The primary managing physician should have specialized skills in IDD therapy and coordinate care among a multidisciplinary team. This includes overseeing the transition from systemic to IT opioids, monitoring for complications, and managing long-term therapy. Regular communication with oncologists, palliative care teams, and other healthcare providers is essential.

Advanced practice clinicians, registered nurses, pharmacists, and other team members should be trained in pump management, refills, and complication identification. A thorough understanding of pump programming and sterile technique is necessary for ensuring patient safety during refills and dose adjustments. All refill personnel should be trained to avoid and recognize immediate refill complications like a pocket fill and how the team should manage them³⁰.

All patients with IT pumps should have a medical alert identification and be informed about the availability of naloxone, which can be used to treat respiratory depression from opioid overdoses following refills. Written protocols should be distributed to any facility where the patient might receive care if pump management is not available on-site.

Consensus Point 18. The PACC recommends that clinicians should discuss with patients the risks and benefits of having naloxone available for opioid overdoses following IDDS refill and in the hours immediately following refill. USPSTF Grade B; Level of certainty high; Quality of evidence II

Transfer of Care to Another Location

Patients with IT pumps may relocate and will require a detailed plan to ensure continued care. The managing physician should find a new accredited facility and provide complete documentation of the patient’s pain history, surgical records, and pump management details. If the patient moves to an area without access to an IDD program, tele-health options should be explored, and, if necessary, the patient may need to be weaned off the pump.

Conclusions

The use of IDD for managing cancer pain continues to evolve, with ongoing updates to best practices in patient selection, drug and pump selection, dosing strategies, and the management of comorbidities. Future research will likely focus on new intrathecal drugs, hardware improvements, and the integration of AI-based dosing algorithms to further enhance patient outcomes and safety. The PACC remains dedicated to improving patient care through international collaboration and evolving guidelines.