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Intrathecal Pain Management – Ziconotide — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationIntrathecal Pain Management – ZiconotideSCE Neurology

A 55-year-old man with chronic MS and severe neuropathic pain has tried gabapentin, pregabalin, amitriptyline, duloxetine, tramadol, and combination therapy. He has been referred to the specialist pain service. They discuss intrathecal drug delivery. What intrathecal options exist for refractory neuropathic pain?

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Correct answer: D — Intrathecal baclofen (if spasticity-related), intrathecal clonidine, and intrathecal ziconotide (a synthetic peptide derived from cone snail venom that blocks N-type calcium channels) — these can provide significant pain relief when systemic therapies fail

For refractory neuropathic pain, intrathecal drug delivery can provide significant relief: (1) intrathecal baclofen — primarily for spasticity-related pain, (2) intrathecal clonidine — alpha-2 agonist with analgesic properties, (3) intrathecal ziconotide (Prialt) — a synthetic omega-conotoxin from the marine cone snail that selectively blocks N-type voltage-gated calcium channels on nociceptive nerve terminals in the dorsal horn, (4) intrathecal morphine/hydromorphone — for mixed nociceptive-neuropathic pain. Ziconotide is specifically effective for neuropathic pain. A: Multiple intrathecal options. C: Multiple agents available. D: Epidural steroids are for different indications. E: Chemotherapy is for neoplastic conditions.

Reference: NICE CG173; PACC Intrathecal Drug Delivery Guidelines