Timothy R Deer1, Salim M Hayek2, Jason E Pope3, Tim J Lamer4, Maged Hamza5, Jay S Grider6, Steven M Rosen7, Samir Narouze8, Christophe Perruchoud9, Simon Thomson10, Marc Russo11, Eric Grigsby12, Daniel M Doleys13, Marilyn S Jacobs14, Michael Saulino15, Paul Christo16, Philip Kim17,18, Elliot Marc Huntoon19, Elliot Krames20, Nagy Mekhail21. 1. Center for Pain Relief, Charleston, WV, USA. 2. Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA. 3. Summit Pain Alliance, Santa Rosa, CA, USA. 4. Mayo Clinic, Rochester, MN, USA. 5. Virginia Commonwealth University Spine Center, Richmond, VA, USA. 6. UK HealthCare Pain Services, University of Kentucky College of Medicine, Lexington, KY, USA. 7. Delaware Valley Pain & Spine Institute, Chalfront, PA, USA. 8. Western Reserve Hospital, Cuyahoga Falls, OH, USA. 9. Hôpital de Zone Morges, Morges, Switzerland. 10. Basildon and Thurrock University Hospitals FHT, Essex, UK. 11. Hunter Pain Clinic, Newcastle, NSW, Australia. 12. Neurovations Clinical Research, Napa, CA, USA. 13. Doleys Clinic, Birmingham, AL, USA. 14. California Pain Medicine Center, Los Angeles, CA, USA. 15. MossRehab, Elkins Park, PA, USA. 16. The Johns Hopkins Hospital, Baltimore, MD, USA. 17. Bryn Mawr Hospital, Bryn Mawr, PA, USA. 18. Christiana Hospital, Newark, DE, USA. 19. Vanderbilt University Medical Center, Nashville, TN, USA. 20. Pacific Pain Treatment Center (ret.), San Francisco, CA, USA. 21. Cleveland Clinic, Evidence-Based Pain Management Research, Cleveland, OH, USA.
Abstract
INTRODUCTION: Intrathecal (IT) drug infusion is an appropriate and necessary tool in the algorithm to treat refractory cancer and noncancer pain. The decision-making steps/methodology for selecting appropriate patients for implanted targeted drug delivery systems is controversial and complicated. Therefore, a consensus on best practices for determining appropriate use of IT drug infusion may involve testing/trialing this therapy before implantation. METHODS: This current Polyanalgesic Consensus Conference (PACC) update was designed to address the deficiencies and emerging innovations since the previous PACC convened in 2012. A literature search identified publications available since the previous PACC publications in 2014, and relevant sources were contributed by the PACC members. After reviewing the literature, the panel determined the evidence levels and degrees of recommendations. The developed consensus was ranked as strong (>80%), moderate (50-79%), or weak (<49%). RESULTS: The trialing for IT drug delivery systems (IDDS) remains an area of continued controversy. The PACC recommendations for trialing are presented in 34 consensus points and cover trialing for morphine, ziconotide, and medication admixtures; starting doses and titration practices; measurements of success; trial settings and monitoring; management of systemic opioids during trialing; and the role of psychological evaluation. Finally, the PACC describes clinical scenarios in which IT trialing is required or not required. CONCLUSION: The PACC provides consensus guidance on best practices of trialing for IDDS implants. In addition, the PACC recommends that no trial may be required in certain patient populations.
INTRODUCTION: Intrathecal (IT) drug infusion is an appropriate and necessary tool in the algorithm to treat refractory cancer and noncancer pain. The decision-making steps/methodology for selecting appropriate patients for implanted targeted drug delivery systems is controversial and complicated. Therefore, a consensus on best practices for determining appropriate use of IT drug infusion may involve testing/trialing this therapy before implantation. METHODS: This current Polyanalgesic Consensus Conference (PACC) update was designed to address the deficiencies and emerging innovations since the previous PACC convened in 2012. A literature search identified publications available since the previous PACC publications in 2014, and relevant sources were contributed by the PACC members. After reviewing the literature, the panel determined the evidence levels and degrees of recommendations. The developed consensus was ranked as strong (>80%), moderate (50-79%), or weak (<49%). RESULTS: The trialing for IT drug delivery systems (IDDS) remains an area of continued controversy. The PACC recommendations for trialing are presented in 34 consensus points and cover trialing for morphine, ziconotide, and medication admixtures; starting doses and titration practices; measurements of success; trial settings and monitoring; management of systemic opioids during trialing; and the role of psychological evaluation. Finally, the PACC describes clinical scenarios in which IT trialing is required or not required. CONCLUSION: The PACC provides consensus guidance on best practices of trialing for IDDS implants. In addition, the PACC recommends that no trial may be required in certain patient populations.
Authors: Mansoor M Aman; Ammar Mahmoud; Timothy Deer; Dawood Sayed; Jonathan M Hagedorn; Shane E Brogan; Vinita Singh; Amitabh Gulati; Natalie Strand; Jacqueline Weisbein; Johnathan H Goree; Fangfang Xing; Ali Valimahomed; Daniel J Pak; Antonios El Helou; Priyanka Ghosh; Krishna Shah; Vishal Patel; Alexander Escobar; Keith Schmidt; Jay Shah; Vishal Varshney; William Rosenberg; Sanjeet Narang Journal: J Pain Res Date: 2021-07-16 Impact factor: 3.133
Authors: Antonello Sica; Beniamino Casale; Maria Teresa Di Dato; Armando Calogero; Alessandro Spada; Caterina Sagnelli; Mario Santagata; Pietro Buonavolontà; Alfonso Fiorelli; Anna Salzano; Concetta Anna Dodaro; Erika Martinelli; Elisabetta Saracco; Teresa Troiani; Dario Tammaro; Fortunato Ciardiello; Alfonso Papa Journal: Open Med (Wars) Date: 2019-10-17