Evolving Best Practices With Intrathecal Analgesics

Faculty

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

Jason E. Pope, MD, DABPM, FIPP
President
Summit Pain Alliance
Santa Rosa, California

Target Audience

The educational design of this activity addresses the needs of pain specialists and other clinicians who manage patients with severe chronic pain.

Statement of Need/Program Overview

Complexities in the underlying pathophysiologic mechanisms and clinical manifestations of chronic pain result in a large number of patients for whom conventional management strategies fail to produce adequate pain relief or functional gains.^1,2 For some of these individuals, medications delivered directly to the intrathecal space can be a safe and effective treatment option.^{3, 4} The US Food and Drug Administration (FDA) has approved 2 analgesics—ziconotide and morphine—for intrathecal delivery in patients with severe chronic pain.^5,6 However, intrathecal therapy remains underutilized for chronic pain, in part owing to historically suboptimal outcomes stemming from poor patient selection, systemic barriers, and safety concerns (eg, opioid-induced respiratory depression).⁷ Available in multiple formats, this multimedia eHealth Source™ will cover the latest published evidence and practical guidance on evaluating candidates for intrathecal drug delivery, initiating this treatment strategy using FDA-approved intrathecal analgesics, longitudinally monitoring patients with implanted pumps, and tailoring therapy based on analgesia, functional outcomes, and treatment-emergent adverse effects.

References

1. National Research 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.

Educational Objectives

After completing this activity, the participant will be better able to: 

• Describe key anatomic and neurologic issues related to the practical use of intrathecal analgesics for the treatment of severe chronic pain
• Perform comprehensive preimplantation workups of candidates for intrathecal analgesic therapy
• Discuss the clinical profiles, dosing strategies, and other prescribing considerations for FDA-approved analgesics that have been approved for intrathecal use
• Utilize intrathecal therapy for patients with severe chronic pain to reflect the benefits and risks of available medications, trial results, the latest guideline recommendations, and other recently published evidence
• Tailor intrathecal therapy for severe chronic pain based on ongoing monitoring of analgesia, functional outcomes, and treatment-emergent adverse events

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 activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

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

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. Provider number: 110121. This activity is accredited for 1.5 contact hour(s) which includes 0.2 hour(s) of pharmacology.

Activity ID #2148E.
This activity was planned in accordance with AANP CE Standards and Policies.

Instructions to Receive Credit

In order to receive credit for this activity, participants must score 70% or better on the posttest and complete the program evaluation at www.exchangecme.com/ITehealth.

System Requirements

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

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
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: 

Jason E. Pope, MD, DABPM, FIPP  Consultant: Flowonix Medical, Inc., Jazz Pharmaceuticals plc, Medtronic, Nuvectra Corp., St. Jude Medical, Inc.; Grant/Research: lowonix Medical, Inc., Jazz Pharmaceuticals plc, St. Jude Medical,Inc.; Other/Royalty: Elsevier, Springer Nature

Timothy R. Deer, MD, DABPM  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 plc, 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 following 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:

Kristen Delisi  Nothing to disclose
Andrea Funk  Nothing to disclose
Amanda Glazar, PhD   Nothing to disclose
Laura Gilsdorf  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.