title: Polyanalgesic Consensus Conference 2003: an update on the management of pain by intraspinal drug delivery-- report of an expert panel.
abstract: 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.
authors.affiliation: Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Hassenbusch
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
authors.forename: Michael
authors.initials: M
authors.lastname: Cousins
authors.forename: Eric
authors.initials: E
authors.lastname: Buchser
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Du Pen
authors.forename: James
authors.initials: J
authors.lastname: Eisenach
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Follett
authors.forename: Keith R
authors.initials: KR
authors.lastname: Hildebrand
authors.forename: Elliot S
authors.initials: ES
authors.lastname: Krames
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.forename: Pamela P
authors.initials: PP
authors.lastname: Palmer
authors.forename: James P
authors.initials: JP
authors.lastname: Rathmell
authors.forename: Richard L
authors.initials: RL
authors.lastname: Rauck
authors.forename: Peter S
authors.initials: PS
authors.lastname: Staats
authors.forename: Lisa
authors.initials: L
authors.lastname: Stearns
authors.forename: K Dean
authors.initials: KD
authors.lastname: Willis
mesh_terms: 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
chemical_list: D000700:Analgesics