Intrathecal drug delivery systems (IDDS) have been successfully utilized for both chronic, refractory cancer and non-cancer pain. Currently, only three pharmacologic agents are approved for intrathecal (IT) use by the Food and Drug Administration (FDA): morphine, baclofen, and ziconotide. Historically, morphine has been relied upon as a first-line agent for pain with (IT) therapy given its profound analgesic properties. However, even at the small doses typically used with IT therapy, morphine can lead to adverse events, complications with therapy, and even death. Baclofen is a power agent used for spasticity with no application in the treatment or management of chronic pain. Ziconotide is the only non-opioid analgesic agent currently available for IT use in the United States. Its pharmacologic effects are modulated via a selective block of presynaptic neuronal N-type calcium channels in the spinal cord. Given the unique mechanism of action of ziconotide, it holds significant advantages over IT opioids when implemented within IDDS. In this chapter, we will overview the current role of ziconotide for IT use in patients with refractory chronic pain.
KeywordsNeuromodulation Neuropathic pain Cancer pain Intrathecal drug delivery system Ziconotide Intrathecal pump Refractory chronic pain Nociceptive pain Intrathecal drug delivery system Chronic pain
- 2.Bhatia G, Lau M, Gulur P. Intrathecal Drug Delivery (ITDD) systems for cancer pain. F1000Research, 2013.Google Scholar
- 6.Collins R, Lieberburg I, Ludington E, Howard R. Effectiveness of intrathecal ziconotide in multiple pain etiologies: a meta‐analysis of three controlled trials [abstract]. Pain Med. 2005;6:195.Google Scholar
- 14.Hunter C, Diwan S, Deer T. Neuroaugmentation by stimulation vs. Intrathecal drug delivery. In: Intrathecal pump delivery for pain and spasticity, vol. 2. Philadelphia: Elsevier; 2012.Google Scholar
- 15.Maeyaert J, Buchser E, Van Buyten J, Rainov N, Becker R. Patient-controlled Analgesia in Intrathecal therapy for chronic pain: safety and effective operation of the Model 8831 personal therapy manager with a pre-implanted synchromed infusion system. Neuromodulation. 2003;6(3):133–41.CrossRefGoogle Scholar
- 16.McDowell GC. Use of the personal therapy manager with Prialt® (ziconotide) for patient‐controlled analgesia: a case series highlighting techniques and outcomes. Las Vegas. Presented at the 14th Annual Meeting of the North American Neuromodulation Society, December 2–5, 2010. http://www.slideserve.com/uri/use-of-the-personal-therapy-manager-with-prialt-ziconotide-intrathecal-infusion-for-patient-controlled-analgesia-case. Accessed 28 Aug 2017.
- 20.Pope JE, Deer TR. Intrathecal ziconotide in the treatment of failed back surgery syndrome. Pain Med News Spec Ed. 2014:79–80.Google Scholar
- 22.PRIALT [package insert] Jazz Pharmaceuticals: Palo Alto; 2013.Google Scholar
- 26.Saulino M, Kim P, Shaw E. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain. J Pain Res. 2014:627.Google Scholar
- 29.Stearns L, Boortz‐Marx R, Du PS, et al. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J Support Oncol. 2005;3:399–408.Google Scholar