The Polyanalgesic Consensus Conference (PACC)®: Intrathecal Drug Delivery Guidance on Safety and Therapy Optimization When Treating Chronic Noncancer Pain.

The International Neuromodulation Society convened a multispecialty group of physicians and scientists based on expertise with international representation to establish evidence-based guidance on intrathecal drug delivery in treating chronic pain. This Polyanalgesic Consensus Conference (PACC)® project, created more than two decades ago, intends to provide evidence-based guidance for important safety and efficacy issues surrounding intrathecal drug delivery and its impact on the practice of neuromodulation. Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when PACC® last published guidelines) to the present. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence is scant. The PACC® examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. The PACC® recommends best practices regarding intrathecal drug delivery to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.

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Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Conflict of Interest Alaa Abd-Elsayed is a consultant for Medtronic. Philip Kim reports consulting fees from Medtronic, personal fees from TerSera, outside the submitted work; personal fees from Biotronik and Medtronic on a medical board; reseach support from Biotronik, Medtronic, Boston, Nevro, Saluda, and Cornerloc; and participation in a data safety monitoring board on RTX on Morton neuroma study. Christophe Perruchoud reports consulting fees, honoraria, and participation on a data safety monitoring board or advisory board for Medtronic. Anjum Bux reports personal fees from Flowonix Corp, Boston Scientific, AIS, Medtronic, and Vertos, outside the submitted work. Rui Duarte reports personal fees from Saluda Medical, Boston Scientific, Medtronic, and Mainstay Medical, outside the submitted work. Michael Saulino reports research grants from Medtronic and Flowonix; fellowship support from Medtronic, Piramal, and Saol; Denis Dupoiron reports personal fees from Medtronic and Esteve, outside the submitted work. Dennis Patin consults for Medtronic, Abbott, Boston Scientific, and Nevro. Julie G. Pilitsis reports grants and other from Boston Scientific, Nevro, Abbott, TerSera, and Medtronic; other from Saluda, Aim Medical Robotics, and Karuna Labs; grants from National Institutes of Health (NIH) 2R01CA166379-06; and grants from NIH U44NS115111, outside the submitted work. Lawrence R. Poree reports personal fees from Medtronic and Nalu, and grants and personal fees from Saluda, outside the submitted work. Harry Sukumaran reports personal fees from Abbott, Boston Scientific, and Nevro, and personal fees and nonfinancial support from Vertos Medical, outside the submitted work. Erik Shaw reports support from Pfizer/Lilly for tanezumab articles; consulting fees and/or honoraria from TerSera, Boston Scientific, SPR Therapeutics; participation on a data safety monitoring board or advisory board for Pfizer/Lilly NGF blocker; and stock options from SpineThera and ROM Tech. Tony L. Yaksh reports grants from NIH-National Institute of Neurological Disorders and Stroke (NINDS), other from CODA, IONIS, and Medtronic during the conduct of the study; grants from NIH-NINDS, IONIS, and Medtronic, outside the submitted work. Robert M. Levy is an unpaid and uncompensated consultant for Abbott, Biotronik, Nalu, and Synergia. The remaining authors reported no conflict of interest.