Intrathecal Drug Delivery for Chronic Pain Evolving Best-Practice Strategies to Maximize Efficacy and Safety

Timothy R. Deer, MD, DABPM

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc. 


Timothy R. Deer, MD, DABPM
President and Chief Executive Officer
Center for Pain Relief, Inc.
Charleston, West Virginia

Educational Objectives

Upon completion of this activity, participants will be better prepared to:

  • Identify patients with chronic pain who are candidates for intrathecal drug delivery
  • Discuss the clinical profiles, prescribing considerations, and latest clinical trial data for analgesics that have been approved by the FDA for intrathecal drug delivery
  • Individualize intrathecal treatment regimens for patients with chronic pain based on medical histories, preimplantation trials, and therapeutic responses
  • Monitor patients receiving intrathecal drug therapy for efficacy, functional gains, and treatment-emergent adverse events

Target Audience

This educational activity is targeted to an audience of pain specialists and other healthcare providers involved in the management of chronic pain patients who are candidates for intrathecal drug delivery.

Statement of Need/Program Overview

An estimated 100 million adults in the United States suffer from at least 1 chronically painful condition.1 Complexities in the underlying pathophysiologic mechanisms and clinical manifestations result in a large number of patients for whom conventional management strategies fail to produce adequate pain relief or the desired functional gains.2 For some of these individuals, intrathecal delivery of analgesic medications can be a safe and effective treatment modality.3, 4 The US Food and Drug Administration (FDA) has approved 2 analgesics—ziconotide and morphine—as intrathecal medications for patients with severe chronic pain.5,6 Nevertheless, the use of intrathecal therapy for chronic pain is often suboptimal, in part owing to poor patient selection, systemic barriers, and safety concerns (eg, opioid-induced respiratory depression).7 Using a unique case-based educational format, this Interactive Professor™ program will review the latest published evidence and practical guidance on evaluating candidates for intrathecal drug delivery, prescribing FDA-approved intrathecal analgesics, monitoring patients over time, and tailoring therapy based on analgesia, functional outcomes, and treatment-emergent adverse effects.


  1. National Researc Council. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine. Washington, DC. The National Academies Press, 2011. 
  2. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
  3. Onofrio BM, Yaksh TL, Arnold PG. Continuous low-dose intrathecal morphine administration in the treatment of chronic pain of malignant origin. Mayo Clin Proc. 1981;56(8) 516-520.
  4. Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354-372.
  5. Ver Donck A, Vranken JH, Puylaert M, et al. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461-476. 
  6. Kim P, Grigsby E, Deer T, et al. Effectiveness and safety of intrathecal ziconotide as the first agent in pump for adult patients with severe chronic pain. Presented at the 22nd Annual Napa Pain Conference; August 27-29, 2015; Napa, CA.
  7. Coffey RJ, Owens ML, Broste SK, et al. Mortality associated with implantation and management of intrathecal opioid drug infusion systems to treat noncancer pain. Anesthesiology. 2009;111(4):881-891.

Physician Accreditation Statement

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 Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

Global Education Group designates this live 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.

Nursing Continuing Education

Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (COA).

This educational activity for 0.5 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education (CE). Provider number: 110121. This activity is accredited for 0.5 contact hour(s) which includes 0.0 hour(s) of pharmacology.

Activity ID #2074E.
This activity was planned in accordance with AANP CE Standards and Policies.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score at least 70% on the posttest and complete the program evaluation.

System Requirements

Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Adobe Acrobat Reader

MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

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     Consultant – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Flowonix Medical, Inc., Medtronic, Nevro Corp., Nuvectra Corp., Saluda Medical Pty Ltd., SpineThera, Inc., St. Jude Medical, Inc., Vertos Medical Inc.; Grant/Research Support – Bioness Inc., Jazz Pharmaceuticals, Inc., Medtronic, St. Jude Medical, Inc.; Stock Options – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Nuvectra Corp., Saluda Medical Pty Ltd., SpineThera, Inc., Vertos Medical Inc.

The planners and managers 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:

Amanda Glazar, PhD     Nothing to disclose
Andrea Funk     Nothing to disclose
Ashley Marostica, RN, MSN     Nothing to disclose
Kristen Delisi, NP     Nothing to disclose
Jim Kappler, PhD     Nothing to disclose

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. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


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 in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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expiration 12/19/2017

type Webcast