A critique of the latest consensus panel for intrathecal therapy

Because of the relative lack of placebo and dose-ranging studies regarding the initiation and titration of intrathecal (IT) therapy, the Polyanalgesic Consensus Conference (2007) yielded recommendations regarding the management of pain by IT drug delivery. Expert opinion is valuable; however, further consideration might be given to the established literature on the subject. Conclusions of the Polyanalgesic Consensus Conference (2007) were reviewed in light of existing literature. Of note, few published data exist to determine hydromorphone equianalgesic doses or maximum IT dose, the risk of spinal cord lesion secondary to bupivacaine, the suitability of ziconotide as a first-line agent, and the practicality of computed tomography-myelography for diagnosis of granuloma at the IT catheter tip. Common practices are not necessarily supported by established data. Nevertheless, continuous IT infusion has established itself as a powerful, effective, and safe modality for the treatment of pain in selected individuals who cannot tolerate or find relief with noninvasive analgesic techniques.