Polyanalgesic Consensus Conference--2012: recommendations to reduce morbidity and mortality in intrathecal drug delivery in the treatment of chronic pain.

Deer, Timothy R; Levy, Robert; Prager, Joshua; Buchser, Eric; Burton, Allen; Caraway, David; Cousins, Michael; De Andrés, José; Diwan, Sudhir; Erdek, Michael; Grigsby, Eric; Huntoon, Marc; Jacobs, Marilyn S; Kim, Philip; Kumar, Krishna; Leong, Michael; Liem, Liong; McDowell, Gladstone C; Panchal, Sunil; Rauck, Richard; Saulino, Michael; Sitzman, B Todd; Staats, Peter; Stanton-Hicks, Michael; Stearns, Lisa; Wallace, Mark; Willis, K Dean; Witt, William; Yaksh, Tony; Mekhail, Nagy

INTRODUCTION Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of both cancer and noncancer pain; however, it has become clear in recent years that intrathecal drug delivery is associated with risks for serious morbidity and mortality. METHODS The Polyanalgesic Consensus Conference is a meeting of experienced implanting physicians who strive to improve care in those receiving implantable devices. Employing data generated through an extensive literature search combined with clinical experience, this work group formulated recommendations regarding awareness, education, and mitigation of the morbidity and mortality associated with intrathecal therapy to establish best practices for targeted intrathecal drug delivery systems. RESULTS Best practices for improved patient care and outcomes with targeted intrathecal infusion are recommended to minimize the risk of morbidity and mortality. Areas of focus include respiratory depression, infection, granuloma, device-related complications, endocrinopathies, and human error. Specific guidance is given with each of these issues and the general use of the therapy. CONCLUSIONS Targeted intrathecal drug delivery systems are associated with risks for morbidity and mortality that can be devastating. The panel has given guidance to treating physicians and healthcare providers to reduce the incidence of these problems and to improve outcomes when problems occur.