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Intrathecal Drug Delivery for Chronic Pain The Role of Nurses in Optimizing Long-term Outcomes

Timothy R. Deer, MD, DABPM; Ashley Comer, NP

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

 

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

 

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standard.

Faculty

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

Ashley Comer, NP
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 of intrathecally delivered analgesic medications, including ziconotide and morphine
  • Monitor patients receiving intrathecal drug therapy for efficacy, functional gaps, and treatment-emergent adverse events
  • Assist in the long-term care of individuals with intrathecally treated chronic pain via patient education, iterative assessment, and proper techniques for ongoing device and drug maintenance 

Target Audience

This educational activity is targeted to an audience of pain management nurses and other providers involved in managing patients who are candidates for intrathecal analgesic drug delivery.

Statement of Need/Program Overview

Chronic pain affects an estimated 100 million adults in the United States.1 When pain is severe and refractory to conventional medical management, patients are often unable to achieve adequate pain relief, resulting in dire functional and psychosocial consequences.2 Some of these indivduals are likely to benefit from the intrathecal delivery of analgesics. Over the last 3 decades, the more than 300,000 patients who have received implanted pumps for a variety of indications have helped establish intrathecal therapy as a relatively safe and effective method of drug delivery.3, 4 Two analgesic agents have been approved for intrathecal use by the US Food and Drug Administration: ziconotide and morphine.5, 6 Studies suggest that intrathecal therapy may be underutilized owing to poor patient selection, safety concerns, and other systemic barriers.7 This Interactive Professor™ program will provide guidance on evaluating patients who are candidates for intrathecal drug delivery, and tailoring this modality based on ongoing monitoring of efficacy and treatment-emergent adverse effects. 

References

  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; discussion 372.
  5. Ver Donck A, Vranken JH, Puylaert M, Hayek S, Mekhail N, Van Zundert J. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461-476. 
  6. Pope JE, Deer TR. Ziconotide: a clinical update and pharmacologic review. Expert Opin Pharmacother. 2013; 14(7):957-966.
  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.

Global Education Group designates this 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.

Nurse Practitioner Continuing Education

Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. This program has been approved for 0.5 contact hours of continuing education (which includes 0.5 hours of pharmacology).

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit, participants must complete the preactivity questionnaire, postactivity questionnaire, and program evaluation. Participants must also score at least a 70% on the posttest.

System Requirements

PC/MAC: Supports any web browser.

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/Independent Contractor: Flowonix Medical Inc., Mallinckrodt Pharmaceuticals, Medtronic, Inc.

Ashley Comer, NP     Nothing to disclose

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
Kristen Delisi      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.

Disclaimer

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 01/06/2017

type Webcast