Second video in our series about pain management during the coronavirus (COVID-19) pandemic
As of 2014, pain relievers are the 2nd most commonly abused drugs in the United States with 4.3 million Americans using them for nonmedical reasons. The number of those using pain relievers for nonmedical reasons has remained relatively unchanged from 2002 to 2014, however the number of deaths from prescription drugs, namely opioids, is up 3-fold since 2001. At a time where opioids appear to be causing more problems than they solve, the medical profession is in desperate need of something new.
Enter ziconotide. This unique medication is created from a toxin naturally made by the Cone snail (a ω-conotoxin peptide). The molecule is a calcium channel blocker that works by infused into the cerebrospinal fluid to inhibit the release of glutamate, CGRP and substance P in the brain and spinal cord to provide pain relief ,; the best part is – it is not an opioid. This alone should assuage large portion of the fears many encountered when considering ways to treat severe chronic pain that has failed to respond to other treatments. What’s even more impressive is there has never been a single death reported in the world as a result of using this drug – which is much more than anyone can say about opioid pain medication or even Tylenol!
It can be trialed safely as an outpatient with bolus injections of 3mcg or 6mcg into the intrathecal space.
While it work for my pain?
Ziconotide has been shown to be effective in even the worst pain cases where everything else has failed. Patients who are intolerant to opioids or whose pain is still severe despite extremely high doses of opioids – ziconotide has been effective.
There will always be a need for opioids on some level. However, the use of opioids long-term in the treatment of nonmalignant pain is questionable at best and extremely controversial. In cases where all reasonable procedural interventions have been exhausted, consideration of continuing pharmacologic solutions is only logical – aka the end-of-the-road. Before the advent of ziconotide, the options were opioids given orally or opioids given intrathecally. Putting pen to pad and writing for an opioid seems to carry less inherent risk than managing a pump, requires less maintenance and demands considerably less expertise – as such, many simply naturally choose oral. The fact is, oral opioids carry just as much risk, if not more, when one considers the effect a single pill can have on the country as a whole in perpetuating the epidemic of prescription drug abuse nationally, i.e. drug diversion, addiction, etc.
Ziconotide presents an additional barrier before relegating a patient to a life of opioids of some form. At face value, it seems to carry less risk and is in keeping with the philosophy many pain doctors ascribe to: procedure not prescription. Perhaps ziconotide can shed some positive light on treating severe chronic pain without creating addiction.
If you are interested in learning more about this amazing medication and to see if you are a candidate for treatment with it, call our office today and schedule an initial consult with one of our pain management specialists.
 Hedden SL, et al. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. NSDUH Report. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
 National Institute on Drug Abuse (NIH). Overdose Death Rates. 2015. http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates (accessed 23 Nov 2015)
 Skov MJ, Beck JC, de Kater AW, Shopp GM (2007). “Nonclinical safety of ziconotide: an intrathecal analgesic of a new pharmaceutical class”. Int. J. Toxicol. 26 (5): 411–21.
 Milijanich GP. Ziconotide: neuronal calcium channel blocker for treating severe chronic pain.” Curr Med Chem 2004;11:3029-40.
 McGivern JG. Ziconotide: a review of its pharmacology and use in the treatment of pain. Neuropsychiatr Dis Treat 2007;3:69-85.