Polyanalgesic Consensus Conference--2012: recommendations on trialing for intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel.

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

INTRODUCTION Trialing for intrathecal pump placement is an essential part of the decision-making process in placing a permanent device. In both the United States and the international community, the proper method for trialing is ill defined. METHODS The Polyanalgesic Consensus Conference (PACC) is a group of well-published experienced practitioners who meet to update the state of care for intrathecal therapies on the basis of current knowledge in the literature and clinical experience. Anexhaustive search is performed to create a base of information that the panel considers when making recommendations for best clinical practices. This literature, coupled with clinical experience, is the basis for recommendations and for identification of gaps in the base of knowledge regarding trialing for intrathecal pump placement. RESULTS The panel has made recommendations for the proper methods of trialing for long-term intrathecal drug delivery. CONCLUSION The use of intrathecal drug delivery is an important part of the treatment algorithm for moderate to severe chronic pain. It has become common practice to perform a temporary neuroaxial infusion before permanent device implantation. On the basis of current knowledge, the PACC has developed recommendations to improve care. The need to update these recommendations will be very important as new literature is published.