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The Art and Science of Intrathecal Pain Management

neuroscienceCME Webcast

Premiere Date: Wednesday, January 21, 2015

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:
Thursday, January 21, 2016
Note: Credit Is No Longer Available


Gladstone C. McDowell II, MDGladstone C. McDowell II, MD 
Medical Director
Integrated Pain Solutions
Columbus, OH

Michael Saulino, MD, PhDMichael Saulino, MD, PhD 
Associate Professor
Department of Rehabilitation Medicine
Thomas Jefferson University
Philadelphia, PA , PA

Statement of Need

Intrathecal (IT) therapy has become an increasingly accepted alternative to standard medical management for patients with moderate-to-severe intractable pain. Suitable patient and treatment selections are imperative for achieving optimum outcome.1 However, even in the right patient, the right drug may not be efficacious or may result in intolerable adverse effects if the treatment is not initiated properly. Evidence suggests that ongoing education is warranted to build and strengthen the use of evidence-based, best practices among clinicians regarding use of IT therapy in pain management.2

This webcast is a replay of the case-based symposium presented at the North American Neuromodulation Society (NANS) meeting on December 13, 2014. Utilizing video of a patient with chronic pain, Dr. McDowell and Dr. Saulino will help clinicians identify patients who are appropriate candidates for IT pain management, implement evidence-based trialing strategies, and then devise and implement an IT pain treatment plan that maximizes efficacy and minimizes side effects.

  1. Mitchell AA, Sapienza-Crawford AJ, Hanley KL, et al. Administering ziconotide and monitoring patients treated with ziconotide: expert opinion. Pain Manag Nurs. 2013;14(3):e84-e94. PMID: 23972874.
  2. 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.

Activity Goal

This educational activity centers on the CME Outfitters Make One Change statement. This statement is crafted from pertinent quality measures or clinical guidelines as a performance challenge to all participants. The Make One Change statement for this activity is: Learners will implement an evidence- and best practice-based approach to the initiation of IT pain management in all appropriate patients.

Learning Objectives

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

  • Utilize current, evidence-based, best-practice criteria to guide appropriate patient selection for intrathecal (IT) pain treatment.
  • Implement best practice-based intrathecal medication trialing strategies as a routine component of an individualized treatment approach to pain management.
  • Implement a slow dose-titration strategy for intrathecal pain management that maximizes efficacy while minimizing the potential for side effects.

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

  • Review the latest evidence for patient selection for intrathecal pain treatment.
  • Analyze trialing strategies to personalize a treatment plan in intrathecal pain management.
  • Define dosing and titration strategies for intrathecal pain treatment.

Financial Support

Supported by an educational grant from Jazz Pharmaceuticals, Inc.

Target Audience

Pain physicians, physician assistants, nurse practitioners, nurses, 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 enduring material 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.

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 hour (0.1 CEUs)
Universal Activity Number: 0376-0000-15-004-H01-P
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

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. McDowell has disclosed that he has received research and grant support from Jazz Pharmaceuticals, Inc. and Mallinckrodt Pharmaceuticals. He is on the speakers bureau of Jazz Pharmaceuticals, Inc. and Medtronic, Inc. He serves as a consultant for Jazz Pharmaceuticals, Inc. and Medtronic, Inc.

Dr. Saulino has disclosed that he has received research and grant support from Jazz Pharmaceuticals, Inc.; Mallinckrodt Pharmaceuticals; and Medtronic, Inc. He is on the speakers bureau of Jazz Pharmaceuticals, Inc. and Medtronic, Inc. He serves as a consultant for Independence Blue Cross and SPR Therapeutics. He has received other financial or material support from the Board of Directors of the North American Neuromodulation Society

Tony Graham, MD (peer reviewer) has nothing to disclose.

Ruth Cody, BSN, RN-BC (peer reviewer) has nothing to disclose.

Robert Kennedy (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.

Disclosures were obtained from the CME Outfitters, LLC staff: 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.

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


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