多模式镇痛共识会议（PACC）：关于鞘内药物输注系统最佳实践和指南的建议。
The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines.
作者信息
Deer Timothy R, Pope Jason E, Hayek Salim M, Bux Anjum, Buchser Eric, Eldabe Sam, De Andrés Jose A, Erdek Michael, Patin Dennis, Grider Jay S, Doleys Daniel M, Jacobs Marilyn S, Yaksh Tony L, Poree Lawrence, Wallace Mark S, Prager Joshua, Rauck Richard, DeLeon Oscar, Diwan Sudhir, Falowski Steven M, Gazelka Helena M, Kim Philip, Leong Michael, Levy Robert M, McDowell Gladstone, McRoberts Porter, Naidu Ramana, Narouze Samir, Perruchoud Christophe, Rosen Steven M, Rosenberg William S, Saulino Michael, Staats Peter, Stearns Lisa J, Willis Dean, Krames Elliot, Huntoon Marc, Mekhail Nagy
机构信息
Center for Pain Relief, Charleston, WV, USA.
Summit Pain Alliance, Santa Rosa, CA, USA.
出版信息
Neuromodulation. 2017 Feb;20(2):96-132. doi: 10.1111/ner.12538. Epub 2017 Jan 2.
INTRODUCTION
Pain treatment is best performed when a patient-centric, safety-based philosophy is used to determine an algorithmic process to guide care. Since 2007, the International Neuromodulation Society has organized a group of experts to evaluate evidence and create a Polyanalgesic Consensus Conference (PACC) to guide practice.
METHODS
The current PACC update was designed to address the deficiencies and innovations emerging since the previous PACC publication of 2012. An extensive literature search identified publications between January 15, 2007 and November 22, 2015 and authors contributed additional relevant sources. After reviewing the literature, the panel convened to determine evidence levels and degrees of recommendations for intrathecal therapy. This meeting served as the basis for consensus development, which was ranked as strong, moderate or weak. Algorithms were developed for intrathecal medication choices to treat nociceptive and neuropathic pain for patients with cancer, terminal illness, and noncancer pain, with either localized or diffuse pain.
RESULTS
The PACC has developed an algorithmic process for several aspects of intrathecal drug delivery to promote safe and efficacious evidence-based care. Consensus opinion, based on expertise, was used to fill gaps in evidence. Thirty-one consensus points emerged from the panel considerations.
CONCLUSION
New algorithms and guidance have been established to improve care with the use of intrathecal drug delivery.
引言
当采用以患者为中心、基于安全的理念来确定指导护理的算法流程时，疼痛治疗的效果最佳。自2007年以来，国际神经调节学会组织了一批专家评估证据，并召开多模式镇痛共识会议（PACC）以指导实践。
方法
本次PACC更新旨在解决自2012年上次PACC发布以来出现的不足和创新。通过广泛的文献检索，确定了2007年1月15日至2015年11月22日期间的出版物，作者们还提供了其他相关资料。在回顾文献后，专家小组召开会议确定鞘内治疗的证据水平和推荐程度。本次会议作为共识形成的基础，共识分为强、中、弱三个等级。针对癌症、终末期疾病和非癌性疼痛患者，无论疼痛是局部性还是弥漫性，开发了鞘内用药选择算法，用于治疗伤害性疼痛和神经性疼痛。
结果
PACC针对鞘内给药的多个方面制定了算法流程，以促进基于证据的安全有效护理。基于专业知识的共识意见被用于填补证据空白。专家小组的审议产生了31个共识点。
结论
已建立新的算法和指南，以改善鞘内给药的护理。
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