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Translating Algorithms to Clinical Practice in the Management of Patients With Chronic Pain: Focus on Intrathecal Delivery

Live Webstream from the Symposium at the NANS 17th Annual Meeting

Premiere Date: Saturday, December 7, 2013

This activity offers CE credit for:

  1. Physicians (CME)
  2. Nurses (CNE)
  3. Pharmacists (ACPE)
  4. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Creditâ„¢

Credit Expiration Date:
Sunday, December 7, 2014
Note: Credit Is No Longer Available


David L. Caraway, MD, PhDDavid L. Caraway, MD, PhD 
Medical Director
Center for Pain Relief
Tri State, PLLC
Huntington, WV

Eric Grigsby, MD, MBAEric Grigsby, MD, MBA 
Founder and Medical Director
Napa Pain Institute
Neurovations Clinical Research
Napa, CA

Statement of Need

Optimal pain management is a national health care priority, and the use of opioid therapy for patients with both acute and chronic pain is safer and more effective than ever before. However, for many patients with severe and intractable chronic pain, oral opioid therapy is not enough; other options are better suited to achieving pain control. Intrathecal (IT) therapy is becoming an increasingly accepted strategy for delivering opioid and non-opioid analgesics, as well as neuromodulators, for the management of intractable pain in appropriate patients. Evidence suggests that ongoing education is warranted to build and strengthen the use of evidence-based, best practices among clinicians regarding use of IT in pain management.

This symposium will help clinicians first identify patients who are candidates for IT pain management and then devise and modify the IT pain-treatment plan using an algorithm that balances efficacy and side effects and addresses common barriers to care.

For clinicians unable to attend the NANS 17th Annual Meeting, this symposium will be available as a live webstream on December 7, 2013 at 3:30 PM ET for the opportunity to view the symposium live and ask questions of the Experts. Register now!

  • Deer TR, Smith HS, Cousins M, et al. Consensus guidelines for the selection and implantation of patients with noncancer pain for intrathecal drug delivery. Pain Physician. 2010;13(3):E175-E213. PMID: 20495597.
  • Duarte RV, Raphael JH, Sparkes E, Southall JL, LeMarchand K, Ashford RL. Long-term intrathecal drug administration for chronic nonmalignant pain. J Neurosurg Anesthesiol. 2012;24(1):63-70. PMID: 21904220.
  • Activity Goal

    This educational activity centers on the CMEO Make-One-Change (M1C) Statement. This statement is crafted from pertinent quality measures or clinical guidelines as a performance challenge to all participants. The M1C Statement for this activity is to: Translate the latest, evidence-based literature and algorithms in pain management to appropriate patient selection and optimal management of patients who would benefit from intrathecal pain therapy.

    Learning Objectives

    At the end of this CE activity, participants should be able to:

    • Apply appropriate patient selection criteria to select candidates for intrathecal analgesia to maximize clinical benefit.
    • Utilize algorithms for appropriate, long-term treatment selection and monitoring for progression for chronic pain management.
    • Implement a slow, dose-titration strategy for intrathecal analgesia that maximizes efficacy while minimizing the potential for side effects.
    • Devise a strategy to overcome barriers that hinder the use of intrathecal analgesia, such as cost and reimbursement issues.

    The following learning objectives pertain only to those requesting CNE or CPE credit:

    • List selection criteria used to identify patients who are candidates for intrathecal therapy to maximize clinical benefit.
    • Describe how a slow, dose-titration strategy for intrathecal analgesia can minimize the potential for side effects.
    • Identify barriers to care that may hinder the appropriate use of intrathecal analgesia.

    Financial Support

    Supported by an educational grant from Jazz Pharmaceuticals, Inc.

    Target Audience

    Anesthesiologists, pain specialists, and other clinicians whose scope of practice includes providing care to patients with intractable pain.

    Credit Information

    CME Credit (Physicians):
    CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    CME Outfitters, LLC, designates this live activity for a maximum of 1.0 AMA PRA Category 1 Creditâ„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    CNE Credit (Nurses):
    Provider approved by the California Board of Registered Nursing, Provider Number CEP 15510, for 1.0 contact hour. This program is approved for pharmacology credit.

    CPE Credit (Pharmacists):
    ACPE CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 1.0 contact hours (0.1 CEUs)
    Universal Activity Number: 0376-0000-13-017-L01-P (live programs)
    Activity Type: knowledge-based

    Post-tests, credit request forms, and activity evaluations must be completed online at (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit

    This program is not affiliated with NANS.

    Disclosure Declaration

    It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CME/CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CME/CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

    Dr. Caraway has disclosed that he has received research and grant support from Bioness Inc.; CNS Therapeutics, Inc.; Jazz Pharmaceuticals, Inc.; Medtronic, Inc.; and Vertos Medical Inc. He is on the speakers bureau of Jazz Pharmaceuticals, Inc.; Medtronic, Inc.; and Vertos Medical Inc. He serves as a consultant for Jazz Pharmaceuticals, Inc.; Medtronic, Inc.; Spinal Modulation; and Vertos Medical Inc.

    Dr. Grigsby has disclosed that he has received research and grant support from Alfred Mann Foundation; Boston Scientific; Collegium Pharmaceutical; CNS Therapeutics, Inc.; Jazz Pharmaceuticals, Inc.; Medtronic, Inc.; myoscience; NeurAxon Inc.; Spinal Restoration, Inc.; and St. Jude Medical, Inc. He is on the speakers bureau of Medtronic, Inc.; and Salix Pharmaceuticals, Inc. He serves as a consultant for Abbott; Alfred Mann Foundation; Cervel Neurotech, Inc.; Covidien; CNS Therapeutics; Cumberland Pharmaceuticals Inc.; Flowonix Medical; Jazz Pharmaceuticals, Inc.; Mainstay Medical; Medtronic, Inc.; myoscience; Neurophage Pharmaceuticals; Nevro Corp.; Palyon Medical Corp.; St. Jude Medical, Inc.; Spinal Modulation; VertiFlex Inc.; Vertos Medical Inc.; Xalud Therapeutics, Inc. He is a shareholder of Medtronin, Inc.; Nervo Corp.; and Spinal Modulation.

    Monique Johnson, MD, CCMEP (planning committee) has nothing to disclose.

    Joy Bartnett Leffler, MLA, NASW, CSE (planning committee) has nothing to disclose.

    Sandra Haas Binford, MAEd (planning committee) has nothing to disclose.

    Sharon Tordoff, CCMEP (planning committee) has nothing to disclose.

    CME Outfitters, LLC, the faculty, and Jazz Pharmaceuticals, Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

    Equal Opportunity Statement: CME Outfitters reserves the right to cancel this program due to unforeseen circumstances. In the unlikely event of such cancellation, CME Outfitters will not be responsible for travel expenses incurred by the participant.

    Questions about this activity? Call us at 877.CME.PROS (877.263.7767).


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