At the Napa Pain Conference, Dr. Salim Hayek, Associate Professor at Case Western Reserve University and Division Chief of Pain Medicine at University Hospitals, presented on Curbing Intrathecal Dose Escalation. The doctor began by stating that his objectives were to cover the pharmacokinetics of intrathecal medications, review catheter placement, aid in understanding intrathecal opioids (specifically in non-cancer pain patients), discuss the effects of age, and examine the use of bupivacaine in conjunction with opioids administered intraspinally.

One aspect that the doctor focused on was patient selection: reviewing the patients, differentiating between cancer and non-cancer pain, looking at age, and understanding whether the pain is localized or diffused. He reviewed trial procedures, and discussed intrathecal medications used (including their pharmacology considerations).

Dr. Hayek transitioned his discussion to a review of opioid dose escalations in a study of malignant versus non-malignant pain — which led into the issue of rapid-dose escalation as it relates to granuloma formation. He touched on micro-dosing, including a study by Dr. Grider, et al., that was published in Pain Physician in 2011. He reviewed some of the common intrathecal drugs, as well as their applications as they relate to the new 2012 polyanalgesic algorithm for nociceptive pain.

I enjoyed hearing Dr. Hayek, again, present issues of intrathecal drug delivery for the treatment of chronic and malignant or non-malignant pain, and his lecture was well-received by the individuals in attendance.

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