• Timothy R Deer, Joshua Prager, Robert Levy, James Rathmell, Eric Buchser, Allen Burton, David Caraway, Michael Cousins, José De Andrés, Sudhir Diwan, Michael Erdek, Eric Grigsby, Marc Huntoon, Marilyn S Jacobs, Philip Kim, Krishna Kumar, Michael Leong, Liong Liem, Gladstone C McDowell, Sunil Panchal, Richard Rauck, Michael Saulino, B Todd Sitzman, Peter Staats, Michael Stanton-Hicks, Lisa Stearns, Mark Wallace, K Dean Willis, William Witt, Tony Yaksh, and Nagy Mekhail.
• Center for Pain Relief, Charleston, WV 25301, USA. doctdeer@aol.com
• Neuromodulation. 2012 Sep 1;15(5):436-64; discussion 464-6.

IntroductionThe use of intrathecal (IT) infusion of analgesic medications to treat patients with chronic refractory pain has increased since its inception in the 1980s, and the need for clinical research in IT therapy is ongoing. The Polyanalgesic Consensus Conference (PACC) panel of experts convened in 2000, 2003, and 2007 to make recommendations on the rational use of IT analgesics based on preclinical and clinical literature and clinical experiences.MethodsThe PACC panel convened again in 2011 to update the standard of care for IT therapies to reflect current knowledge gleaned from literature and clinical experience. A thorough literature search was performed, and information from this search was provided to panel members. Analysis of published literature was coupled with the clinical experience of panel members to form recommendations regarding the use of IT analgesics to treat chronic pain.ResultsAfter a review of literature published from 2007 to 2011 and discussions of clinical experience, the panel created updated algorithms for the rational use of IT medications for the treatment of neuropathic pain and nociceptive pain.ConclusionsThe advent of new algorithmic tracks for neuropathic and nociceptive pain is an important step in improving patient care. The panel encourages continued research and development, including the development of new drugs, devices, and safety recommendations to improve the care of patients with chronic pain.© 2012 International Neuromodulation Society.

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