MossRehab is one of the few centers in the region exploring the use of Prialt® (ziconotide intrathecal infusion) for severe, chronic pain. Approved by the FDA in 2004 and commercially available for clinical use since 2005, Prialt is a powerful weapon against chronic pain emanating from conditions as diverse as SCI, amputation, CRPS, AIDS and cancer. The utilization of Prialt at MossRehab is yielding intriguing results and significant relief for patients who are intolerant or refractory to other treatments.

A Major Advance in Analgesia for Chronic Pain

A synthetic version of a chemical found in the venom of the Conus Magus snail, Prialt is a non-opioid calcium channel blocker. These agents circumvent nerve signal conduction by preventing calcium from entering neurons by blocking N-type voltage-sensitive calcium channels. Appropriate solely for intrathecal therapy, Prialt is a highly selective, reversible blocker that targets these ion channels found in the spinal cord’s dorsal horn.

Prialt is a major advance in analgesia for chronic pain because, unlike intrathecal opiates that are commonly used for intractable pain, the medication is non-sedating, non-addictive, does not promote tolerance, and can be interrupted or discontinued abruptly without tapering dosages. Prialt may cause psychiatric and neurological side effects such as hallucinations and anxiety, and patients with a pretreatment history of psychiatric disorders may be at increased risk for these side effects. However, Moss clinicians have found that such effects typically are reversible through reducing the dose or halting the medication.

MossRehab Evaluates Innovative Combination Therapy

As reported in a recent case study, Dr. Michael Saulino, a MossRehab physiatrist, employed Prialt in combination with hydromorphone to treat intractable neuropathic pain in a 23-year-old female.(1) The patient had sustained a SCI that resulted in T5 ASIA A paraplegia and she reported two pain syndromes. In this report, one of the first to describe Prialt use in combination with another analgesic, as well as the first in the SCI population, Dr. Saulino stated that the patient’s two pain syndromes were probably due to different mechanisms and were modulated differently by the two medications. The patient ultimately achieved excellent control of both pain syndromes by using combination therapy with hydromorphone and Prialt. This report was presented at two international conferences and was recently published in the journal Spinal Cord.

Prialt May Improve Symptoms and Function

Further study at MossRehab has raised the possibility that Prialt may be neuroplastic as well as palliative. Dr. Michael Saulino describes a CRPS patient who presented in a wheelchair and was unable to tolerate a sock on a painful foot. Although the patient’s pain took months to lessen following initiation of Prialt therapy, progressive changes in the patient’s level of functioning were observed much sooner. Observations made in a December 2006 letter by Stanton-Hicks et al in the Journal of Pain and Symptom Management (www.sciencedirect.com/science/journal/08853924) appear to support this theory.(2)

MossRehab and Dr. Saulino are planning to explore the use of Prialt in combination with baclofen for spastic patients who have residual pain that is recalcitrant to other pain relief methods.

1. Saulino M. Successful reduction of neuropathic pain associated with spinal cord injury via a combination of intrathecal hydromorphone and ziconotide: a case report. Spinal Cord. 2007 Feb 20 Epublished.

2. Stanton-Hicks M and Kapural L. An effective treatment of severe Complex Regional Pain Syndrome type 1 in a child using high doses of intrathecal ziconotide. J Pain Symptom Manage 2006;32(6):509-511.