The Polyanalgesic Consensus Conference (PACC)®: Updates on Clinical Pharmacology and Comorbidity Management in Intrathecal Drug Delivery for Cancer Pain.

The International Neuromodulation Society convened a multispecialty group of physicians based on expertise with international representation to establish evidence-based guidance on using intrathecal drug delivery in chronic pain treatment. This Polyanalgesic Consensus Conference (PACC)® project's scope is to provide evidence-based guidance for clinical pharmacology and best practices for intrathecal drug delivery for cancer pain. 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 using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus from 2017 (when the 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 were based on the strength of evidence, and when evidence was scant, recommendations were based on expert consensus. The PACC evaluated the published literature and established evidence- and consensus-based expert opinion recommendations to guide best practices in treating cancer pain. Additional guidance will occur as new evidence is developed in future iterations of this process. The PACC recommends best practices regarding the use of intrathecal drug delivery in cancer pain, with an emphasis on managing the unique disease and patient characteristics encountered in oncology. These evidence- and consensus-based expert opinion recommendations should be used as a guide to assist decision-making when clinically appropriate.

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Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of Interest Shane E. Brogan acts as a paid consultant for Medtronic. Eric Buchser reports grants from the Swiss National Foundation and the Commission for Technology and Innovation; and grants, personal fees and nonfinancial support from Medtronic, during the conduct of the study. Timothy R. Deer reports no conflicts that pertain to intrathecal therapy; reports conflicts within the neuromodulation field that include consulting for Abbott, Saluda, Ethos, Nalu, PainTeq, and Cornorloc; he also holds a patent pending with Abbott; is on the advisory board of Abbott and Nalu; has stock options Saluda, Spinethera, and Nalu; and has institutional research grants from Abbott, Saluda, Vertiflex and Mainstay. Denis Dupoiron reports personal fees from Medtronic and Esteve during the conduct of the study. Amitabh Gulati reports personal fees from Medtronic, Flowonix, AIS HealthCare, SPR Therapeutics, Nalu Medical, Bausch Health, and Spark Medical, outside the submitted work. Jennifer Hah reports grants from NIH NIDA, outside the submitted work. Gladstone C. McDowell II reports personal fees and other from Medtronic Corporation; personal fees, nonfinancial support, and other from Flowonix Corporation and TerSera Therapeutics, outside the submitted work. Christophe Perruchoud reports grants and personal fees from Medtronic and Boston Scientific, during the conduct of the study; and personal fees from Medtronic and Boston Scientific, outside the submitted work. Fabian Piedimonte reports personal fees from Medtronic and Abbott, which stopped in June 2020. Julie G. Pilitsis reports grants and other from Boston Scientific, Nevro, Abbott, Medtronic, and TerSera; other from Saluda; grants from NIH 2R01CA166379-06, other from Aim Medical Robotics and Karuna Labs; and grants from NIH U44NS115111, outside the submitted work. Jason E. Pope reports other from Ethos Labs, Flowonix, Saluda, PainTeq, Aurora Spine, Thermaquil, Celeri Health, Spine Thera, AGR, NIS, Abbott, Medtronic, Biotronik, Mainstay, Muse, AIS, SPR Therapeutics, TerSera, Vertiflex, Boston Scientific, Vertos, SPARK, and WISE, outside the submitted work. Michael F. Saulino reports research grants from Medtronic and Flowonix; fellowship support from Medtronic, Piramal, and Saol. Peter S. Staats reports grants from Saluda, Nalu, AIS Therapeutics, Thermaquil, Biotronik, electroCore and Vertos, outside the scope of this work; royalties from the Averitas-Qutenza Patch, outside the scope of this work; payment or honoraria from Medtronic and SPR Therapeutics, outside the scope of this work; patents for vagus nerve and topical capsaicin products; participation in a Data Safety Monitoring or Advisory Board for Nalu and Saluda; a leadership role in the World Institute of Pain, American Society of Pain and Neuroscience, American Society of Interventional Pain Physicians, and the Florida Academy of Pain Management; and stock options in Saluda, Nalu and electroCore. Mark S. Wallace reports grants from NIH and is a consultant to TerSera. Tony L. Yaksh reports grants from NIH NINDS, other from CODA, IONIS, and Medtronic, during the conduct of the study; and grants from NIH-NINDS, IONIS, and Medtronic, outside the submitted work. The remaining authors reported no conflict of interest.