The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines

Timothy R Deer; Jason E Pope; Salim M Hayek; Anjum Bux; Eric Buchser; Sam Eldabe; Jose A De Andrés; Michael Erdek; Dennis Patin; Jay S Grider; Daniel M Doleys; Marilyn S Jacobs; Tony L Yaksh; Lawrence Poree; Mark S Wallace; Joshua Prager; Richard Rauck; Oscar DeLeon; Sudhir Diwan; Steven M Falowski; Helena M Gazelka; Philip Kim; Michael Leong; Robert M Levy; Gladstone McDowell II; Porter McRoberts; Ramana Naidu; Samir Narouze; Christophe Perruchoud; Steven M Rosen; William S Rosenberg; Michael Saulino; Peter Staats; Lisa J Stearns; Dean Willis; Elliot Krames; Marc Huntoon; Nagy Mekhail

doi:10.1111/ner.12538

The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines

Neuromodulation. 2017 Feb;20(2):96-132. doi: 10.1111/ner.12538. Epub 2017 Jan 2.

Authors

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 Kim^{22

23}, Michael Leong²⁴, Robert M Levy²⁵, Gladstone McDowell II²⁶, Porter McRoberts²⁷, Ramana Naidu²⁸, Samir Narouze²⁹, Christophe Perruchoud³⁰, Steven M Rosen³¹, William S Rosenberg³², Michael Saulino³³, Peter Staats^{34

35}, Lisa J Stearns³⁶, Dean Willis³⁷, Elliot Krames³⁸, Marc Huntoon³⁹, Nagy Mekhail⁴⁰

Affiliations

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.

PMID: 28042904
DOI: 10.1111/ner.12538

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.

Keywords: Chronic pain; consensus; fixed rate pump; intrathecal drug delivery; neuropathic pain; nonmalignant pain; opioid; programmable pump; psychological evaluation; safety.

Publication types

Review

MeSH terms

Analgesics / administration & dosage*
Consensus*
Drug Delivery Systems / methods
Drug Delivery Systems / standards*
Humans
Injections, Spinal / standards*
Pain / drug therapy
Practice Guidelines as Topic*

Substances

Analgesics