The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines

The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks

“…Recent research describing these strategies offers a different, more patient‐centric point of view that supports continued use of IT therapy for noncancer‐related pain. Evidence levels, recommendation grades and consensus strength from the most recent PACC update appear in Table and apply to treating cancer‐ and noncancer‐related pain .…”

“…The PACC of 2012 , and the current PACC companion articles to this manuscript , have provided an updated treatment algorithm, including an extensive evaluation and discussion of evidence, for intrathecal medications . The United States Food and Drug Administration (FDA) has approved only two intrathecal agents for pain relief: preservative‐free morphine (Infumorph) and the conotoxin peptide ziconotide (Prialt).…”

The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy

“…As highlighted in the PACC 2016 publication presenting treatment algorithms , previous systemic opioid exposure needs to be considered prior to IT medication selection. The PACC recommends that systemic opioid therapy be markedly reduced or eliminated when IT therapy is instituted.…”

“…As highlighted in a companion PACC 2016 publication , consideration for the site of service isrequired and is based on the patient's disease state, the IT medication given, previous opioid exposure, and risk stratification. The need for monitoring in the inpatient setting is required for continuous infusion and for bolus trials with long‐acting opioids such as morphine.…”

“…As stated in the main PACC 2016 publication , risk stratification is necessary, and conservative dosing is always recommended. If outpatient trialing is performed, observation for at least 6–8 hours is highly recommended and patient compliance is a necessity.…”