
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.

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
Improving the Care of Patients With Severe Chronic Pain
Evolving Best-Practice Strategies to Maximize Efficacy and Safety
Module 2
Module 3
Module 4
Relevant Resources
Balancing the Benefits and Risk of Opioid-Based Therapy
Individualized Assessment and Mechanism-Based Multimodal Treatment
Responsible Opioid Prescribing to Achieve Individualized Functional Goals
Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes
Proactive Diagnosis and Targeted Management
Selecting Patients and Optimizing Long-Term Outcomes
Proactive Diagnosis and Targeted Management
Consensus and Controversies for Responsible Opioid Prescribing
The Role of Nurses in Optimizing Long-term Outcomes
Evolving Best-Practice Strategies to Maximize Efficacy and Safety
A Focus on Patients With Opioid-Induced Constipation
Engaging With Patients About Opioid-Induced Constipation
The PCP’s Role in Timely Recognition and Referral
Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling
Expanding the Conversation on Opioid-Induced Constipation
Translating Guidelines Into Patient Care
New Paths to Chronic Pain Management
Unlocking Novel Paths to Patient Care