management Centers, Shrewsbury, NJ, USA. 35. Johns Hopkins University, Baltimore, MD, USA. 36. Center for Pain and Supportive Care, Phoenix, AZ, USA. 37. Alabama Pain Center, Huntsville, AL, USA. 38. Pacific Pain Treatment Center (ret.), San Francisco, CA, USA. 39. Vanderbilt University Medical Center, Nashville, TN, USA. 40. Cleveland Clinic, Cleveland, OH, USA.
Abstract
INTRODUCTION: Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice. METHODS: The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012. An extensive literature search identified publications between January 15, 2007 and November 22, 2015 and authors contributed additional relevant sources. After reviewing the literature, the panel convened to determine evidence levels and degrees of recommendations for intrathecal therapy. This meeting served as the basis for consensus development, which was ranked as strong, moderate or weak. Algorithms were developed for intrathecal medication choices to treat nociceptive and neuropathic pain for patients with cancer, terminal illness, and noncancer pain, with either localized or diffuse pain. RESULTS: The PACC has developed an algorithmic process for several aspects of intrathecal drug delivery to promote safe and efficacious evidence-based care. Consensus opinion, based on expertise, was used to fill gaps in evidence. Thirty-one consensus points emerged from the panel considerations. CONCLUSION: New algorithms and guidance have been established to improve care with the use of intrathecal drug delivery.
INTRODUCTION: Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice. METHODS: The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012. An extensive literature search identified publications between January 15, 2007 and November 22, 2015 and authors contributed additional relevant sources. After reviewing the literature, the panel convened to determine evidence levels and degrees of recommendations for intrathecal therapy. This meeting served as the basis for consensus development, which was ranked as strong, moderate or weak. Algorithms were developed for intrathecal medication choices to treat nociceptive and neuropathic pain for patients with cancer, terminal illness, and noncancer pain, with either localized or diffuse pain. RESULTS: The PACC has developed an algorithmic process for several aspects of intrathecal drug delivery to promote safe and efficacious evidence-based care. Consensus opinion, based on expertise, was used to fill gaps in evidence. Thirty-one consensus points emerged from the panel considerations. CONCLUSION: New algorithms and guidance have been established to improve care with the use of intrathecal drug delivery.
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