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26th Napa Pain Conference

NPC26-Sa4-C - Intrathecal Drug Delivery System (IDDS) Risks, Benefits & Safety

Aug 17, 2019 11:00am ‐ Aug 17, 2019 12:30pm


Intrathecal Drug Delivery System (IDDS) Risks, Benefits & Safety

Target Audience: Clinicians supervising or providing direct care for patients with intrathecal drug delivery systems, and providers considering the use of IDDs

Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Implement strategies to prevent the two clinician-related factors that contribute to the most serious adverse events
  • Triage inflammatory catheter tip granulomas


Risks & Benefits, Long Term Effects, & Trouble-shooting with IDDs

Kimberly Bayless, DNP, NP, RN

Reviewing the Principles of Asepsis

Hilary Cromwell, RN

Recognizing, Diagnosing, Treating, & Preventing the Subcutaneous Injection of Highly Concentrated Drugs During the Reservoir Refill Procedure

Gail McGlothlen, DNP, RN-BC


Intrathecal infusions of analgesics have been used since the latter 1980s for the treatment of spasticity and persistent pain. Recent consensus guidelines provide paths for the treatment of nociceptive, neuropathic and mixed pain syndromes.

Clinical providers need to be aware of and prepared to address possible mechanical, pharmacological, surgical, and patient-specific complications, including granuloma formation and pocket fills.

Additional Reading

  • Mcglothlen G & Rodriguez L. Training for the intraspinal drug delivery system reservoir refill procedure highly variable: A nationwide survey of health care professionals. Neuromodulation. 2017; 20(7):727-732.
  • Fitzgibbon, D. R., Stephens, L. S., Posner, K. L., Michna, E., Rathmell, J. P., Pollak, K. A., & Domino, K. B. (2016). Injury and liability associated with implantable devices for chronic pain. The Journal of the American Society of Anesthesiologists, 124(6), 1384-1393.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Lamer, T. J., Veizi, I. E., Erdek, M., ... & Rosen, S. M. (2017). The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation: Technology at the Neural Interface, 20(2), 155-176.
  • Bottros, M. M., & Christo, P. J. (2014). Current perspectives on intrathecal drug delivery. Journal of Pain Research, 7, 615.
  • McGlothlen, Gail, “Intraspinal Drug Delivery Reservoir Refill Procedure by Non-Physician Clinicians: A Nation-Wide Survey of Training, Pocket Fill Experience, and Life-Long Learning Behaviors” (2016). Doctoral Projects. 39.
  • Follett, K. A., & Naumann, C. P. (2000). A prospective study of catheter-related complications of intrathecal drug delivery systems. Journal of Pain and Symptom Management, 19(3), 209-215.
  • Adler, J. A., & Lotz, N. M. (2017). Intrathecal pain management: a team-based approach. Journal of Pain Research, 10, 2565.
  • Smith, H. S., Deer, T. R., Staats, P. S., Singh, V., Sehgal, N., & Cordner, H. (2008). Intrathecal drug delivery. Pain Physician, 11(2 Suppl), S89-S104.
  • Rauck, R. L., Cherry, D., Boyer, M. F., Kosek, P., Dunn, J., & Alo, K. (2003). Long-term intrathecal opioid therapy with a patient-activated, implanted delivery system for the treatment of refractory cancer pain. The Journal of Pain, 4(8), 441-447.
  • Ruan, X. (2007). Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician, 10(2), 357.
  • Deer, T., Chapple, I., Classen, A., Javery, K., Stoker, V., Tonder, L., & Burchiel, K. (2004). Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain. Pain Medicine, 5(1), 6-13.


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