Timothy R Deer1, Jason E Pope2, Salim M Hayek3, Tim J Lamer4, Ilir Elias Veizi5, Michael Erdek6, Mark S Wallace7, Jay S Grider8, Robert M Levy9, Joshua Prager10, Steven M Rosen11, Michael Saulino12, Tony L Yaksh13, Jose A De Andrés14, David Abejon Gonzalez15, Jan Vesper16, Stefan Schu17, Brian Simpson18, Nagy Mekhail19. 1. Center for Pain Relief, Charleston, WV, USA. 2. Summit Pain Alliance, Santa Rosa, CA, USA. 3. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA. 4. Mayo Clinic, Rochester, MN, USA. 5. Veterans Administration Medical Center, Case Western Reserve University, Cleveland, OH, USA. 6. Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 7. Department of Anesthesia, UC San Diego, San Diego, CA, USA. 8. UK HealthCare Pain Services, University of Kentucky College of Medicine, Lexington, KY, USA. 9. Marcus Neuroscience Institute, Boca Raton, FL, USA. 10. Center for the Rehabilitation of Pain Syndromes (CRPS) at UCLA Medical Plaza, Los Angeles, CA, USA. 11. Fox Chase Pain Management Associates PC, Doylestown, PA, USA. 12. MossRehab, Elkins Park, PA, USA. 13. Anesthesiology and Pharmacology, University of California, San Diego, CA, USA. 14. Valencia School of Medicine, Hospital General Universitario, Valencia, Spain. 15. Hospital Universitario Quiron Madrid, Madrid, Spain. 16. Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Germany. 17. Sana Kliniken, Duisburg, Germany. 18. Department of Neurosurgery, University Hospital of Wales, Cardiff, UK. 19. Cleveland Clinic, Cleveland, OH, USA.
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.
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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