The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain

Timothy R Deer; Salim M Hayek; Jay S Grider; Jonathan M Hagedorn; Gladstone C McDowell 2nd; Philip Kim; Denis Dupoiron; Vasudha Goel; Rui Duarte; Julie G Pilitsis; Michael S Leong; Jose De Andrés; Christophe Perruchoud; Harry Sukumaran; Alaa Abd-Elsayed; Michael Saulino; Dennis Patin; Lawrence R Poree; Natalie Strand; Karina Gritsenko; Jill A Osborn; Ivano Dones; Anjum Bux; Jay M Shah; Brad L Lindsey; Erik Shaw; Tony L Yaksh; Robert M Levy

doi:10.1016/j.neurom.2024.03.003

The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain

Neuromodulation. 2024 May 13:S1094-7159(24)00066-7. doi: 10.1016/j.neurom.2024.03.003. Online ahead of print.

Authors

Timothy R Deer¹, Salim M Hayek², Jay S Grider³, Jonathan M Hagedorn⁴, Gladstone C McDowell 2nd⁵, Philip Kim⁶, Denis Dupoiron⁷, Vasudha Goel⁸, Rui Duarte⁹, Julie G Pilitsis¹⁰, Michael S Leong¹¹, Jose De Andrés¹², Christophe Perruchoud¹³, Harry Sukumaran¹⁴, Alaa Abd-Elsayed¹⁵, Michael Saulino¹⁶, Dennis Patin¹⁷, Lawrence R Poree¹⁸, Natalie Strand¹⁹, Karina Gritsenko²⁰, Jill A Osborn²¹, Ivano Dones²², Anjum Bux²³, Jay M Shah²⁴, Brad L Lindsey¹, Erik Shaw²⁵, Tony L Yaksh²⁶, Robert M Levy²⁷

Affiliations

¹ The Spine and Nerve Centers of the Virginias, Charleston, WV, USA.
² Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA. Electronic address: Salim.Hayek@UHhospitals.org.
³ UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
⁴ Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA.
⁵ Integrated Pain Solutions, Columbus, OH, USA.
⁶ Christiana Hospital, Newark, DE, USA; Bryn Mawr Hospital, Bryn Mawr, PA, USA.
⁷ Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de L'Ouest, Angers, France.
⁸ Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
⁹ Institute of Population Health, University of Liverpool, Liverpool, UK.
¹⁰ Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
¹¹ Stanford Pain Management Center, Redwood City, CA, USA.
¹² Anesthesia, Critical Care, and Multidisciplinary Pain Management Department, General University Hospital, València, Spain; Anesthesia Unit, Surgical Specialties Department, Valencia University Medical School, València, Spain.
¹³ Pain Clinic, La Tour Medical Group, Geneva, Switzerland.
¹⁴ Department of Anesthesiology, Detroit Medical Center/Wayne State University, Detroit, MI, USA.
¹⁵ Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA.
¹⁶ Department of Physical Medicine and Rehabilitation, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.
¹⁷ University of Miami Health System, Miami, FL, USA.
¹⁸ Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA.
¹⁹ Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
²⁰ Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA.
²¹ St. Paul's Hospital, Vancouver, British Columbia, Canada.
²² Department of Neurosurgery, Istituto Nazionale Neurologico "C Besta" of Milan, Milan, Italy.
²³ Anesthesia and Chronic Pain Management, Ephraim McDowell Regional Medical Center, Danville, KY, USA.
²⁴ SamWell Institute for Pain Management, Colonia, NJ, USA.
²⁵ Shepherd Pain and Spine Institute, Atlanta, GA, USA.
²⁶ Anesthesiology and Pharmacology, University of California, San Diego, CA, USA.
²⁷ Neurosurgical Services, Anesthesia Pain Care Consultants, Tamarac, FL, USA.

PMID: 38752946
DOI: 10.1016/j.neurom.2024.03.003

Abstract

Introduction: The International Neuromodulation Society convened a multispecialty group of physicians and scientists based on expertise with international representation to establish evidence-based guidance on intrathecal drug delivery in treating chronic pain. This Polyanalgesic Consensus Conference (PACC)® project, created more than two decades ago, intends to provide evidence-based guidance for important safety and efficacy issues surrounding intrathecal drug delivery and its impact on the practice of neuromodulation.

Materials and methods: Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when PACC® last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence is scant.

Results: The PACC® examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process.

Conclusions: The PACC® recommends best practices regarding intrathecal drug delivery to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

Keywords: Best practices; chronic pain; consensus; intrathecal drug delivery; neuromodulation.

Publication types

Review