title: The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks.
abstract: BACKGROUND
  Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy.
  
  
  METHODS
  A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery.
  
  
  RESULTS
  The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation.
  
  
  CONCLUSIONS
  Intrathecal therapy is a viable and relatively safe option for the treatment of cancer- and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.
authors.affiliation: Center for Pain Relief, Charleston, WV, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.affiliation: Summit Pain Alliance, Santa Rosa, CA, USA.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Lamer
authors.affiliation: Veterans Administration Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Ilir Elias
authors.initials: IE
authors.lastname: Veizi
authors.affiliation: Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Erdek
authors.affiliation: Department of Anesthesia, UC San Diego, San Diego, CA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wallace
authors.affiliation: UK HealthCare Pain Services, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Grider
authors.affiliation: Marcus Neuroscience Institute, Boca Raton, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.affiliation: Center for the Rehabilitation of Pain Syndromes (CRPS) at UCLA Medical Plaza, Los Angeles, CA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Prager
authors.affiliation: Fox Chase Pain Management Associates PC, Doylestown, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Rosen
authors.affiliation: MossRehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.affiliation: Anesthesiology and Pharmacology, University of California, San Diego, CA, USA.
authors.forename: Tony L
authors.initials: TL
authors.lastname: Yaksh
authors.affiliation: Valencia School of Medicine, Hospital General Universitario, Valencia, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: De Andrés
authors.affiliation: Hospital Universitario Quiron Madrid, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Abejon Gonzalez
authors.affiliation: Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Vesper
authors.affiliation: Sana Kliniken, Duisburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schu
authors.affiliation: Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Simpson
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy*; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000592:standards; D007278:Injections, Spinal / Q000379:methods / Q000592:standards*; D012449:Safety
chemical_list: D000700:Analgesics
keywords: Bupivacaine; chronic pain; clonidine; fixed rate pump; intrathecal drug delivery; intrathecal granuloma; neuropathic pain; nonmalignant pain; opioid; programmable pump; safety; ziconotide