Intrathecal Therapy for Severe Chronic Pain: Evidence-Based Recommendations Module 1

Timothy R. Deer, MD, DABPM; Yeshvant A. Navalgund, MD

This activity has been supported by an independent educational grant from Jazz Pharmaceuticals.


Jointly provided by the Elsevier Office of Continuing Medical Education and Integritas Communications


Timothy R. Deer, MD, DABPM
President and Chief Executive Officer
The Center for Pain Relief, Inc.
Spine and Nerve Centers of the Virginias
Charleston, West Virginia

Yeshvant A. Navalgund, MD
Assistant Professor
Department of Anesthesiology
Division of Pain Management
West Virginia University School of Medicine
Morgantown, West Virginia
President and CEO
DNA Advanced Pain Treatment Center
Greensburg, Pennsylvania

Course Description

Chronic pain affects 100 million Americans. Certain patients with chronic pain are candidates for intrathecal (IT) therapy, which can mitigate some of the risks associated with systemic opioids. Following appropriate patient selection based on medical and psychiatric history and a physical exam, a patient can begin a trial with morphine or ziconotide, the 2 US Food and Drug Administration (FDA)–approved IT therapies. Monitoring for adverse events should continue after IT pump implantation, as should monitoring for catheter- or pump-related complications. This CME/CE-accredited Point of Care 201™ 2-part series discusses identification of candidates for IT therapy, available IT therapies, optimal treatment initiation and management, and both surgical implantation and pump refill techniques.

Target Audience

This activity has been designed to meet the educational needs of interventional pain specialists, interventional pain fellows and residents, and other physician specialists with a focus on managing patients with severe cancer-related or chronic noncancer pain.

Educational Objectives

  • Discuss the analgesic mechanisms of action, clinical trial data, published real-world outcomes, and prescribing considerations for intrathecal analgesics with FDA approvals to treat severe chronic pain 
  • Implement 2017 Polyanalgesic Consensus Conference (PACC) guidelines on identifying candidates for long-term treatment with intrathecally infused analgesics, medication selection algorithms, preimplantation trialing, and long-term optimization of efficacy and safety 

Disclosure of Conflicts of Interest

It is the policy of the Elsevier Office of Continuing Medical Education that all faculty, instructors, and planner disclose any real or apparent conflicts of interest relating to the topics of this educational activity.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Timothy R. Deer, MD, DABPM: Consultant: Abbott Laboratories; Axonics Modulation Technologies, Inc., Flowonix Medical Inc., Inc., Mainstay Medical Limited, Nalu Medical, Inc., Saluda Medical Pty. Ltd., SpineThera, Inc., Vertiflex Inc., Vertos Medical Inc. Speakers Bureau: Jazz Pharmaceuticals Grant/Research: Abbott Laboratories, Mainstay Medical Limited, Saluda Medical Pty. Ltd., Vertiflex Inc. Royalties, patents: Abbott Laboratories Stock Ownership: Axonics Modulation Technologies, Inc., Nalu Medical, Inc., Saluda Medical Pty. Ltd., SpineThera, Inc., Vertiflex Inc., Vertos Medical Inc.

Yeshvant A. Navalgund, MD: Consultant/Advisor: Jazz Pharmaceuticals, Medtronic plc Speakers Bureau: Jazz Pharmaceuticals, Medtronic plc


Gena Dolson, MS; Sandy Breslow; Alison Kemp; and Bernard M. Abrams, MD, hereby state that neither they nor their spouses/life partners have had any financial relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

CME Credit (Physicians)

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Elsevier Office of Continuing Medical Education and Integritas Communications. The Elsevier Office of Continuing Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

The Elsevier Office of Continuing Medical Education designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME Inquiries/Special Needs

For all CME inquiries or special needs, please contact

Disclosure of Unlabeled Use 

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The Elsevier Office of Continuing Medical Education, Integritas Communications, and Jazz Pharmaceuticalsdo not recommend the use of any agent outside of the labeled indications. 


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Method of Participation

In order to claim credit, participants must complete the following:

  1. Read the educational objectives, accreditation information, and faculty disclosures at the beginning of this activity.
  2. Complete the Pre-Activity Questions.
  3. Read or Review the activity content.
  4. Complete the Post Activity Test Questions and Evaluation.
  5. Physicians who receive a grade of 70% or better on the Post-Activity Test Questions and who complete the Evaluation will receive a CME Certificate.
  6. All other participants who receivve a grade of 70% or better on the Post-Activity Test Questions and who complete the Evaluation will receive a Certificate of Participation.

Click "Begin Activity" to acknowledge that you have reviewed the preamble information for this activity.

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expiration 01/30/2020

type POC201