Intrathecal Drug Delivery for Chronic Pain - Selecting Patients and Optimizing Long-term Outcomes
Release Date: May 06, 2015
Expiration Date: May 06, 2016
This activity is jointly provided by Global Education Group and Integritas Communications.
This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.
This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standard.
This educational activity is targeted to an audience of pain specialists and other healthcare providers involved in the management of chronic pain patients who are candidates for intrathecal drug delivery.
Statement of Need/Program Overview
Chronic pain affects an estimated 100 million adults in the United States.1 Because of the diversity of patient background and of chronic pain conditions, mechanisms, and clinical manifestations, a large population of patients is unable to achieve adequate pain relief or attainable functional goals.2 When patients are refractory to conventional medical management, intrathecal delivery of analgesics may provide certain advantages. Over the last 3 decades, the more than 300,000 patients who have received implanted pumps for a variety of indications have helped establish intrathecal therapy as a safe and effective method of drug delivery.3, 4 Two analgesic agents have been approved for intrathecal use by the US Food and Drug Administration: ziconotide and morphine.5 Nevertheless, intrathecal therapy may be underutilized owing to poor patient selection, safety concerns, and other systemic barriers.6 This Interactive Professor™ program will provide data and guidance on evaluating patients who are candidates for intrathecal drug delivery, initiating intrathecal therapy for chronic pain, and tailoring therapy to reflect ongoing monitoring.
- Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. http://iprcc.nih.gov/docs/032712_mtg_presentations/IOM_Pain_Report_508comp.pdf
- 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.
- 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.
- Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354-372; discussion 372.
- Ver Donck A, Vranken JH, Puylaert M, Hayek S, Mekhail N, Van Zundert J. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461-476.
- 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.
Upon completion of this activity, participants will be better prepared to:
- Comprehensively evaluate patients with chronic pain who are candidates for intrathecal drug delivery
- Discuss the clinical profiles and prescribing considerations associated with intrathecally delivered analgesic medications, including ziconotide and morphine
- Initiate intrathecal therapy for chronic pain based on an individualized evaluation of potential benefits and risks, previous treatment responses, and an adequate therapeutic trial
- Tailor intrathecal drug therapy to reflect ongoing monitoring for efficacy and treatment-emergent adverse events
Timothy R. Deer, MD, DABPM
President and Chief Executive Officer
Center for Pain Relief, Inc.
Charleston, West Virginia
Physician Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas 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 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Pharmacist Accreditation Statement
Global Education Group is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Global Education Group designates this continuing education activity for 0.5 contact hour(s) (0.05 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number - 0530-9999-15-051-H01-P)
This is a knowledge based activity.
Nurse Practitioner Continuing Education
Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. This program has been approved for 0.5 contact hours of continuing education (which includes 0.5 hours of pharmacology).
Global Contact Information
For information about the accreditation of this program, please contact Global at 303-395-1782 or firstname.lastname@example.org.
Instructions to Receive Credit
In order to receive credit, participants must complete the preactivity questionnaire, postactivity questionnaire, and program evaluation. Participants must also score at least a 70% on the posttest.
- Computer, tablet, or smart phone with internet access
- HTML5 compatible browser or Adobe Flash Player
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:
Timothy R. Deer, MD - Grant/Research Support – Bioness Inc., Jazz Pharmaceuticals, Inc., Medtronic, Inc., Spinal Modulation Inc., St. Jude Medical, Inc.; Advisory Boards – Axonics Modulation Technologies, Inc., Bioness Inc., Flowonix Medical Inc., Jazz Pharmaceuticals, Inc., Medtronic, Inc., Nevro Corp., Spinal Modulation Inc., St. Jude Medical, Inc.; Speakers Bureau – Jazz Pharmaceuticals, Inc.; Consultant – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Flowonix Medical Inc., Mallinckrodt Pharmaceuticals, Medtronic, Inc., Nevro Corp., Spinal Modulation Inc., SpineThera, Inc., St. Jude Medical, Inc., Vertos Medical Inc.; Stock Options – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Nevro Corp., Spinal Modulation Inc., SpineThera, Inc., Vertos Medical Inc.
The 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:
Amanda Glazar, PhD - Nothing to disclose
Andrea Funk - Nothing to disclose
Kristen Delisi - 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.
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.