title: Polyanalgesic Consensus Conference--2012: consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses).
abstract: BACKGROUND
  Continuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications.
  
  
  METHODS
  The Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas.
  
  
  RESULTS
  The panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas.
  
  
  CONCLUSIONS
  The use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.
authors.affiliation: Center for Pain Relief, Charleston, WV 25301, USA. doctdeer@aol.com
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.forename: Joshua
authors.initials: J
authors.lastname: Prager
authors.forename: Robert
authors.initials: R
authors.lastname: Levy
authors.forename: James
authors.initials: J
authors.lastname: Rathmell
authors.forename: Eric
authors.initials: E
authors.lastname: Buchser
authors.forename: Allen
authors.initials: A
authors.lastname: Burton
authors.forename: David
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authors.lastname: Caraway
authors.forename: Michael
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authors.lastname: Cousins
authors.forename: José
authors.initials: J
authors.lastname: De Andrés
authors.forename: Sudhir
authors.initials: S
authors.lastname: Diwan
authors.forename: Michael
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authors.lastname: Erdek
authors.forename: Eric
authors.initials: E
authors.lastname: Grigsby
authors.forename: Marc
authors.initials: M
authors.lastname: Huntoon
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Jacobs
authors.forename: Philip
authors.initials: P
authors.lastname: Kim
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: Michael
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authors.lastname: Leong
authors.forename: Liong
authors.initials: L
authors.lastname: Liem
authors.forename: Gladstone C
authors.initials: GC
authors.lastname: McDowell
authors.forename: Sunil
authors.initials: S
authors.lastname: Panchal
authors.forename: Richard
authors.initials: R
authors.lastname: Rauck
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.forename: B Todd
authors.initials: BT
authors.lastname: Sitzman
authors.forename: Peter
authors.initials: P
authors.lastname: Staats
authors.forename: Michael
authors.initials: M
authors.lastname: Stanton-Hicks
authors.forename: Lisa
authors.initials: L
authors.lastname: Stearns
authors.forename: Mark
authors.initials: M
authors.lastname: Wallace
authors.forename: K Dean
authors.initials: KD
authors.lastname: Willis
authors.forename: William
authors.initials: W
authors.lastname: Witt
authors.forename: Tony
authors.initials: T
authors.lastname: Yaksh
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D057785:Catheters / Q000009:adverse effects*; D006099:Granuloma / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007249:Inflammation / Q000209:etiology; D015918:Infusion Pumps, Implantable / Q000009:adverse effects* / Q000592:standards; D007278:Injections, Spinal / Q000009:adverse effects* / Q000379:methods / Q000592:standards
chemical_list: D000701:Analgesics, Opioid