Intrathecal pain management: a team-based approach

Abstract

Objective

Physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs.

Methods

Narrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain.

Results

The specific roles and responsibilities of PAs, NPs, and RNs in the management of patients receiving IT therapy vary by practice. In many pain treatment centers, PAs, NPs, and RNs are responsible for patient education, postimplant maintenance, and ongoing supportive care of patients receiving IT therapy. Topics that we address include patient selection, patient expectations and goal setting, medication selection, outcome assessment, and treatment adjustment. Currently, morphine and ziconotide (a nonopioid, selective N-type calcium channel blocker) are the only agents approved by the US Food and Drug Administration for IT analgesia. We provide relevant information on the dosing, titration, and adverse effect management of these medications for PAs, NPs, and RNs responsible for administering IT therapy.

Conclusion

PAs, NPs, and RNs are valuable members of IT pain management teams. Treatment success requires ongoing monitoring of efficacy and adverse effects, with corresponding adjustments to medication selection and dosing, in addition to good communication among the health care professionals involved in patient care.

Keywords:

• chronic pain
• implantable drug delivery system
• morphine
• patient education
• ziconotide

Acknowledgments

The authors thank Nancy Holland, PhD, and Sophie Bolick, PhD, of Synchrony Medical Communications, LLC, for providing writing support and Synchrony Medical Communications for editorial assistance in formatting, proofreading, copy editing, and fact checking, which was funded by Jazz Pharmaceuticals in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). Jazz Pharmaceuticals also reviewed the manuscript. Although Jazz Pharmaceuticals was involved in the review of the manuscript, the content of the manuscript, the ultimate interpretation, and the decision to submit for publication in the Journal of Pain Research were determined by the authors independently.

Author contributions

All authors were involved in the study concept, drafted/revised the manuscript for important intellectual content, approved the final version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

JAA reports serving as a speaker or consultant for AstraZeneca, Daiichi Sankyo Company, Limited, Depomed, Kaléo, Inc., Egalet, Inc., Millennium Labs, Pernix, St. Jude Medical Neuromodulation Systems, and Quest Diagnostics. NL reports serving on the speakers’ bureau for Azur Pharma Inc. The authors report no other conflicts of interest in this work.