• Neuromodulation · Sep 2012

    Polyanalgesic Consensus Conference--2012: consensus on diagnosis, detection, and treatment of catheter-tip granulomas (inflammatory masses).

    • 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):483-95; discussion 496.

    IntroductionContinuous intrathecal infusion of drugs to treat chronic pain and spasticity has become a standard part of the algorithm of care. The use of opioids has been associated with noninfectious inflammatory masses at the tip of the intrathecal catheter, which can result in neurologic complications.MethodsThe Polyanalgesic Consensus Conference is a meeting of a group of well-published and experienced practitioners; the purpose of the meeting is to update the standard of care for intrathecal therapies to reflect current knowledge gleaned from literature and clinical experience. An exhaustive literature search was performed, and information from this search was provided to panel members. Analysis of the published literature was coupled with the clinical experience of panel participants to form recommendations regarding intrathecal inflammatory masses or granulomas.ResultsThe panel has made recommendations for the prevention, diagnosis, and management of intrathecal granulomas.ConclusionThe use of chronic infusions of intrathecal opioids is associated with the formation of inflammatory masses at the intrathecal catheter tip in a small minority of treated patients. Nonetheless, the appearance of these space-occupying lesions can lead to devastating neurologic sequelae. The prevention, early detection, and successful treatment of intraspinal granulomas are important considerations when offering intrathecal drug therapy to patients with chronic intractable pain.© 2012 International Neuromodulation Society.

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