Review
Anesthesiology
Jay Karri, Mani Singh, Devas J. Modi, Vwaire Orhurhu, Caleb Seale, Michael Saulino, Anuj Marathe, Darrell Vydra, Jonathan M. Hagedorn, Brian Bruel, Alaa Abd-Elsayed
Summary: Studies have shown that CIDT strategies can provide improved analgesic benefits by utilizing variances in intrathecal pharmacokinetics and pharmacodynamics, but the appropriate use may come with increased risks of adverse effects. The supportive evidence for CIDT use for chronic pain conditions is limited, with recommended CIDT strategies including polyanalgesia combinations to treat chronic pain patients effectively while maintaining safety profiles.
Article
Clinical Neurology
Elizabeth E. Ginalis, Saim Ali, Antonios Mammis
Summary: Intrathecal delivery of pain management medications is a significant advancement in treating chronic pain, demonstrating higher efficiency and fewer side effects compared to oral medications. However, more randomized controlled trials are needed to strengthen the evidence for intrathecal therapy. It is often considered a last resort for patients with nonmalignant pain. Updated expert guidelines on intrathecal treatment consensus are required.
NEUROSURGERY CLINICS OF NORTH AMERICA
(2022)
Article
Clinical Neurology
Miriam M. Shao, Olga Khazen, Abigail Hellman, Margaret Czerwinski, Rachel Dentinger, Marisa DiMarzio, Michael Gillogly, Amir Hadanny, Charles Argoff, Julie G. Pilitsis
Summary: The study demonstrates that ziconotide IDT can improve pain, emotional components, and function in patients with neuropathic pain. The results provide prospective evidence supporting the use of IDT for improving disability, emotional well-being, and catastrophizing in this patient population.
WORLD NEUROSURGERY
(2021)
Article
Anesthesiology
Keith-Austin Scarfo, Owen P. Leary, Darlene Gaudet, Alexios G. Carayannopoulos, Gail Grande
Summary: This study analyzed the cost difference between monotherapy and compounded therapy in targeted drug delivery (TDD), indicating that transitioning to monotherapy resulted in cost savings, albeit dependent on the specific drug combination initially used for therapy.
Article
Medicine, General & Internal
Ryan Holden, Gaurav Chauhan, Trent Emerick
Summary: Migraine is a highly prevalent and debilitating illness, and one emerging treatment option for refractory cases is intrathecal Ziconotide. This therapy selectively blocks N-type calcium channels, potentially providing relief for chronic neuropathic pain, including migraines. However, there are limited studies on the successful use of Ziconotide for migraine treatment.
CUREUS JOURNAL OF MEDICAL SCIENCE
(2022)
Review
Behavioral Sciences
Georgios Matis, Pasquale De Negri, Denis Dupoiron, Rudolf Likar, Xander Zuidema, Dirk Rasche
Summary: This article summarizes recommendations made by six pain specialists regarding ziconotide intrathecal analgesia (ITA) and its potential as a first-line alternative to morphine in Europe. The specialists advocate for more European prospective studies on ziconotide to further investigate its low-and-slow dosing strategies and reduce opioid usage among patients.
BRAIN AND BEHAVIOR
(2021)
Article
Medicine, General & Internal
Ji Yeong Kim, Yong Ho Lee, Ji Young Kim, Hyun Hwa Lee, Young Hoon Kim
Summary: A 37-year-old woman with severe intractable pain below the T5 level following Sjogren's syndrome-induced transverse myelitis underwent treatment with an intrathecal pump, resulting in effective pain control and improved functional independence.
Review
Pharmacology & Pharmacy
Alan Chalil, Michael D. Staudt, Tessa A. Harland, Elizabeth M. Leimer, Ravneet Bhullar, Charles E. Argoff
Summary: Morphine and ziconotide are effective IT therapies for patients with chronic pain. Ziconotide is recommended as first-line therapy due to its efficacy and avoidance of common adverse effects associated with opioids, while the use of IT morphine requires careful patient selection and management.
EXPERT OPINION ON DRUG SAFETY
(2021)
Article
Biochemistry & Molecular Biology
Chih-Cheng Wu, Cheng-Yi Chang, Chung-Yuh Tzeng, Jen-Hsuan Huang, Chih-Jen Hung, Wen-Ying Chen, Su-Lan Liao, Yu-Hsiang Kuan, Chun-Jung Chen
Summary: In this study, the preventive effects of intrathecal bupivacaine administration against neuropathic pain were investigated. Bupivacaine attenuated pain behaviors and inflammatory alternations by suppressing microglia M1 polarization and pro-inflammatory cytokine expression. The Interferon Regulatory Factor 5 (IRF5)/P2X Purinoceptor 4 (P2X4R) and High Mobility Group Box 1 (HMGB1)/Toll-Like Receptor 4 (TLR4)/NF-kappa B inflammatory axes were identified as key players in microglia polarization and cytokine expression.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Medicine, Research & Experimental
Sue Copley, Peter Edward Yassa, Alan Mark Batterham, Eric Buchser, Nagy Mekhail, Rui V. Duarte, Sam Eldabe
Summary: This study evaluated the impact of nonapproved drugs and drug mixtures on the accuracy of intrathecal drug delivery devices. The results showed that in a clinical setting, these devices maintained high levels of accuracy and acceptable precision despite the use of nonapproved drugs or mixtures and various flow modes.
Article
Biochemistry & Molecular Biology
Sherelle L. Casey, Vanessa A. Mitchell, Eddy E. Sokolaj, Bryony L. Winters, Christopher W. Vaughan
Summary: Intrathecal administration of THC and CBD, either alone or in combination, effectively reduces neuropathic pain without significant side effects. The anti-allodynic effects of THC are partially mediated by CB1 and CB2 receptors, while the effects of CBD are partially mediated by CB2 receptors.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2022)
Article
Medicine, Research & Experimental
Julien Robert, Jeremy Sorrieul, Denis Dupoiron, Sabrina Jubier-Hamon, Florent Bienfait, Anne Visbecq, Catherine Devys
Summary: This study investigated the physicochemical stability of morphine-ropivacaine-ziconotide mixtures used in intrathecal analgesia. Results showed excellent stability for morphine and ropivacaine, but a decrease in ziconotide concentration and the appearance of degradation products were observed. The filling intervals for implantable pumps could be adjusted based on the mixing profile to ensure maximum analgesic efficacy.
Article
Multidisciplinary Sciences
Vidhura Ratnasekara, Laurence Weinberg, Samuel Anthony Johnston, Luke Fletcher, Patrick Nugraha, Daniel Robert Anthony Cox, Raymond Hu, Ilonka Meyer, Osamu Yoshino, Marcos Vinius Perini, Vijayaragavan Muralidharan, Mehrdad Nikfarjam, Dong-Kyu Lee
Summary: In a retrospective study of patients undergoing complex hepato-pancreato-biliary (HPB) surgery, the use of a multimodal intrathecal analgesia (MITA) technique combining intrathecal morphine, clonidine, and bupivacaine was found to result in reduced postoperative opioid use and better analgesia compared to the use of intrathecal morphine alone. However, patients in the MITA group had a higher incidence of postoperative hypotension requiring vasopressor support.
Article
Endocrinology & Metabolism
Sajad Hassanzadeh, Soraya Bagheri, Seyed Majid Ahmadi, Seyed Ahmadreza Ahmadi, Isaac Moradishibany, Hosein Dolatkhah, Sajjad Reisi
Summary: This study compared the efficacy of oral clonidine and gabapentin with gabapentin alone in diabetic patients, and the results showed that the clonidine + gabapentin group was significantly more effective in reducing neuropathic pain and its severity compared to the gabapentin group.
BMC ENDOCRINE DISORDERS
(2023)
Article
Medicine, Research & Experimental
Sheu-Ran Choi, Ho Jae Han, Alvin J. Beitz, Jang-Hern Lee
Summary: Administration of IL-1 beta during the early phase of nerve injury can reduce the expression of Sig-1R in spinal astrocytes, decrease pGluN1 expression, and suppress the development of mechanical allodynia and thermal hyperalgesia, producing an analgesic effect on neuropathic pain.
BIOMEDICINE & PHARMACOTHERAPY
(2021)