Polyanalgesic Consensus Conference 2003: an update on the management of pain by intraspinal drug delivery-- report of an expert panel.
Intraspinal drug infusion using fully implantable pump and catheter systems is a safe and effective therapy for selected patients with chronic pain. The options for this approach are increasing, as drugs that are commercially available for systemic administration are adapted to this use and other drugs that are in development specifically for intraspinal administration become available. In 2000 a Polyanalgesic Consensus Conference was organized to evaluate the existing literature and develop guidelines for drug selection. The major outcome of this effort, an algorithm for drug selection, was based on the best available evidence at the time. Rapid changes have occurred in the science and practice of intraspinal infusion and a Polyanalgesic Consensus Conference 2003 was organized to pursue the following goals: 1) to review the literature on intraspinal drug infusion since 1999, 2) to revise the 2000 drug-selection algorithm, 3) to develop guidelines for optimizing drug dosage and concentration, 4) to create a process for documenting minimum evidence supporting the use of a drug for intraspinal infusion, and 5) to clarify issues pertaining to compounding of drugs. Based on the best available evidence and expert opinion, consensus recommendations were developed in all these areas. The panel's conclusions may provide a foundation for clinical practice and a rational basis for new research.
Hassenbusch
Samuel J
SJ
Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
Portenoy
Russell K
RK
Cousins
Michael
M
Buchser
Eric
E
Deer
Timothy R
TR
Du Pen
Stuart L
SL
Eisenach
James
J
Follett
Kenneth A
KA
Hildebrand
Keith R
KR
Krames
Elliot S
ES
Levy
Robert M
RM
Palmer
Pamela P
PP
Rathmell
James P
JP
Rauck
Richard L
RL
Staats
Peter S
PS
Stearns
Lisa
L
Willis
K Dean
KD
D000465:Algorithms; D000700:Analgesics / Q000008:administration & dosage* / Q000592:standards*; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D004339:Drug Compounding / Q000379:methods / Q000592:standards; D005104:Expert Testimony / Q000379:methods; D006801:Humans; D007278:Injections, Spinal / Q000379:methods* / Q000592:standards*; D010146:Pain / Q000188:drug therapy*; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D014481:United States
D000700:Analgesics