Education and Experience in Intrathecal Drug Delivery Systems (IDDS) During Pain Medicine Fellowships

Abstract

Objective

Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training.

Materials and Methods

An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021–2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies.

Results

Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers.

Conclusion

A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows’ education.

Keywords:

• intrathecal drug delivery system
• targeted drug delivery
• Accreditation Council for Graduate Medical Education
• neuromodulation

Acknowledgments

The authors thank the anonymous referees for their useful suggestions on our article.

Disclosure

Dr Mahmoud reports personal fees from Boston Scientific. Dr Aman reports personal fees from Abbott, Medtronic, Vertos, SPR Therapeutics and Bioventus. Dr Erika Petersen reports personal fees from Abbott Neuromodulation, Biotronik, Medtronic Neuromodulation, Nalu, Neuros Medical, Nevro, Saluda Medical, MainStay, SPR, Presidio Medical, Versos and Nalu; board of directors and stock options from SynerFuse; stock options from neuro.42. The authors declare no other conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.