Presented at the 2013 AAPM Annual Meeting « Back

Intrathecal Treatment (IT) of Nociceptive and Neuropathic Pain: Morphine vs. Ziconotide

Lara Tollapi, MD, meryparoli@hotmail.it¹, Mery Paroli, PsycD¹, Franca Bondi, MD¹, Paolo Poli, MD², (1) Santa Chiara University Hospital, Pisa, Italy, (2) Pisa University, Pisa, Tuscany, Italy

Introduction: We want to evaluate the efficacy and tolerability of IT administration of morphine versus ziconotide in patients with complex pain. Materials and Methods: 61 patients with complex pain received a mono drug/pharmacological IT treatment. 38 patients were treated with morphine and 23 with ziconotide. 65% of our sample were oncologic patients. 43 patients were implanted with Medtronic Synchromed II® and 18 with Prometra Programmable pump® Results: Enrolled morphine-treated patients VAS pain score at baseline (T0) was 8,7 while ziconotide-treated was 8,9. Mean morphine dose at T0 was 0.54 mg/die and ziconotide was 0,67 mcg/die, after 1 month (T1) mean morphine dose was 2.1 mg/die and ziconotide was 2,7 mcg/die. Mean morphine dosage at 3 months (T2) was 3,8 mg/die and ziconotide was 3,6 mcg/die at six months (T3) after the implant was 5.3 mg/die and ziconotide was 4,8 mcg/die, 1 year after morphine dosage was 6.4 mg/die and ziconotide was 5.4 mcg/die. No significant differences were observed at T1 between morphine and ziconotide in analgesic effect. During the other follow-up ziconotide showed to be more effective than morphine (p<.001). Some adverse events (Aes) such as dysesthesia, burning throat, pyosis and auditory hallucinations were observed in 9 ziconotide patients. Hallucinations, vomiting and unsteadiness when walking (dizziness) were observed in 11 morphine patients. 4 patients interrupted ziconotide and 2 interrupted morphine because of Aes. 7 oncologic patient died during the study due to their own pathology. Conclusion: Despite side effects, ziconotide resulted better than morphine in pain relief.

Funding: None