1
|
Lin J, Chen S, Butt UD, Yan M, Wu B. A comprehensive review on ziconotide. Heliyon 2024; 10:e31105. [PMID: 38779019 PMCID: PMC11110537 DOI: 10.1016/j.heliyon.2024.e31105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Managing severe chronic pain is a challenging task, given the limited effectiveness of available pharmacological and non-pharmacological treatments. This issue continues to be a significant public health concern, requiring a substantial therapeutic response. Ziconotide, a synthetic peptide initially isolated from Conus magus in 1982 and approved by the US Food and Drug Administration and the European Medicines Agency in 2004, is the first-line intrathecal method for individuals experiencing severe chronic pain refractory to other therapeutic measures. Ziconotide produces powerful analgesia by blocking N-type calcium channels in the spinal cord, which inhibits the release of pain-relevant neurotransmitters from the central terminals of primary afferent neurons. However, despite possessing many favorable qualities, including the absence of tolerance development, respiratory depression, and withdrawal symptoms (largely due to the absence of a G-protein mediation mechanism), ziconotide's application is limited due to factors such as intrathecal administration and a narrow therapeutic window resulting from significant dose-related undesired effects of the central nervous system. This review aims to provide a comprehensive and clinically relevant summary of the literatures concerning the pharmacokinetics and metabolism of intrathecal ziconotide. It will also describe strategies intended to enhance clinical efficacy while reducing the incidence of side effects. Additionally, the review will explore the current efforts to refine the structure of ziconotide for better clinical outcomes. Lastly, it will prospect potential developments in the new class of selective N-type voltage-sensitive calcium-channel blockers.
Collapse
Affiliation(s)
- Jinping Lin
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Shuwei Chen
- Fuyang People's Hospital, Hangzhou 311400, China
| | | | - Min Yan
- Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Bin Wu
- Ocean College, Zhejiang University, Zhoushan 321000, China
| |
Collapse
|
2
|
Puntillo F, Giglio M, Preziosa A, Dalfino L, Bruno F, Brienza N, Varrassi G. Triple Intrathecal Combination Therapy for End-Stage Cancer-Related Refractory Pain: A Prospective Observational Study with Two-Month Follow-Up. Pain Ther 2020; 9:783-792. [PMID: 32350753 PMCID: PMC7648800 DOI: 10.1007/s40122-020-00169-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION In cancer-related pain refractory to systemic opioids, intrathecal (IT) administration of morphine can be a useful strategy. In clinical practice, IT morphine is usually combined with other drugs with different mechanisms of action, in order to obtain a synergistic analgesic effect. However, the discussion on efficacy and safety of IT combination therapy is still ongoing. The aim of this observational study was to report the effects of an IT combination of low doses of ziconotide, morphine, and levobupivacaine in end-stage cancer refractory pain. METHODS Sixty adult patients, 21 females and 39 males, were enrolled to an IT device implant. The mean visual analogue scale of pain intensity (VASPI) score was 88 ± 20 mm. All patients started with a triple combination therapy: the initial IT dose of morphine was calculated for each patient based on the equivalent daily dose of morphine; an oral/IT ratio of 400/1 was used. For ziconotide, a standard slow titration schedule was started at 1.2 μg/day and the initial dose of levobupivacaine was 3 mg/day. RESULTS The initial IT mean doses of morphine, ziconotide, and levobupivacaine were 0.8 ± 0.3 mg/day, 1.2 mcg/day and 3 mg/day, respectively. At day 2, a significant reduction in VASPI score was registered (49 ± 17, p < 0.001), and this significant reduction persisted at 56 days (mean VASPI score 44 ± 9, p < 0.001), with mean doses of morphine 2 ± 1 mg/day, ziconotide 2.8 ± 1 mcg/day, and levobupivacaine 3.8 ± 2 mg/day. Very few adverse effects (AEs) were observed. Patients' satisfaction was very high during the entire study period. CONCLUSIONS Our results, within the limit of the study design, suggest that the IT combination of ziconotide, morphine, and levobupivacaine, at low doses, allows safe and rapid control of refractory cancer pain, with high levels of patient satisfaction.
Collapse
Affiliation(s)
- Filomena Puntillo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.
| | | | - Angela Preziosa
- Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy
| | - Lidia Dalfino
- Anaesthesia and Intensive Care Unit, Policlinico Hospital, Bari, Italy
| | - Francesco Bruno
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Brienza
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | | |
Collapse
|
3
|
Giribaldi J, Ragnarsson L, Pujante T, Enjalbal C, Wilson D, Daly NL, Lewis RJ, Dutertre S. Synthesis, Pharmacological and Structural Characterization of Novel Conopressins from Conus miliaris. Mar Drugs 2020; 18:E150. [PMID: 32155768 PMCID: PMC7143535 DOI: 10.3390/md18030150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/21/2022] Open
Abstract
Cone snails produce a fast-acting and often paralyzing venom, largely dominated by disulfide-rich conotoxins targeting ion channels. Although disulfide-poor conopeptides are usually minor components of cone snail venoms, their ability to target key membrane receptors such as GPCRs make them highly valuable as drug lead compounds. From the venom gland transcriptome of Conus miliaris, we report here on the discovery and characterization of two conopressins, which are nonapeptide ligands of the vasopressin/oxytocin receptor family. These novel sequence variants show unusual features, including a charge inversion at the critical position 8, with an aspartate instead of a highly conserved lysine or arginine residue. Both the amidated and acid C-terminal analogues were synthesized, followed by pharmacological characterization on human and zebrafish receptors and structural investigation by NMR. Whereas conopressin-M1 showed weak and only partial agonist activity at hV1bR (amidated form only) and ZFV1a1R (both amidated and acid form), both conopressin-M2 analogues acted as full agonists at the ZFV2 receptor with low micromolar affinity. Together with the NMR structures of amidated conopressins-M1, -M2 and -G, this study provides novel structure-activity relationship information that may help in the design of more selective ligands.
Collapse
Affiliation(s)
- Julien Giribaldi
- Institut des Biomolécules Max Mousseron, UMR 5247, Université de Montpellier-CNRS, 34095 Montpellier, France; (J.G.); (T.P.); (C.E.)
| | - Lotten Ragnarsson
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia; (L.R.); (R.J.L.)
| | - Tom Pujante
- Institut des Biomolécules Max Mousseron, UMR 5247, Université de Montpellier-CNRS, 34095 Montpellier, France; (J.G.); (T.P.); (C.E.)
| | - Christine Enjalbal
- Institut des Biomolécules Max Mousseron, UMR 5247, Université de Montpellier-CNRS, 34095 Montpellier, France; (J.G.); (T.P.); (C.E.)
| | - David Wilson
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia; (D.W.); (N.L.D.)
| | - Norelle L. Daly
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia; (D.W.); (N.L.D.)
| | - Richard J. Lewis
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland 4072, Australia; (L.R.); (R.J.L.)
| | - Sebastien Dutertre
- Institut des Biomolécules Max Mousseron, UMR 5247, Université de Montpellier-CNRS, 34095 Montpellier, France; (J.G.); (T.P.); (C.E.)
| |
Collapse
|
4
|
Staub BP, Casini GP, Monaco EA, Sekula RF, Emerick TD. Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report. J Pain Res 2019; 12:945-949. [PMID: 30881103 PMCID: PMC6413753 DOI: 10.2147/jpr.s193746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Persistent idiopathic facial pain (PIFP) is a poorly defined and debilitating chronic pain state with a challenging and often inadequate treatment course. This is the first case report identifying the novel use of low-dose lumbar intrathecal ziconotide to successfully treat PIFP with nearly complete resolution of pain and minimal to no side effects. Methods The patient was a 37 year-old female whose PIFP was refractory to multimodal medication management and multiple neurovascular surgical interventions. A single-shot lumbar intrathecal trial of ziconotide (2.5 mL, equivalent 2.5 μg) was injected when she was at her baseline pain level — VAS 7/10. She received complete resolution of her pain for about 9 hours, concordant with ziconotide’s half-life. She was subsequently implanted with a lumbar intrathecal delivery system. Results The patient experienced complete resolution of her facial pain with a single-shot intrathecal trial of ziconotide. The intrathecal pump system has provided nearly complete (VAS 1/10) pain relief. Two flares of pain occurred 10 and 18 months after pump placement, which subsequently resolved after increasing the ziconotide dose by 0.5 μg/day on each occasion. The patient is currently maintained on a dose of 2.0 μg/day and is pain-free. Conclusion This is the first case report describing the use of a single-shot lumbar intrathecal trial of ziconotide and subsequent placement of lumbar (as opposed to thoracic) intrathecal ziconotide pump for PIFP. A single-injection intrathecal trial is a low-risk, viable option for patients with this debilitating and frustrating pain condition. Successful trials and subsequent intrathecal pump placement with ziconotide may supplant multimodal medication management and/or invasive orofacial surgical intervention for PIFP.
Collapse
Affiliation(s)
- Brandon P Staub
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Edward A Monaco
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Physicians, Pittsburgh, PA, USA,
| | - Raymond F Sekula
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Physicians, Pittsburgh, PA, USA,
| | - Trent D Emerick
- University of Pittsburgh Physicians, Pittsburgh, PA, USA, .,Division of Chronic Pain, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,
| |
Collapse
|
5
|
Rationally Designed α-Conotoxin Analogues Maintained Analgesia Activity and Weakened Side Effects. Molecules 2019; 24:molecules24020337. [PMID: 30669328 PMCID: PMC6358911 DOI: 10.3390/molecules24020337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/05/2019] [Accepted: 01/17/2019] [Indexed: 11/16/2022] Open
Abstract
A lack of specificity is restricting the further application of conotoxin from Conus bullatus (BuIA). In this study, an analogue library of BuIA was established and virtual screening was used, which identified high α7 nicotinic acetylcholine receptor (nAChR)-selectivity analogues. The analogues were synthesized and tested for their affinity to functional human α7 nAChR and for the regulation of intracellular calcium ion capacity in neurons. Immunofluorescence, flow cytometry, and patch clamp results showed that the analogues maintained their capacity for calcium regulation. The results of the hot-plate model and paclitaxel-induced peripheral neuropathy model indicated that, when compared with natural BuIA, the analgesia activities of the analogues in different models were maintained. To analyze the adverse effects and toxicity of BuIA and its analogues, the tail suspension test, forced swimming test, and open field test were used. The results showed that the safety and toxicity of the analogues were significantly better than BuIA. The analogues of BuIA with an appropriate and rational mutation showed high selectivity and maintained the regulation of Ca2+ capacity in neurons and activities of analgesia, whereas the analogues demonstrated that the adverse effects of natural α-conotoxins could be reduced.
Collapse
|
6
|
Nadherny W, Anderson B, Abd‐Elsayed A. Perioperative and Periprocedural Care of Patients With Intrathecal Pump Therapy. Neuromodulation 2018; 22:775-780. [DOI: 10.1111/ner.12880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Weston Nadherny
- University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Brooke Anderson
- Edgewood College, Henry Predolin School of Nursing Madison WI USA
| | - Alaa Abd‐Elsayed
- Anesthesiology DepartmentUniversity of Wisconsin School of Medicine and Public Health Madison WI USA
| |
Collapse
|
7
|
Bäckryd E. Do the potential benefits outweigh the risks? An update on the use of ziconotide in clinical practice. Eur J Pain 2018; 22:1193-1202. [DOI: 10.1002/ejp.1229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 01/17/2023]
Affiliation(s)
- E. Bäckryd
- Pain and Rehabilitation Centre; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| |
Collapse
|
8
|
Deer T, Rauck RL, Kim P, Saulino MF, Wallace M, Grigsby EJ, Huang IZ, Mori F, Vanhove GF, McDowell GC. Effectiveness and Safety of Intrathecal Ziconotide: Interim Analysis of the Patient Registry of Intrathecal Ziconotide Management (PRIZM). Pain Pract 2017; 18:230-238. [DOI: 10.1111/papr.12599] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Deer
- The Center for Pain Relief; Charleston West Virginia U.S.A
| | - Richard L. Rauck
- Carolinas Pain Institute and The Center for Clinical Research; Winston-Salem North Carolina U.S.A
| | - Philip Kim
- Center for Interventional Pain and Spine, LLC; Newark Delaware U.S.A
| | | | - Mark Wallace
- University of California; San Diego La Jolla California U.S.A
| | | | - I-Zu Huang
- Jazz Pharmaceuticals; Palo Alto California U.S.A
| | - Fannie Mori
- Jazz Pharmaceuticals; Palo Alto California U.S.A
| | | | | |
Collapse
|
9
|
Brookes ME, Eldabe S, Batterham A. Ziconotide Monotherapy: A Systematic Review of Randomised Controlled Trials. Curr Neuropharmacol 2017; 15:217-231. [PMID: 26861472 PMCID: PMC5412704 DOI: 10.2174/1570159x14666160210142056] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 12/31/2015] [Accepted: 01/26/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Chronic neuropathic pain is difficult to treat and is often refractory to most modalities of treatment. Ziconotide is a novel, potent, non-opioid, calcium channel blocking agent which has been shown in clinical trials to be effective in treating chronic neuropathic pain. METHODS EMBASE, MEDLINE, CINAHL Plus and Web of Science electronic databases were searched for English language studies. Reference sections of articles were examined for further papers and the manufacturer of ziconotide was contacted for further unpublished data. Three randomised controlled trials in ziconotide monotherapy were included and subjected to a random effects meta-analysis. RESULTS All three studies used the similar main outcome measure (visual analogue scale of pain intensity; VASPI) and were therefore comparable. A Jadad score was performed for each paper. Frequent serious adverse events (SAEs) were observed which resulted in two of the studies revising the protocol. The metaanalysis revealed a pooled odds ratio (responders on ziconotide vs. placebo) of 2.77 (95% CI, 1.37 to 5.59). DISCUSSION The results suggest that ziconotide is beneficial for pain reduction in chronic neuropathic pain. However, there remain some methodological issues that may call into question the validity of the results. It is evident that more work needs to be conducted to further validate the efficacy of ziconotide and to discover new areas of use.
Collapse
Affiliation(s)
- Morag E. Brookes
- Department of Anaesthesia and Pain Management, The James Cook
University Hospital, Middlesbrough, TS4 3BW, UK
- Department of Anaesthesia and Pain Management, The James Cook
University Hospital, Middlesbrough, TS4 3BW, UK
| | - Sam Eldabe
- Department of Anaesthesia and Pain Management, The James Cook
University Hospital, Middlesbrough, TS4 3BW, UK
| | - Alan Batterham
- Teesside University, Borough Road, Middlesbrough, TS1 3BA
| |
Collapse
|
10
|
De León-Nava MA, Romero-Núñez E, Luna-Nophal A, Bernáldez-Sarabia J, Sánchez-Campos LN, Licea-Navarro AF, Morales-Montor J, Muñiz-Hernández S. In Vitro Effect of the Synthetic cal14.1a Conotoxin, Derived from Conus californicus, on the Human Parasite Toxoplasma gondii. Mar Drugs 2016; 14:md14040066. [PMID: 27070627 PMCID: PMC4849070 DOI: 10.3390/md14040066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 12/24/2022] Open
Abstract
Toxins that are secreted by cone snails are small peptides that are used to treat several diseases. However, their effects on parasites with human and veterinary significance are unknown. Toxoplasma gondii is an opportunistic parasite that affects approximately 30% of the world’s population and can be lethal in immunologically compromised individuals. The conventional treatment for this parasitic infection has remained the same since the 1950s, and its efficacy is limited to the acute phase of infection. These findings have necessitated the search for new drugs that specifically target T. gondii. We examined the effects of the synthetic toxin cal14.1a (s-cal14.1a) from C. californicus on the tachyzoite form of T. gondii. Our results indicate that, at micromolar concentrations, s-cal14.1a lowers viability and inhibits host cell invasion (by 50% and 61%, respectively) on exposure to extracellular parasites. Further, intracellular replication decreased significantly while viability of the host cell was unaffected. Our study is the first report on the antiparasitic activity of a synthetic toxin of C. californicus.
Collapse
Affiliation(s)
- Marco A De León-Nava
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Baja California, C.P. 22860, Mexico.
| | - Eunice Romero-Núñez
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud, San Fernando No. 22, Col. Sección XVI, Tlalpan, Ciudad de Mexico, C.P. 14080, Mexico.
| | - Angélica Luna-Nophal
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico; Ciudad de Mexico, C.P. 04510, Mexico.
| | - Johanna Bernáldez-Sarabia
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Baja California, C.P. 22860, Mexico.
| | - Liliana N Sánchez-Campos
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Baja California, C.P. 22860, Mexico.
| | - Alexei F Licea-Navarro
- Departamento de Innovación Biomédica, Centro de Investigación Científica y de Educación Superior de Ensenada (CICESE), Baja California, C.P. 22860, Mexico.
| | - Jorge Morales-Montor
- Departamento de Inmunología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de Mexico; Ciudad de Mexico, C.P. 04510, Mexico.
| | - Saé Muñiz-Hernández
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Secretaría de Salud, San Fernando No. 22, Col. Sección XVI, Tlalpan, Ciudad de Mexico, C.P. 14080, Mexico.
| |
Collapse
|
11
|
Toll L, Bruchas MR, Calo' G, Cox BM, Zaveri NT. Nociceptin/Orphanin FQ Receptor Structure, Signaling, Ligands, Functions, and Interactions with Opioid Systems. Pharmacol Rev 2016; 68:419-57. [PMID: 26956246 PMCID: PMC4813427 DOI: 10.1124/pr.114.009209] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The NOP receptor (nociceptin/orphanin FQ opioid peptide receptor) is the most recently discovered member of the opioid receptor family and, together with its endogenous ligand, N/OFQ, make up the fourth members of the opioid receptor and opioid peptide family. Because of its more recent discovery, an understanding of the cellular and behavioral actions induced by NOP receptor activation are less well developed than for the other members of the opioid receptor family. All of these factors are important because NOP receptor activation has a clear modulatory role on mu opioid receptor-mediated actions and thereby affects opioid analgesia, tolerance development, and reward. In addition to opioid modulatory actions, NOP receptor activation has important effects on motor function and other physiologic processes. This review discusses how NOP pharmacology intersects, contrasts, and interacts with the mu opioid receptor in terms of tertiary structure and mechanism of receptor activation; location of receptors in the central nervous system; mechanisms of desensitization and downregulation; cellular actions; intracellular signal transduction pathways; and behavioral actions with respect to analgesia, tolerance, dependence, and reward. This is followed by a discussion of the agonists and antagonists that have most contributed to our current knowledge. Because NOP receptors are highly expressed in brain and spinal cord and NOP receptor activation sometimes synergizes with mu receptor-mediated actions and sometimes opposes them, an understanding of NOP receptor pharmacology in the context of these interactions with the opioid receptors will be crucial to the development of novel therapeutics that engage the NOP receptor.
Collapse
Affiliation(s)
- Lawrence Toll
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida (L.T.); Departments of Anesthesiology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri (M.R.B.); Section of Pharmacology, Department of Medical Science, and National Institute of Neurosciences, University of Ferrara, Ferrara, Italy (G.C.); Professor of Pharmacology & Neuroscience, Uniformed Services University, Bethesda, Maryland (B.M.C.); and Astraea Therapeutics, LLC, Mountain View, California (N.T.Z.)
| | - Michael R Bruchas
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida (L.T.); Departments of Anesthesiology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri (M.R.B.); Section of Pharmacology, Department of Medical Science, and National Institute of Neurosciences, University of Ferrara, Ferrara, Italy (G.C.); Professor of Pharmacology & Neuroscience, Uniformed Services University, Bethesda, Maryland (B.M.C.); and Astraea Therapeutics, LLC, Mountain View, California (N.T.Z.)
| | - Girolamo Calo'
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida (L.T.); Departments of Anesthesiology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri (M.R.B.); Section of Pharmacology, Department of Medical Science, and National Institute of Neurosciences, University of Ferrara, Ferrara, Italy (G.C.); Professor of Pharmacology & Neuroscience, Uniformed Services University, Bethesda, Maryland (B.M.C.); and Astraea Therapeutics, LLC, Mountain View, California (N.T.Z.)
| | - Brian M Cox
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida (L.T.); Departments of Anesthesiology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri (M.R.B.); Section of Pharmacology, Department of Medical Science, and National Institute of Neurosciences, University of Ferrara, Ferrara, Italy (G.C.); Professor of Pharmacology & Neuroscience, Uniformed Services University, Bethesda, Maryland (B.M.C.); and Astraea Therapeutics, LLC, Mountain View, California (N.T.Z.)
| | - Nurulain T Zaveri
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida (L.T.); Departments of Anesthesiology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri (M.R.B.); Section of Pharmacology, Department of Medical Science, and National Institute of Neurosciences, University of Ferrara, Ferrara, Italy (G.C.); Professor of Pharmacology & Neuroscience, Uniformed Services University, Bethesda, Maryland (B.M.C.); and Astraea Therapeutics, LLC, Mountain View, California (N.T.Z.)
| |
Collapse
|
12
|
Bäckryd E, Sörensen J, Gerdle B. Ziconotide Trialing by Intrathecal Bolus Injections: An Open-Label Non-Randomized Clinical Trial in Postoperative/Posttraumatic Neuropathic Pain Patients Refractory to Conventional Treatment. Neuromodulation 2015; 18:404-13. [PMID: 25879804 DOI: 10.1111/ner.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this open-label, non-randomized, clinical trial was to evaluate the feasibility of trialing ziconotide by intrathecal bolus injections. MATERIAL AND METHODS Twenty-three patients, who had peripheral neuropathic pain refractory to pharmacological treatment and were under consideration for Spinal Cord Stimulation, received up to three ziconotide bolus injections according to a comprehensive algorithm. After a first injection of 2.5 μg, the patients progressed in the algorithm depending on the presence or absence of pain reduction and significant adverse events. A patient was considered a "responder" if experiencing pain reduction and no significant adverse event on two consecutive occasions at the same dosage. RESULTS We found a low proportion of responders (13%). However 30% of patients experienced ≥30% pain reduction on a least one injection, yielding a number needed to treat of ∼3 for clinically significant pain relief. Pain intensity changed significantly over time (0-6 h) (p = 0.047) after a mean ziconotide dose of 2.75 μg. Adverse events were as expected, and no serious adverse event occurred. We did not find any statistical association between response to Spinal Cord Stimulation and response to ziconotide. CONCLUSIONS Ziconotide bolus injection trialing seems feasible, but the proportion of responders in the present study was low. Adverse events were as expected, and no serious adverse event occurred. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (slow tissue penetration due to high hydrophilicity) calls the rationale for bolus trialing into question.
Collapse
Affiliation(s)
- Emmanuel Bäckryd
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, SE 581 85, Sweden.,Pain and Rehabilitation Centre, UHL, County Council of Östergötland, Linköping, SE 581 85, Sweden
| | - Jan Sörensen
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, SE 581 85, Sweden.,Pain and Rehabilitation Centre, UHL, County Council of Östergötland, Linköping, SE 581 85, Sweden
| | - Björn Gerdle
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, SE 581 85, Sweden.,Pain and Rehabilitation Centre, UHL, County Council of Östergötland, Linköping, SE 581 85, Sweden
| |
Collapse
|
13
|
|
14
|
Müller-Schwefe G, Ahlbeck K, Aldington D, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Ferri CM, Morlion B, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements. Curr Med Res Opin 2014; 30:1895-908. [PMID: 24841174 DOI: 10.1185/03007995.2014.925439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms - rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level.
Collapse
|
15
|
Akondi KB, Muttenthaler M, Dutertre S, Kaas Q, Craik DJ, Lewis RJ, Alewood PF. Discovery, synthesis, and structure-activity relationships of conotoxins. Chem Rev 2014; 114:5815-47. [PMID: 24720541 PMCID: PMC7610532 DOI: 10.1021/cr400401e] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Sébastien Dutertre
- Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD 4072, Australia
| | - Quentin Kaas
- Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD 4072, Australia
| | - David J Craik
- Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD 4072, Australia
| | - Richard J Lewis
- Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD 4072, Australia
| | - Paul F Alewood
- Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD 4072, Australia
| |
Collapse
|
16
|
Ver Donck A, Vranken JH, Puylaert M, Hayek S, Mekhail N, Van Zundert J. Intrathecal drug administration in chronic pain syndromes. Pain Pract 2013; 14:461-76. [PMID: 24118774 DOI: 10.1111/papr.12111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/29/2013] [Indexed: 01/01/2023]
Abstract
Chronic pain may recur after initial response to strong opioids in both patients with cancer and patients without cancer or therapy may be complicated by intolerable side effects. When minimally invasive interventional pain management techniques also fail to provide satisfactory pain relief, continuous intrathecal analgesic administration may be considered. Only 3 products have been officially approved for long-term intrathecal administration: morphine, baclofen, and ziconotide. The efficacy of intrathecal ziconotide for the management of patients with severe chronic refractory noncancer pain was illustrated in 3 placebo-controlled trials. A randomized study showed this treatment option to be effective over a short follow-up period for patients with pain due to cancer or AIDS. The efficacy of intrathecal opioid administration for the management of chronic noncancer pain is mainly derived from prospective and retrospective noncontrolled trials. The effect of intrathecal morphine administration in patients with pain due to cancer was compared with oral or transdermal treatment in a randomized controlled trial, which found better pain control and fewer side effects with intrathecal opioids. Other evidence is derived from cohort studies. Side effects of chronic intrathecal therapy may either be technical (catheter or pump malfunction) or biological (infection). The most troublesome complication is, however, the possibility of granuloma formation at the catheter tip that may induce neurological damage. Given limited studies, the evidence for intrathecal drug administration in patients suffering from cancer-related pain is more compelling than that of chronic noncancer pain.
Collapse
|
17
|
Calo’ G, Guerrini R. Medicinal Chemistry, Pharmacology, and Biological Actions of Peptide Ligands Selective for the Nociceptin/Orphanin FQ Receptor. ACS SYMPOSIUM SERIES 2013. [DOI: 10.1021/bk-2013-1131.ch015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Girolamo Calo’
- Department of Experimental and Clinical Medicine, Section of Pharmacology, University of Ferrara and National Institute of Neuroscience, Italy
- Department of Pharmaceutical Sciences and LTTA (Laboratorio per le Tecnologie delle Terapie Avanzate), University of Ferrara, Italy
| | - Remo Guerrini
- Department of Experimental and Clinical Medicine, Section of Pharmacology, University of Ferrara and National Institute of Neuroscience, Italy
- Department of Pharmaceutical Sciences and LTTA (Laboratorio per le Tecnologie delle Terapie Avanzate), University of Ferrara, Italy
| |
Collapse
|
18
|
Molinari S, Camarda V, Rizzi A, Marzola G, Salvadori S, Marzola E, Molinari P, McDonald J, Ko MC, Lambert DG, Calo' G, Guerrini R. [Dmt1]N/OFQ(1-13)-NH2: a potent nociceptin/orphanin FQ and opioid receptor universal agonist. Br J Pharmacol 2013; 168:151-62. [PMID: 22827708 PMCID: PMC3570011 DOI: 10.1111/j.1476-5381.2012.02115.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 06/21/2012] [Accepted: 06/28/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Intrathecally (i.t.) administered nociceptin/orphanin FQ (N/OFQ) evokes antinociceptive effects in rodents. Recent studies in monkeys demonstrated that i.t. co-application of N/OFQ and morphine elicits synergistic antinociceptive actions suggesting mixed N/OFQ peptide (NOP) and μ opioid receptor agonists as innovative spinal analgesics. Thus, novel N/OFQ related peptides were synthesized in order to identify and pharmacologically characterize a mixed NOP/ μ opioid receptor agonist. EXPERIMENTAL APPROACH The following in vitro assays were used: calcium mobilization in cells expressing the human NOP or classical opioid receptors and chimeric G proteins, receptor and [(35)S]-GTPγS binding, [(35)S]-GTPγS binding in rat spinal cord membranes, guinea pig ileum bioassay. In vivo experiments were performed in monkeys using the tail withdrawal assay. KEY RESULTS From calcium mobilization studies [Dmt(1)]N/OFQ(1-13)-NH(2) was selected as the most potent and least selective compound. The mixed NOP/opioid full agonist activity and high affinity of [Dmt(1)]N/OFQ(1-13)-NH(2) was confirmed at human recombinant receptors in receptor binding, calcium mobilization and/or [(35)S]-GTPγS binding studies, at rat spinal cord receptors in [(35)S]-GTPγS binding experiments, and at guinea pig receptors inhibiting neurogenic contractions in the ileum. In vivo in the tail withdrawal assay in monkeys i.t. [Dmt(1) ]N/OFQ(1-13)-NH(2) was able to elicit robust and long-lasting antinociceptive effects. CONCLUSIONS AND IMPLICATIONS Collectively, these results demonstrate that [Dmt(1)]N/OFQ(1-13)-NH(2) behaves as NOP/opioid receptor universal agonist and substantiate the suggestion that such mixed ligands are worthy of development as innovative spinal analgesics.
Collapse
Affiliation(s)
- S Molinari
- Department of Experimental and Clinical Medicine, Section of Pharmacology, University of Ferrara, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Shao PP, Ye F, Chakravarty PK, Varughese DJ, Herrington JB, Dai G, Bugianesi RM, Haedo RJ, Swensen AM, Warren VA, Smith MM, Garcia ML, McManus OB, Lyons KA, Li X, Green M, Jochnowitz N, McGowan E, Mistry S, Sun SY, Abbadie C, Kaczorowski GJ, Duffy JL. Aminopiperidine Sulfonamide Cav2.2 Channel Inhibitors for the Treatment of Chronic Pain. J Med Chem 2012; 55:9847-55. [DOI: 10.1021/jm301056k] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pengcheng P. Shao
- Departments of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Feng Ye
- Departments of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Prasun K. Chakravarty
- Departments of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Deepu J. Varughese
- Departments of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - James B. Herrington
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Ge Dai
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Randal M. Bugianesi
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Rodolfo J. Haedo
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Andrew M. Swensen
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Vivien A. Warren
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - McHardy M. Smith
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Maria L. Garcia
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Owen B. McManus
- Ion Channels, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Kathryn A. Lyons
- Drug Metabolism and
Pharmacokinetics, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Xiaohua Li
- Drug Metabolism and
Pharmacokinetics, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Mitchell Green
- Drug Metabolism and
Pharmacokinetics, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| | - Nina Jochnowitz
- Pharmacology, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Erin McGowan
- Pharmacology, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Shruti Mistry
- Pharmacology, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Shu-Yu Sun
- Pharmacology, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | - Catherine Abbadie
- Pharmacology, Merck Research Laboratories, Rahway, New Jersey 07065, United
States
| | | | - Joseph L. Duffy
- Departments of Medicinal Chemistry, Merck Research Laboratories, Rahway, New Jersey 07065,
United States
| |
Collapse
|
20
|
Deer TR, Levy R, Prager J, Buchser E, Burton A, Caraway D, Cousins M, De Andrés J, Diwan S, Erdek M, Grigsby E, Huntoon M, Jacobs MS, Kim P, Kumar K, Leong M, Liem L, McDowell GC, Panchal S, Rauck R, Saulino M, Sitzman BT, Staats P, Stanton-Hicks M, Stearns L, Wallace M, Willis KD, Witt W, Yaksh T, Mekhail N. Polyanalgesic Consensus Conference--2012: recommendations to reduce morbidity and mortality in intrathecal drug delivery in the treatment of chronic pain. Neuromodulation 2012; 15:467-82; discussion 482. [PMID: 22849581 DOI: 10.1111/j.1525-1403.2012.00486.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of both cancer and noncancer pain; however, it has become clear in recent years that intrathecal drug delivery is associated with risks for serious morbidity and mortality. METHODS The Polyanalgesic Consensus Conference is a meeting of experienced implanting physicians who strive to improve care in those receiving implantable devices. Employing data generated through an extensive literature search combined with clinical experience, this work group formulated recommendations regarding awareness, education, and mitigation of the morbidity and mortality associated with intrathecal therapy to establish best practices for targeted intrathecal drug delivery systems. RESULTS Best practices for improved patient care and outcomes with targeted intrathecal infusion are recommended to minimize the risk of morbidity and mortality. Areas of focus include respiratory depression, infection, granuloma, device-related complications, endocrinopathies, and human error. Specific guidance is given with each of these issues and the general use of the therapy. CONCLUSIONS Targeted intrathecal drug delivery systems are associated with risks for morbidity and mortality that can be devastating. The panel has given guidance to treating physicians and healthcare providers to reduce the incidence of these problems and to improve outcomes when problems occur.
Collapse
|
21
|
Deer TR, Prager J, Levy R, Rathmell J, Buchser E, Burton A, Caraway D, Cousins M, De Andrés J, Diwan S, Erdek M, Grigsby E, Huntoon M, Jacobs MS, Kim P, Kumar K, Leong M, Liem L, McDowell GC, Panchal S, Rauck R, Saulino M, Sitzman BT, Staats P, Stanton-Hicks M, Stearns L, Wallace M, Willis KD, Witt W, Yaksh T, Mekhail N. Polyanalgesic Consensus Conference 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 2012; 15:436-64; discussion 464-6. [PMID: 22748024 DOI: 10.1111/j.1525-1403.2012.00476.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The use of intrathecal (IT) infusion of analgesic medications to treat patients with chronic refractory pain has increased since its inception in the 1980s, and the need for clinical research in IT therapy is ongoing. The Polyanalgesic Consensus Conference (PACC) panel of experts convened in 2000, 2003, and 2007 to make recommendations on the rational use of IT analgesics based on preclinical and clinical literature and clinical experiences. METHODS The PACC panel convened again in 2011 to update the standard of care for IT therapies to reflect current knowledge gleaned from literature and clinical experience. A thorough literature search was performed, and information from this search was provided to panel members. Analysis of published literature was coupled with the clinical experience of panel members to form recommendations regarding the use of IT analgesics to treat chronic pain. RESULTS After a review of literature published from 2007 to 2011 and discussions of clinical experience, the panel created updated algorithms for the rational use of IT medications for the treatment of neuropathic pain and nociceptive pain. CONCLUSIONS The advent of new algorithmic tracks for neuropathic and nociceptive pain is an important step in improving patient care. The panel encourages continued research and development, including the development of new drugs, devices, and safety recommendations to improve the care of patients with chronic pain.
Collapse
|
22
|
Hama A, Sagen J. Combination Drug Therapy for Pain following Chronic Spinal Cord Injury. PAIN RESEARCH AND TREATMENT 2012; 2012:840486. [PMID: 22550581 PMCID: PMC3324948 DOI: 10.1155/2012/840486] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 01/06/2012] [Indexed: 12/15/2022]
Abstract
A number of mechanisms have been elucidated that maintain neuropathic pain due to spinal cord injury (SCI). While target-based therapeutics are being developed based on elucidation of these mechanisms, treatment for neuropathic SCI pain has not been entirely satisfactory due in part to the significant convergence of neurological and inflammatory processes that maintain the neuropathic pain state. Thus, a combination drug treatment strategy, wherein several pain-related mechanism are simultaneously engaged, could be more efficacious than treatment against individual mechanisms alone. Also, by engaging several targets at once, it may be possible to reduce the doses of the individual drugs, thereby minimizing the potential for adverse side effects. Positive preclinical and clinical studies have demonstrated improved efficacy of combination drug treatment over single drug treatment in neuropathic pain of peripheral origin, and perhaps such combinations could be utilized for neuropathic SCI pain. At the same time, there are mechanisms that distinguish SCI from peripheral neuropathic pain, so novel combination therapies will be needed.
Collapse
Affiliation(s)
- Aldric Hama
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 SW 14th Terrace, Miami, FL 33136, USA
| | - Jacqueline Sagen
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 SW 14th Terrace, Miami, FL 33136, USA
| |
Collapse
|
23
|
Alicino I, Giglio M, Manca F, Bruno F, Puntillo F. Intrathecal combination of ziconotide and morphine for refractory cancer pain: A rapidly acting and effective choice. Pain 2012; 153:245-249. [DOI: 10.1016/j.pain.2011.10.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 07/09/2011] [Accepted: 10/03/2011] [Indexed: 11/17/2022]
|
24
|
BÄCKRYD E, LARSSON B. Movement-evoked breakthrough cancer pain despite intrathecal analgesia: a prospective series. Acta Anaesthesiol Scand 2011; 55:1139-46. [PMID: 22092213 DOI: 10.1111/j.1399-6576.2011.02510.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intrathecal analgesia (ITA) is a valuable treatment option for intractable cancer-related pain. However, the issue of movement-evoked breakthrough pain (BTP) has not been specifically investigated in the ITA setting. The aim of the study was to evaluate the effect of ITA on spontaneous resting pain intensity (SRPI), doses of non-ITA opioids, and specifically on movement-evoked pain intensity (MEPI). METHODS We prospectively studied 28 consecutive patients who graded SRPI and MEPI on a 0-10 numerical rating scale (NRS) at the time of ITA procedure, after 1 week, and after 1 month. Mild pain was defined as NRS ≤ 3 and severe pain as NRS ≥ 7. Concomitant doses of opioids were registered. RESULTS After 1 week, no patient had severe SRPI compared with 31% before ITA, and the proportion of patients with mild SRPI had increased from 27% to 76%. Meanwhile, the median daily dose of non-ITA opioids decreased from 575 to 120 mg of oral morphine equivalents. The effect on SRPI and on doses of non-ITA opioids remained essentially unchanged during the study month, but the proportion of patients having severe MEPI did not change significantly: 44% still had severe MEPI after 1 week and 40% after 1 month. CONCLUSION Movement-evoked BTP was a major clinical problem throughout the study month despite otherwise successful ITA. Improving the quality of life of patients with intractable cancer-related pain should include developing strategies to better deal with movement-evoked BTP.
Collapse
Affiliation(s)
- E BÄCKRYD
- Pain and Rehabilitation Centre; University Hospital; Linköping; Sweden
| | | |
Collapse
|
25
|
|
26
|
[Selected interventional methods for the treatment of chronic pain : part 2: regional anesthetic techniques close to the spinal cord and neuromodulative methods]. Anaesthesist 2011; 60:571-90. [PMID: 21562897 DOI: 10.1007/s00101-011-1891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Approximately 5-8 million people in Germany suffer from chronic pain and some patients can profit from specific interventional techniques. In detail these are regional anesthetic techniques close to the spinal cord, neuromodulation, blocks of the sympathetic chain and peripheral nerve blocks. Part 2 of the article presents regional anesthetic techniques close to the spinal cord and neuromodulative methods. Regional anesthetic techniques close to the spinal cord are of high importance for the treatment of chronic low back pain although the efficiency is highly disputed due to the lack of evidence. Neuromodulation includes amongst others intrathecal pharmacotherapy and spinal cord stimulation, which are used for highly selected patients and can lead to very good results for these patients.
Collapse
|
27
|
Saez NJ, Senff S, Jensen JE, Er SY, Herzig V, Rash LD, King GF. Spider-venom peptides as therapeutics. Toxins (Basel) 2010; 2:2851-71. [PMID: 22069579 PMCID: PMC3153181 DOI: 10.3390/toxins2122851] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/17/2010] [Accepted: 12/17/2010] [Indexed: 01/01/2023] Open
Abstract
Spiders are the most successful venomous animals and the most abundant terrestrial predators. Their remarkable success is due in large part to their ingenious exploitation of silk and the evolution of pharmacologically complex venoms that ensure rapid subjugation of prey. Most spider venoms are dominated by disulfide-rich peptides that typically have high affinity and specificity for particular subtypes of ion channels and receptors. Spider venoms are conservatively predicted to contain more than 10 million bioactive peptides, making them a valuable resource for drug discovery. Here we review the structure and pharmacology of spider-venom peptides that are being used as leads for the development of therapeutics against a wide range of pathophysiological conditions including cardiovascular disorders, chronic pain, inflammation, and erectile dysfunction.
Collapse
Affiliation(s)
- Natalie J Saez
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, 4072, Australia.
| | | | | | | | | | | | | |
Collapse
|
28
|
Maier C, Gockel HH, Gruhn K, Krumova EK, Edel MA. Increased risk of suicide under intrathecal ziconotide treatment? - a warning. Pain 2010; 152:235-237. [PMID: 21041028 DOI: 10.1016/j.pain.2010.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/27/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
Despite some other known psychiatric adverse effects, ziconotide is recommended for intrathecal pain treatment with a good efficacy and safety. Although some hints in previous studies are apparent, a higher suicidality has not been accepted as a treatment risk of ziconotide treatment by the investigators in the former randomized controlled trials so far. We present two cases supporting the suspicion of ziconotide-induced suicidality. Both showed no depressive symptoms at the time of treatment initiation. One patient performed suicide under low-dose (cumulative dosage: 779μg) 4 weeks after the onset of intrathecal ziconotide treatment despite sufficient pain relief. Another female patient with a history of depression, but free of symptoms under antidepressive medication since more than 15 years, developed severe suicidal ideation 2 months after ziconotide treatment (cumulative dosage: about 2900μg) with rapid recovery after drug discontinuation. The patient, who has completed suicide, had earlier given rise to discuss a potential depressive disorder, however, this diagnosis was scrapped, but the second patient had a clear history of depression. These cases substantiate the suspicion of a causal relationship between ziconotide and suicidality even in symptom-free patients with a history of depression. Therefore, a comprehensive psychiatric evaluation is unavoidable before and during ziconotide treatment.
Collapse
Affiliation(s)
- Christoph Maier
- Department of Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany Krankenhaus Vilsbiburg, Bavaria, Germany Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Germany Department of Psychiatry, Ruhr University Bochum, Germany
| | | | | | | | | |
Collapse
|
29
|
Les douleurs neuropathiques chroniques: diagnostic, évaluation, traitement en médecine ambulatoire. Recommandation pour la pratique clinique de la Société Française d’étude et de Traitement de la Douleur. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s11724-010-0180-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
30
|
Martinez V, Attal N, Bouhassira D, Lantéri-Minet M. Les douleurs neuropathiques chroniques : diagnostic, évaluation et traitement en médecine ambulatoire. Recommandations pour la pratique clinique de la Société française d’étude et de traitement de la douleur. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.douler.2009.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|