A safety review of approved intrathecal analgesics for chronic pain management

被引:11
|
作者
Chalil, Alan [1 ]
Staudt, Michael D. [2 ,3 ]
Harland, Tessa A. [4 ]
Leimer, Elizabeth M. [5 ]
Bhullar, Ravneet [6 ]
Argoff, Charles E. [7 ]
机构
[1] Western Univ, London Hlth Sci Ctr, Dept Clin Neurol Sci, London, ON, Canada
[2] Oakland Univ, William Beaumont Sch Med, Dept Neurosurg, Rochester, MI 48063 USA
[3] Michigan Head & Spine Inst, Southfield, MI USA
[4] Albany Med Coll, Dept Neurosurg, Albany, NY 12208 USA
[5] Oregon Hlth & Sci Univ, Dept Anesthesiol & Perioperat Med, Portland, OR 97201 USA
[6] Albany Med Coll, Dept Anesthesiol, Albany, NY 12208 USA
[7] Albany Med Coll, Dept Neurol, Albany, NY 12208 USA
关键词
Adverse effects; cancer pain; chronic pain; intrathecal; morphine; safety; ziconotide; CONFERENCE PACC RECOMMENDATIONS; CHRONIC NONMALIGNANT PAIN; SPINAL-CORD COMPRESSION; REFRACTORY CANCER PAIN; DRUG-DELIVERY; RESPIRATORY DEPRESSION; INTRACTABLE PAIN; DOUBLE-BLIND; MORPHINE; ZICONOTIDE;
D O I
10.1080/14740338.2021.1889513
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: Intrathecal (IT) drug therapy is an effective treatment option for patients with chronic pain of malignant or nonmalignant origin, with an established safety profile and fewer adverse effects compared to oral or parenteral pain medications. Morphine (a mu-opioid receptor agonist) and ziconotide (a non-opioid calcium channel antagonist) are the only IT agents approved by the U.S. Food and Drug Administration for the treatment of chronic pain. Although both are considered first-line IT therapies, each drug has unique properties and considerations. Areas Covered: This review will evaluate the pivotal trials that established the use of morphine and ziconotide as first-line IT therapy for patients with chronic pain, as well as safety and efficacy data generated from various retrospective and prospective studies. Expert Opinion: Morphine and ziconotide are effective IT therapies for patients with chronic malignant or nonmalignant pain that is refractory to other interventions. IT ziconotide is recommended as a first-line therapy due to its efficacy and avoidance of many adverse effects commonly associated with opioids. The use of IT morphine is also considered first-line; however, the risks of respiratory depression, withdrawal with drug discontinuation or pump malfunction, and the development of tolerance require careful patient selection and management.
引用
收藏
页码:439 / 451
页数:13
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