title: The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines.
abstract: Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice.
  
  
  
  The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012. An extensive literature search identified publications between January 15, 2007 and November 22, 2015 and authors contributed additional relevant sources. After reviewing the literature, the panel convened to determine evidence levels and degrees of recommendations for intrathecal therapy. This meeting served as the basis for consensus development, which was ranked as strong, moderate or weak. Algorithms were developed for intrathecal medication choices to treat nociceptive and neuropathic pain for patients with cancer, terminal illness, and noncancer pain, with either localized or diffuse pain.
  
  
  
  The PACC has developed an algorithmic process for several aspects of intrathecal drug delivery to promote safe and efficacious evidence-based care. Consensus opinion, based on expertise, was used to fill gaps in evidence. Thirty-one consensus points emerged from the panel considerations.
  
  
  
  New algorithms and guidance have been established to improve care with the use of intrathecal drug delivery.
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: Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
authors.affiliation: Anesthesia and Chronic Pain Management, Ephraim McDowell Regional Medical Center, Danville, KY, USA.
authors.forename: Anjum
authors.initials: A
authors.lastname: Bux
authors.affiliation: Anaesthesia and Pain Management Department, EHC Hosptial, Morges, and CHUV University Hospital, Lausanne, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Buchser
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Eldabe
authors.affiliation: Valencia School of Medicine, Hospital General Universitario, Valencia, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: De Andrés
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: University of Miami Health System, Miami, FL, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Patin
authors.affiliation: University of Kentucky College of Medicine, UK HealthCare Pain Services, Lexington, KY, USA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Grider
authors.affiliation: Doleys Clinic, Birmingham, AL, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Doleys
authors.affiliation: California Pain Medicine Center, Los Angeles, CA, USA.
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Jacobs
authors.affiliation: Anesthesiology and Pharmacology, University of California, San Diego, CA, USA.
authors.forename: Tony L
authors.initials: TL
authors.lastname: Yaksh
authors.affiliation: Pain Clinic of Monterey Bay, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Poree
authors.affiliation: Department of Anesthesia, UC San Diego, San Diego, CA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wallace
authors.affiliation: Center for the Rehabilitation Pain Syndromes (CRPS) at UCLA Medical Plaza, Los Angeles, CA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Prager
authors.affiliation: Carolina Pain Institute, Wake Forest Baptist Health, Winston-Salem, NC, USA.
authors.forename: Richard
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authors.lastname: Rauck
authors.affiliation: Roswell Park Cancer Institute, SUNY, Buffalo, NY, USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: DeLeon
authors.affiliation: Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, NY, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Diwan
authors.affiliation: St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Falowski
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Gazelka
authors.affiliation: Bryn Mawr Hospital, Bryn Mawr, PA, USA.|Christiana Hospital, Newark, DE, USA.
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authors.lastname: Kim
authors.affiliation: Stanford University, Palo Alto, CA, USA.
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authors.initials: M
authors.lastname: Leong
authors.affiliation: Marcus Neuroscience Institute, Boca Raton, FL, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Levy
authors.affiliation: Integrated Pain Solutions, Columbus, OH, USA.
authors.forename: Gladstone
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authors.lastname: McDowell
authors.affiliation: Holy Cross Hospital, Fort Lauderdale, Florida, USA.
authors.forename: Porter
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authors.lastname: McRoberts
authors.affiliation: San Francisco Medical Center, University of California, San Francisco, CA, USA.
authors.forename: Ramana
authors.initials: R
authors.lastname: Naidu
authors.affiliation: Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Narouze
authors.affiliation: Hôpital de Zone Morges, Morges, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Perruchoud
authors.affiliation: Fox Chase Pain Management Associates PC, Doylestown, PA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Rosen
authors.affiliation: Center for Relief of Pain, Kansas City, MO, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Rosenberg
authors.affiliation: MossRehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.affiliation: Premier Pain Management Centers, Shrewsbury, NJ, USA.|Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Staats
authors.affiliation: Center for Pain and Supportive Care, Phoenix, AZ, USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Stearns
authors.affiliation: Alabama Pain Center, Huntsville, AL, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Willis
authors.affiliation: Pacific Pain Treatment Center (ret.), San Francisco, CA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Krames
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Huntoon
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nagy
authors.initials: N
authors.lastname: Mekhail
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D032921:Consensus; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards*; D006801:Humans; D007278:Injections, Spinal / Q000592:standards*; D010146:Pain / Q000188:drug therapy; D017410:Practice Guidelines as Topic
chemical_list: D000700:Analgesics
keywords: Chronic pain; consensus; fixed rate pump; intrathecal drug delivery; neuropathic pain; nonmalignant pain; opioid; programmable pump; psychological evaluation; safety