The Polyanalgesic Consensus Conference (PACC)®: Updates on clinical pharmacology and comorbidity management in intrathecal drug delivery for cancer pain

Timothy R. Deer, The Spine and Nerve Center of the Virginias, Charleston, WV, USA. Electronic address: doctdeer@aol.com.
Salim M. Hayek, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA.
Jay S. Grider, UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
Jason E. Pope, Evolve Restorative Center, Santa Rosa, CA, USA.
Shane E. Brogan, Department of Anesthesiology, Division of Pain Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Amitabh Gulati, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Jonathan M. Hagedorn, iSpine Pain Physicians, Maple Grove, MN, USA.
Natalie Strand, Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
Jennifer Hah, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA.
Tony L. Yaksh, Anesthesiology and Pharmacology, University of California San Diego, San Diego, CA, USA.
Peter S. Staats, ElectroCore, Rockaway, NJ, USA; National Spine and Pain Centers, Rockville, MD, USA.
Christophe Perruchoud, Pain Clinic, La Tour Medical Group, Geneva, Switzerland.
Nebojsa Nick Knezevic, Advocate Health - MidwestFollow
Mark S. Wallace, Division of Pain Management, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.
Julie G. Pilitsis, Department of Neurosurgery, University of Arizona, Tucson, AZ, USA.
Tim J. Lamer, Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Eric Buchser, Department of Anaesthesia and Pain Management, Neuromodulation Centre, Morges, Switzerland.
Vishal Varshney, Providence Health Care, University of British Columbia, British Columbia, Canada.
Jill Osborn, Department of Anesthesiology, Providence Health Care, Vancouver, British Columbia, Canada.
Vasudha Goel, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
Brian A. Simpson, Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK.
Jose A. Lopez, Service of Neurosurgery and Pain Clinic, University Hospital "Puerta del Mar," Cadiz, Spain.
Denis Dupoiron, Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de L'Ouset, Angers, France.
Michael F. Saulino, Moss Rehab Physical Medicine Associates, Elkins Park, PA, USA.
Gladstone C. McDowell, Integrated Pain Solutions, Columbus, OH, USA.
Fabian Piedimonte, Fundaciόn CENIT, University of Buenos Aires, Buenos Aires, Argentina.
Robert M. Levy, International Neuromodulation Society and Director of Neurosurgical Services, Director of Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA.

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Introduction:The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on using intrathecal drug delivery in chronic pain treatment. This Polyanalgesic Consensus Conference (PACC)® project's scope is to provide evidence-based guidance for clinical pharmacology and best practices for intrathecal drug delivery for cancer pain.

Materials and methods:Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus from 2017 (when the PACC last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations were based on the strength of evidence, and when evidence was scant, recommendations were based on expert consensus.

Results:The PACC evaluated the published literature and established evidence- and consensus-based expert opinion recommendations to guide best practices in treating cancer pain. Additional guidance will occur as new evidence is developed in future iterations of this process.

Conclusions:The PACC recommends best practices regarding the use of intrathecal drug delivery in cancer pain, with an emphasis on managing the unique disease and patient characteristics encountered in oncology. These evidence- and consensus-based expert opinion recommendations should be used as a guide to assist decision-making when clinically appropriate.

Type

Article

PubMed ID

39297833

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