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SNAPSHOT™

Best Practices in Intrathecal Therapy for Chronic Pain

Patient Selection, Treatment Initiation, and Ongoing Monitoring

Guidelines

Polyanalgesic Consensus Conference—2012: Recommendations on Trialing for Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

Deer TR, et al. Neuromodulation. 2012;15(5):420-435.

Polyanalgesic Consensus Conference—2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel

Deer TR, et al. Neuromodulation. 2012;15(5):436-464.

Polyanalgesic Consensus Conference—2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain

Deer TR, et al. Neuromodulation. 2012;15(5):467-482.

Polyanalgesic Consensus Conference—2012: Consensus on Diagnosis, Detection, and Treatment of Catheter-Tip Granulomas (Inflammatory Masses) 

Deer TR, et al. Neuromodulation. 2012;15(5):483-495.

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

Deer TR, et al. Neuromodulation. 2017;20(2):96-132.

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

Deer TR, et al. Neuromodulation. 2017;20(2):133-154.

Best Practices for Intrathecal Drug Delivery for Pain

Prager J, et al. Neuromodulation. 2014;17(4):354-372.

Suggested Readings

Medical practice perspective: identification and mitigation of risk factors for mortality associated with intrathecal opioids for non-cancer pain.

Coffey RJ, et al. Pain Med. 2010;11(7):1001-9. (Replacement for deleted article below) doi: 10.1111/j.1526-4637.2010.00889.x.

Intrathecal Ziconotide and Opioid Combination Therapy for Noncancer Pain: an Observational Study

Deer TR, et al. Pain Physician. 2009;12(4):E291-E296.

A Predictive Model for Intrathecal Opioid Dose Escalation for Chronic Non-Cancer Pain

Duarte RV, et al. Pain Physician. 2012;15(5):363-369

Prospective Study of 3-Year Follow-up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain

Hamza M, et al. Pain Med. 2012;13(10):1304-1313.

Long-term Outcomes Using Intrathecal Drug Delivery Systems in Complex Regional Pain Syndrome.

Herring EZ, et al. Pain Med. 2018 Jun 7. doi: 10.1093/pm/pny104. [Epub ahead of print]

Effectiveness and Safety of Intrathecal Ziconotide: Interim Analysis of the Patient Registry of Intrathecal Ziconotide Management (PRIZM).

Deer T, et al. Pain Pract. 2018;18(2):230-238. doi: 10.1111/papr.12599.

Androgen Deficiency in Long-term Intrathecal Opioid Administration

Kim CH, et al. Pain Physician. 2014;17(4):E543-E548.

Use of Low Dose Ziconotide as First-Line Intrathecal Monotherapy.

Prusik J, et al. Neuromodulation. 2017;20(4):386-391. doi: 10.1111/ner.12486.

Practical Considerations and Patient Selection for Intrathecal Drug Delivery in the Management of Chronic Pain

Saulino M, et al. J Pain Res. 2014;7:627-638. 

Safety and Efficacy of Intrathecal Ziconotide in the Management of Severe Chronic Pain

Smith HS, Deer TR. Ther Clin Risk Manag. 2009;5(3):521-534.

Long-term Intrathecal Ziconotide for Chronic Pain: an Open-Label Study

Webster LR, et al. J Pain Symptom Manage. 2009;37(3):363-372.

Clinical Accuracy and Safety Using the SynchroMed II Intrathecal Drug Infusion Pump

Wesemann K, et al. Reg Anesth Pain Med. 2014;39(4):341-346.

Programmable Intrathecal Pumps for the Management of Chronic Pain: Recommendations for Improved Efficiency

Wilkes D. J Pain Res. 2014;7:571-577.

Interactive Presentation

An Overview of Intrathecal Drug Delivery

Timothy R. Deer, MD, DABPM

Patient Perspectives

Timothy R. Deer, MD, DABPM

Replacement of an Intrathecal Catheter

Timothy R. Deer, MD, DABPM

Activity
Evolving Best Practices With Intrathecal Analgesics

Improving the Care of Patients With Severe Chronic Pain

More information
Activity
Intrathecal Drug Delivery for Chronic Pain

Evolving Best-Practice Strategies to Maximize Efficacy and Safety

More information
Activity
Overview of Intrathecal Therapy For Chronic Pain

Module 1

More information
Activity
Selecting Patients Who May Benefit From Intrathecal Drug Delivery For Severe Chronic Pain

Module 2

More information
Activity
Initiating Intrathecal Therapy For Patients With Severe Chronic Pain

Module 3

More information
Activity
Long-Term Monitoring Of Patients Treated With Intrathecal Analgesics

Module 4

More information

Relevant Resources

Persistent and Breakthrough Pain

Balancing the Benefits and Risk of Opioid-Based Therapy

Improving the Care of Patients With Chronic Pain

Individualized Assessment and Mechanism-Based Multimodal Treatment

Caring For Patients With Chronic Pain

Responsible Opioid Prescribing to Achieve Individualized Functional Goals

Acute Management of Migraine Attacks

Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Intrathecal Drug Delivery for Chronic Pain

Selecting Patients and Optimizing Long-Term Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Clinical Issues in Chronic Pain

Consensus and Controversies for Responsible Opioid Prescribing

Intrathecal Drug Delivery for Chronic Pain

The Role of Nurses in Optimizing Long-term Outcomes

Intrathecal Drug Therapy for Chronic Pain

Evolving Best-Practice Strategies to Maximize Efficacy and Safety

Comprehensive Chronic Pain Management

A Focus on Patients With Opioid-Induced Constipation

Overcoming Challenges in Cancer Pain Management

Engaging With Patients About Opioid-Induced Constipation

Can You Spot Axial Spondyloarthritis?

The PCP’s Role in Timely Recognition and Referral

Clinical Issues in Chronic Pain

Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling

Comprehensive Relief from Cancer Pain

Expanding the Conversation on Opioid-Induced Constipation

Managing Opioid-Induced Constipation

Translating Guidelines Into Patient Care

Finding Relief in Osteoarthritis

New Paths to Chronic Pain Management

What’s New in Systemic Lupus Erythematosus?

Unlocking Novel Paths to Patient Care

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UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539556
 1 0.002859 0.002859 0.002859 0.002859
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
 1 0.002032 0.002032 0.002032 0.002032
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (149, 145, 111, 94, 83, 69, 61, 55, 44, 41, 40, 39, 36, 31, 26, 25, 23, 21, 17, 12, 10, 7)
 1 0.001777 0.001777 0.001777 0.001777
SHOW COLUMNS FROM `resources`
 1 0.001430 0.001430 0.001430 0.001430
SHOW COLUMNS FROM `activities`
 1 0.001384 0.001384 0.001384 0.001384
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
 2 0.001269 0.000635 0.000271 0.000998
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
 2 0.001217 0.000609 0.000477 0.000740
SHOW COLUMNS FROM `users`
 1 0.001217 0.001217 0.001217 0.001217
SHOW COLUMNS FROM `resource_videos`
 1 0.001098 0.001098 0.001098 0.001098
SHOW COLUMNS FROM `interactions`
 1 0.001007 0.001007 0.001007 0.001007
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
 2 0.000845 0.000422 0.000266 0.000579
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
 1 0.000494 0.000494 0.000494 0.000494
SELECT * FROM `resources` `t` WHERE `t`.`id`=59 LIMIT 1
 1 0.000484 0.000484 0.000484 0.000484
SHOW CREATE TABLE `resources`
 1 0.000334 0.000334 0.000334 0.000334
SHOW CREATE TABLE `users`
 1 0.000323 0.000323 0.000323 0.000323
SHOW CREATE TABLE `activities`
 1 0.000313 0.000313 0.000313 0.000313
SHOW CREATE TABLE `resource_videos`
 1 0.000307 0.000307 0.000307 0.000307
SHOW CREATE TABLE `interactions`
 1 0.000295 0.000295 0.000295 0.000295
# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
 0.000998
1
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
 0.000579
2
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
 0.000271
3
select id from resources where FIND_IN_SET(:shortAddress, shortAddress)
 0.000266
4
SHOW COLUMNS FROM `resources`
 0.001430
5
SHOW CREATE TABLE `resources`
 0.000334
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=59 LIMIT 1
 0.000484
7
SHOW COLUMNS FROM `resource_videos`
 0.001098
8
SHOW CREATE TABLE `resource_videos`
 0.000307
9
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
 0.000494
10
SHOW COLUMNS FROM `interactions`
 0.001007
11
SHOW CREATE TABLE `interactions`
 0.000295
12
SHOW COLUMNS FROM `activities`
 0.001384
13
SHOW CREATE TABLE `activities`
 0.000313
14
SHOW COLUMNS FROM `users`
 0.001217
15
SHOW CREATE TABLE `users`
 0.000323
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
 0.000740
17
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
 0.003460
18
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
 0.000477
19
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539556
 0.002859
20
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
 0.002032
21
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
 0.003699
22
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (149, 145, 111, 94, 83, 69, 61, 55, 44, 41, 40, 39, 36, 31, 26, 25, 23, 21, 17, 12, 10, 7)
 0.001777
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