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Evolving Best Practices With Intrathecal Analgesics: Improving the Care of Patients With Severe Chronic Pain

Evolving Best Practices With Intrathecal Analgesics: Improving the Care of Patients With Severe Chronic Pain


Interactive Monograph

Time to Complete

1.50 hours


December 6, 2016


December 6, 2017
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Maximum Credits

1.50 / AMA PRA Category 1 Credit(s)TM
1.50 / CE for Nurse Practitioners (0.20 pharmacology credit)

Accredited Provider

This activity is jointly provided by Global Education Group and Integritas Communications.

Commercial Supporter

This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.

Program Description

Complexities in the underlying pathophysiologic mechanisms and clinical manifestations of chronic pain result in a large number of patients for whom conventional management strategies fail to produce adequate pain relief or functional gains.1,2 For some of these individuals, medications delivered directly to the intrathecal space can be a safe and effective treatment option.3,4 The US Food and Drug Administration (FDA) has approved 2 analgesics—ziconotide and morphine—for intrathecal delivery in patients with severe chronic pain.5,6 However, intrathecal therapy remains underutilized for chronic pain, in part owing to historically suboptimal outcomes stemming from poor patient selection, systemic barriers, and safety concerns (eg, opioid-induced respiratory depression).7 Available in multiple formats, this multimedia eHealth SourceTM will cover the latest published evidence and practical guidance on evaluating candidates for intrathecal drug delivery, initiating this treatment strategy using FDA-approved intrathecal analgesics, longitudinally monitoring patients with implanted pumps, and tailoring therapy based on analgesia, functional outcomes, and treatment-emergent adverse effects.

1. National Research Council. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine. Washington, DC: The National Academies Press; 2011.
2. 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.
3. 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.
4. Prager J, Deer T, Levy R, et al. Best practices for intrathecal drug delivery for pain. Neuromodulation. 2014;17(4):354-372.
5. Ver Donck A, Vranken JH, Puylaert M, et al. Intrathecal drug administration in chronic pain syndromes. Pain Pract. 2014;14(5):461-476.
6. Kim P, Grigsby E, Deer T, et al. Effectiveness and safety of intrathecal ziconotide as the first agent in pump for adult patients with severe chronic pain. Presented at the 22nd Annual Napa Pain Conference; August 27-29, 2015; Napa, CA.
7. 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.

Intended Audience

The educational design of this activity addresses the needs of pain specialists and other clinicians who manage patients with severe chronic pain.

Educational Objectives

Upon completion of this activity, participants will be better prepared to:

  • Describe key anatomic and neurologic issues related to the practical use of intrathecal analgesics for the treatment of severe chronic pain
  • Perform comprehensive preimplantation work-ups of candidates for intrathecal analgesic therapy
  • Discuss the clinical profiles, dosing strategies, and other prescribing considerations for FDA-approved analgesics that have been approved for intrathecal use
  • Utilize intrathecal therapy for patients with severe chronic pain to reflect the benefits and risks of available medications, trial results, the latest guideline recommendations, and other recently published evidence
  • Tailor intrathecal therapy for severe chronic pain based on ongoing monitoring of analgesia, functional outcomes, and treatment-emergent adverse events

Conflict Of Interest Disclosure Policy

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.


Timothy R. Deer, MD, DABPM
President and Chief Executive Officer
Center for Pain Relief, Inc.
Charleston, WV

Dr. Deer discloses the following:
Consultant – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Flowonix Medical, Inc., Medtronic, Nevro Corp., Nuvectra Corp., Saluda Medical Pty Ltd., SpineThera, Inc., St. Jude Medical, Inc., and Vertos Medical Inc.
Grant/Research Support – Bioness Inc., Jazz Pharmaceuticals, Inc., Medtronic, and St. Jude Medical, Inc.
Stock Options – Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Nuvectra Corp., Saluda Medical Pty Ltd., SpineThera, Inc., and Vertos Medical Inc.

Jason E. Pope, MD, DABPM, FIPP
President, Summit Pain Alliance
Santa Rosa, CA

Dr. Pope discloses the following:
Consultant/Independent Contractor – Medtronic, St. Jude Medical, Inc., Nuvectra Corp., Jazz Pharmaceuticals, and Flowonix Medical, Inc.
Grant Research Support – St. Jude Medical, Inc., Flowonix Medical, Inc., and Jazz Pharmaceuticals
Royalty – Springer and Elsevier

Planners' and Managers' Disclosures

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/CE activity:

Kristen Delisi has nothing to disclose.
Amanda Glazar, PhD, has nothing to disclose.
Andrea Funk has nothing to disclose.
Laura Gilsdorf has nothing to disclose.
Jim Kappler, PhD, has nothing to disclose




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas. Global is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Global Education Group designates this enduring material for a maximum of 1.50 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CE for Nurse Practitioners

Accreditation Statement

Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. Activity ID #2148E.

This activity was planned in accordance with AANP CE Standards and Policies.

Designation Statement

This program has been approved for 1.50 contact hour of continuing education (which includes 0.20 hours of pharmacology).

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 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.

Fee and Refund / Cancellation Policy

There is no fee for this educational activity.


In order to receive credit, participants must complete the preactivity questionnaire, post-test, and program evaluation. Participants must also score at least 70% on the post-test. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

For information about the accreditation of this program, please contact Global at 303-395-1782 or

If you have any other questions relating to your certificate or other issues with the activity, please contact

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Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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