Table 1.

PACC 2016 updates that enhance analgesia and patient safety [9]

Treatment Recommendations by Pain Etiology and Breadth	Classification of Cancer Patients Based on Disease State and Prognosis		Recognition that Previous Treatment May Influence Response	Ranking System Used to Grade Evidence
Recommendation categories: Cancer-related localized pain Cancer-related diffuse pain Non–cancer-related localized pain Non–cancer-related diffuse pain	Category 1 Category 2 Category 3	Patient with short life expectancy and a focus on palliation Patients with stable or slowed disease progression but a high likelihood of recurrence Patients with cancer in remission or cured	IT analgesia should be considered only as salvage therapy after failure of high doses of systemic opioids	Validated USPSTF classification Evidence level (e.g., randomized controlled trial) Strength of recommendation (e.g., good evidence to suppose therapy is effective and benefits outweigh harms) PACC grades* Strong: >80% consensus Moderate: 50% to 79% consensus Weak: <49% consensus

Figure adapted with permission from: Deer TR, Pope JE, Hayek S, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation 2017;20(2):96–132 [9].

IT = intrathecal; PACC = Polyanalgesic Consensus Conference; USPSTF = United States Preventive Services Task Force.

^*Consensus grading performed when >80% of the PACC members were present.