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Intrathecal Drug Therapy for Chronic Pain Improving Patient Selection and Maximizing Outcomes

Richard L. Rauck, MD, FIPP; Timothy R. Deer, MD, DABPM; Eric J. Grigsby, MD, MBA

 

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

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

Faculty

Richard L. Rauck, MD, FIPP
Clinical Associate Professor
Department of Anesthesiology
Wake Forest University School of Medicine
Winston-Salem, North Carolina

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

Eric J. Grigsby, MD, MBA
CEO and President, Neurovations
Founder and Medical Director
Napa Pain Institute
Napa, California

Target Audience

The educational design of this activity addresses the needs of interventional pain specialists and other allied healthcare professionals involved in the treatment of patients with severe chronic pain.

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 has approved 2 analgesics—ziconotide and morphine—as intrathecal medications for patients with severe chronic pain.5 Despite the availability of these agents, however, 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).6 Using an engaging educational format, this Interactive Exchange™ program will provide participants with the latest published evidence and practical guidance on the evaluation of candidates for intrathecal drug delivery, the potential benefits and risks of various intrathecal analgesics, and the essential elements of initial and ongoing patient monitoring plans.

References

  1. National Research Council. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine. Washingon 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. 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 should be better able to:

  • Assess candidates for intrathecal therapy via comprehensive medical histories, physical examinations, accurate pain diagnoses, and psychological evaluations
  • Describe the clinical profiles, dosing strategies, and other prescribing considerations for analgesic medications approved for intrathecal delivery
  • Construct intrathecal regimens for chronic pain that reflect potential medication benefits and risks, guideline recommendations, previous treatment responses, and therapeutic trial results
  • Tailor intrathecal drug therapy 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.

Global Education Group designates this activity for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score a 70% or better on the posttest.

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

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.

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:

Richard L. Rauck, MD, FIPP: Consultant – Jazz Pharmaceuticals; Grant/Research Support – Alfred Mann Foundation, Mallinckrodt Pharmaceuticals, Medtronic; Honoraria – Medtronic; Speakers Bureau – Jazz Pharmaceuticals

Timothy R. Deer, MD, DABPM: Advisory Board – Axonics Modulation Technologies, Inc., Bioness Inc., Flowonix Medical Inc., Jazz Pharmaceuticals, Medtronic, Nevro Corp., Spinal Modulation Inc., St. Jude Medical, Inc.; Consultant – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Flowonix Medical Inc., Mallinckrodt Pharmaceuticals, Medtronic, Nevro Corp., Spinal Modulation Inc., SpineThera, Inc., St. Jude Medical, Inc., Vertos Medical Inc.; Grant/Research Support – Bioness Inc., Jazz Pharmaceuticals, Medtronic, Spinal Modulation Inc., St. Jude Medical, Inc.; Speakers Bureau – Jazz Pharmaceuticals; Stock Options – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Nevro Corp., Spinal Modulation Inc., SpineThera, Inc., Vertos Medical Inc.

Eric J. Grigsby, MD, MBA: Consultant – Jazz Pharmaceuticals, Medallion Therapeutics, Inc., Medtronic; Grant/Research Support – Medtronic; Stock Shareholder – Medallion Therapeutics, Inc. 

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Amanda Glazar, PhD Nothing to disclose
Andrea Funk 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.

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expiration 03/01/2017

type Webcast