Neuromodulation zur Schmerztherapie – was ist sinnvoll?

Abstract

Neuromodulatory techniques have replaced the earlier performed neurolesional procedures to treat chronic pain syndromes with only a few exceptions. Nevertheless these procedures are invasive with respective risks and complications and therefore conservative physical, psychological pharmacological as well as interventional treatments should be performed first. Because this therapy is costly, the indication has to be proven carefully with a strict patient selection and also the long-term results have to be considered. The following paper will give an overview over the recent neuromodulatory techniques, their indications and and published results.

In der Schmerztherapie haben Neuromodulationsverfahren die früher durchgeführten läsionellen Methoden bis auf wenige Ausnahmen abgelöst. Dennoch handelt es sich bei diesen Verfahren um invasive Techniken mit therapiespezifischen Risiken und Komplikationen, sodass vor dem Einsatz von Neuromodulationsverfahren weniger invasive physikalische, psychologische, medikamentöse und interventionelle Techniken zum Einsatz gekommen sein müssen. Da es sich zudem um eine kostenintensive Therapie handelt, muss die Indikation genau geprüft werden, die Patientenselektion strikt sein und letztlich auch die Effektivität der Therapie im Langzeitverlauf gesichert sein. Der vorliegende Beitrag gibt einen Überblick über die aktuellen Neuromodulationsverfahren, ihre Indikationen und die publizierten Ergebnisse.

Schlüsselworter

chronischer Schmerz - periphere Nervenstimulation - epidurale Rückenmarkstimulation - subkutane periphere Feldstimulation - DRG-Stimulation - intrathekale Medikamentengabe

Key words

chronic pain - peripheral nerve stimulation - spinal cord stimulation - subcutaneous peripheral field stimulation - DRG stimulation - intrathecal drug delivery

• Literatur

• 1 Melzack R. Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-979
• 2 Sommer C. Birklein F. Das komplexe regionale Schmerzsyndrom. Neurochirurgie Scan 2015; 1: 47-61
• 3 Hassenbusch SJ. Stanton-Hicks M. Schoppa M. et al. Long-term results of peripheral nerve stimulation for reflex sympathetic dystrophy. J Neurosurg 1996; 84: 415-423
• 4 Buschmann D. Oppel F. Periphere Nervenstimulation. Schmerz 1999; 13: 113-120
• 5 Eisenberg E. Waisbrod H. Gerbershagen HU. Long-term peripheral nerve stimulation for painful nerve injuries. Clin J Pain 2004; 20: 143-146
• 6 Van Calenbergh F. Gybels J. Van Laere K. et al. Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain. Surg Neurol 2009; 72: 330-335
• 7 Weiner RL. Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation 1999; 2: 217-221
• 8 May A. Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005; 366: 843-855
• 9 Saper JR. Dodick DW. Silberstein SD. et al. Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia 2011; 31: 271-285
• 10 Silberstein SD. Dodick DW. Saper J. et al. Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, doubleblinded, controlled study. Cephalalgia 2012; 32: 1165-1179
• 11 Verrills P. Rose R. Mitchell B. et al. Peripheral nerve field stimulation for chronic headache: 60 cases and long-term follow-up. Neuromodulation 2013; 17: 54-59
• 12 Magis D. Allena M. Bolla M. et al. Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 2007; 6: 314-321
• 13 Magis D. Schoenen J. Advances and challenges in neurostimulation for headaches. Lancet Neurol 2012; 11: 708-719
• 14 Burns B. Watkins L. Goadsby PJ. Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology 2009; 72: 341-345
• 15 Fontaine D. Christophe Sol J. Raoul S. et al. Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation. Cephalalgia 2011; 31: 1101-1105
• 16 Burns B. Watkins L. Goadsby PJ. Treatment of hemicrania continua by occipital nerve stimulation with a bion device: long-term follow-up of a crossover study. Lancet Neurol 2008; 7: 1001-1012
• 17 Lambru G. Shanahan P. Watkins L. et al. Occipital nerve stimulation in the treatment of medically intractable SUNCT and SUNA. Pain Physician 2014; 17: 29-41
• 18 Jürgens T. Paulus W. Tronnier V. et al. Einsatz neuromodulierender Verfahren bei primären Kopfschmerzen. Therapieempfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft. Nervenheilkunde 2011; 1–2: 47-58
• 19 Marteletti P. Jensen RH. Antal A. et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain 2013; 14: 86
• 20 Brewer AC. Trentman TL. Ivancic MG. et al. Long-term outcome in occipital nerve stimulation patients with medically intractable primary headache disorders. Neuromodulation 2013; 16: 557-564
• 21 Sharan A. Huh B. Narouze S. et al. Analysis of adverse events in the management of chronic migraine by peripheral nerve stimulation. Neuromodulation 2015; 18: 305-312
• 22 Ansarinia M. Rezai A. Tepper SJ. et al. Electrical stimulation of sphenopalatine ganglion for acute treatment of cluster headaches. Headache 2010; 50: 1164-1174
• 23 Tepper SJ. Rezai A. Narouze S. et al. Acute treatment of intractable migraine with sphenopalatine ganglion electrical stimulation. Headache 2009; 49: 983-989
• 24 Schoenen J. Jensen RH. Lantéri-Minet M. et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 2013; 33: 816-830
• 25 Lenaerts ME. Oommen KJ. Couch JR. et al. Can vagus nerve stimulation help migraine?. Cephalalgia 2008; 28: 392-395
• 26 Mauskop A. Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia 2005; 25: 82-86
• 27 Cairns KD. McRoberts WP. Deer T. Peripheral nerve stimulation for the treatment of truncal pain. Prog Neurol Surg 2011; 24: 58-69
• 28 Paicius RM. Bernstein CA. Lempert-Cohen C. Peripheral nerve field stimulation in chronic abdominal pain. Pain Physician 2006; 9: 261-266
• 29 Matsuo H. Uchida K. Nakajima H. et al. Early transcutaneous electrical nerve stimulation reduces hyperalgesia and decreases activation of spinal glial cells in mice with neuropathic pain. Pain 2014; 155: 1888-1901
• 30 Hamm-Faber TE. Aukes H. van Gorp EJ. et al. Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Low Back Pain and Leg Pain in Failed Back Surgery Syndrome: Four-Year Follow-Up. Neuromodulation 06.05.2015; [Epub ahead of print]
• 31 Reverberi C. Dario A. Barolat G. Spinal cord stimulation (SCS) in conjunction with peripheral nerve field stimulation (PNfS) for the treatment of complex pain in failed back surgery syndrome (FBSS). Neuromodulation 2013; 16: 78-82
• 32 Kloimstein H. Likar R. Kern M. et al. Peripheral nerve field stimulation (PNFS) in chronic low back pain: a prospective multicenter study. Neuromodulation 2014; 17: 180-187
• 33 McRoberts WP. Wolkowitz R. Meyer DJ. et al. Peripheral nerve field stimulation for the management of localized chronic intractable back pain: results from a randomized controlled study. Neuromodulation 2013; 16: 565-574
• 34 Shealy CN. Mortimer JT. Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967; 46: 489-491
• 35 Hosobuchi Y. Adams JE. Weinstein PR. Preliminary percutaneous dorsal column stimulation prior to permanent implantation. Technical note. J Neurosurg 1972; 37: 242-245
• 36 North RB. Fischell TA. Long DM. Chronic stimulation via percutaneously inserted epidural electrodes. Neurosurgery 1977; 1: 215-218
• 37 Urban BJ. Nashold BS. Percutaneous epidural stimulation of the spinal cord for relief of pain. J Neurosurg 1978; 48: 323-328
• 38 Shatin D. Mullett K. Hults G. Totally implantable spinal cord stimulation for chronic pain: design and efficacy. Pacing Clin Electrophysiol 1986; 9: 577-583
• 39 North RB. Kidd DH. Olin JC. et al. Spinal cord stimulation electrode design: prospective, randomized, controlled trial comparing percutaneous and laminectomy electrodes – part I: technical outcomes. Neurosurgery 2002; 51: 381-390
• 40 Richter E. Abramova M. Alò K. Low back paresthesia coverage with lateral programming of five-column paddle leads: technical report. J Neurosurg Rev 2011; 1 (Suppl. 01) 64-68
• 41 Holsheimer J. Wesselink WA. Effect of anode-cathode configuration on paresthesia coverage in spinal cord stimulation. Neurosurgery 1997; 41: 654-660
• 42 Lam CK. Rosenow JM. Patient perspectives on the efficacy and ergonomics of rechargeable spinal cord stimulators. Neuromodulation 2010; 13: 218-223
• 43 Coffey RJ. Kalin R. Olsen JM. Magnetic resonance imaging conditionally safe neurostimulation leads: investigation of the maximum safe lead tip temperature. Neurosurgery 2014; 74: 215-224
• 44 De Andres J. Valia JC. Cerda-Olmedo G. et al. Magnetic resonance imaging in patients with spinal neurostimulation systems. Anesthesiology 2007; 106: 779-786
• 45 Tronnier VM. Staubert A. Hähnel S. et al. Magnetic resonance imaging with implanted neurostimulators: an in-vitro and in-vivo study. Neurosurgery 1999; 44: 118-125
• 46 Sparkes E. Raphael JH. Duarte RV. et al. A systematic literature review of psychological characteristics as determinants of outcome for spinal cord stimulation therapy. Pain 2010; 150: 284-289
• 47 Turner JA. Hollingworth W. Comstock BA. et al. Spinal cord stimulation for failed back surgery syndrome: outcomes in a workers’ compensation setting. Pain 2010; 148: 14-25
• 48 Campbell JN. Raja SN. Meyer RA. et al. Myelinated afferents signal the hyperalgesia associated with nerve injury. Pain 1988; 32: 89-94
• 49 Woolf CJ. Doubell TP. The pathophysiology of chronic pain – increased sensitivity to low threshold Aβ-fiber inputs. Curr Opin Neurobiol 1994; 14: 525-534
• 50 Meyerson BA. Ren B. Herregodts P. et al. Spinal cord stimulation in animal models of mononeuropathy: Effects on the withdrawal response and the flexor reflex. Pain 1995; 61: 229-243
• 51 Yakhnitsa V. Linderoth B. Meyerson BA. Spinal cord stimulation attenuates dorsal horn neuronal hyperexcitability in a rat model of mononeuropathy. Pain 1999; 79: 223-233
• 52 Linderoth B. Foreman RD. Physiology of spinal cord stimulation: Review and update. Neuromodulation 1999; 2: 150-164
• 53 Linderoth B. Gazelius B. Franck J. et al. Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn. Neurosurgery 1992; 31: 289-297
• 54 Meyerson BA. Brodin E. Linderoth B. Possible neurohumoral mechanisms in CNS stimulation for pain suppression. Appl Neurophysiol 1985; 48: 175-180
• 55 Linderoth B. Stiller CO. Gunasekera L. et al. Gamma-aminobutyric acid is released in the dorsal horn by electrical spinal cord stimulation: an in vivo microdialysis study in the rat. Neurosurgery 1994; 34: 484-489
• 56 Stiller CO. Cui J-G. O’Connor WT. et al. Release of GABA in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery 1996; 39: 367-375
• 57 Simpson RD. Robertson CS. Goodman JC. Glycine: a potential mediator of electrically induced pain modification. Biomed Lett 1993; 48: 193-207
• 58 Kanqrqa I. Jiang MC. Randic M. Actions of (−)-baclofen on rat dorsal horn neurons. Brain Res 1991; 562: 265-275
• 59 Cui JG. Sollevi A. Linderoth B. et al. Effect of low-adenosine receptor activation suppresses tactile hypersensitivity and potentiates effect of spinal cord in mononeuropathic rats. Neurosci Lett 1997; 223: 173-176
• 60 Barchini J. Tchachagian S. Shamaa F. et al. Spinal segmental and supraspinal mechanisms underlying the pain-relieving effects of spinal cord stimulation: an experimental study in a rat model of neuropathy. Neuroscience 2012; 215: 196-208
• 61 Rasche D. Siebert S. Stippich C. et al. Epidurale Rückenmarkstimulation bei Postnukleotomiesyndrom. Pilotstudie zur Therapieevaluation mit der funktionellen Magnetresonanztomografie (f-MRT). Schmerz 2005; 19: 497-505
• 62 Kemler MA. de Vet HC. Barendse GA. et al. Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial. J Neurosurg 2008; 108: 292-298
• 63 Kumar K. Taylor RS. Jacques L. et al. The effects of spinal cord stimulation in neuropathic pain are sustained: a 24-month follow-up of the prospective randomized controlled multicenter trial of the effectiveness of spinal cord stimulation. Neurosurgery 2008; 63: 762-770
• 64 North RB. Kidd DH. Farrokhi F. et al. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery 2005; 56: 98-106
• 65 North RB. Kumar K. Wallace MS. et al. Spinal cord stimulation versus re-operation in patients with failed back surgery syndrome: an international multicenter randomized controlled trial (EVIDENCE study). Neuromodulation 2011; 14: 330-335
• 66 Slangen R. Schaper NC. Faber CG. et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial. Diabetes Care 2014; 37: 3016-3024
• 67 de Vos CC. Meier K. Zaalberg PB. et al. Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial. Pain 2014; 155: 2426-2431
• 68 NICE technology appraisal guidance 159. Spinal cord stimulation for chronic pain of neuropathic and ischaemic origin. 2011 http://www.nice.org.uk/TA159
• 69 Tronnier V. Baron R. Birklein F. et al. Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen. Schmerz 2011; 25: 484-492
• 70 Kumar K. Caraway DL. Rizvi S. et al. Current challenges in spinal cord stimulation. Neuromodulation 2014; 17 (Suppl. 01) 22-35
• 71 Kapural L. Cywinski JB. Sparks DA. Spinal cord stimulation for visceral pain from chronic pancreatitis. Neuromodulation 2011; 14: 423-426
• 72 Lanza GA. Barone L. Di Monaco A. Effect of spinal cord stimulation in patients with refractory angina: evidence from observational studies. Neuromodulation 2012; 15: 542-549
• 73 Ubbink DT. Vermeulen H. Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia. Cochrane Database Syst Rev 28.02.2013; 2: CD004001
• 74 Mailis A. Taenzer P. Evidence-based guidelines for neuropathic pain interventional treatments: spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks. Pain Res Manage 2012; 17: 150-158
• 75 Airaksinen O. Hildebrandt J. Mannion AF. et al. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006; 15 (Suppl. 02) 192-300
• 76 Manchikanti L. Boswell MV. Sing V. et al. Comprehensive evidence-based guidelines for interventional techniques for the management of chronic spinal pain. Pain Physician 2009; 12: 699-802
• 77 Hegmann KT. Low back disorders. Hegmann KT. ed. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2011: 333-796
• 78 Chou R. Loeser JD. Owens DK. et al. Interventional therapies, surgeries, and interdisciplinary rehabilitation for low back pain. Spine 2009; 34: 1066-1077
• 79 Montalescot G. Sechtem U. Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary disease. Eur Heart J 2013; 34: 2949-3003
• 80 Schu S. Slotty PJ. Bara G. et al. A prospective, randomized, double blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome. Neuromodulation 2014; 14: 443-450
• 81 De Ridder D. Plazier M. Kamerling N. et al. Burst spinal cord stimulation for limb and back pain. World Neurosurg 2013; 80: 642-649
• 82 De Ridder D. Lenders MW. De Vos CC. et al. A 2-center comparative study on tonic versus burst spinal cord stimulation: amount of responders and amount of pain suppression. Clin J Pain 2015; 31: 433-437
• 83 Tiede J. Brown L. Gekht G. et al. Novel spinal cord stimulation parameters in patients with predominant back pain. Neuromodulation 2013; 16: 370-375
• 84 Kapural L. Yu C. Doust MW. et al. Novel 10-kHz high-frequency therapy (HF10 Therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain. The SENZA-RCT randomized controlled trial. Anesthesiology 2015; 123: 851-860
• 85 Van Buyten JP. Al Kaisy A. Smet I. et al. High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation 2013; 16: 59-66
• 86 Krames ES. The role of the dorsal root ganglion in the development of neuropathic pain. Pain Med 2014; 15: 1669-1685
• 87 Liem L. Russo M. Huygen FJ. et al. A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain. Neuromodulation 2013; 16: 471-482
• 88 Liem L. Russo M. Huygen FJ. et al. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation 2015; 18: 41-49
• 89 Huygen FJPM. Baranidharan G. Simpson K. et al. An upper limb neuropathic pain cohort treated with stimulation of dorsal root ganglia (DRG): pooled data from four prospective European studies. Abstract. Las Vegas: 18th Annual Meeting of the North American Neuromodulation Society, December 11–14, 2014
• 90 Schu S. Gulve A. Eldabe S. et al. Spinal cord stimulation of the dorsal root ganglion for groin pain – a retrospective review. Pain Pract 2015; 15: 293-299
• 91 Tsubokawa T. Katayama Y. Yamamoto T. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl Wien 1991; 52: 137-139
• 92 Monsalve GA. Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature. Surg Neurol Int 2012; 3 (Suppl. 04) 290-311
• 93 Nguyen JP. Nizard K. Keravel Y. et al. Invasive brain stimulation for the treatment of neuropathic pain. Nat. Rev. Neurol 2011; 7: 699-709
• 94 García-Larrea L. Peyron R. Mertens P. et al. Electrical stimulation of motor cortex for pain control: a combined PET-scan and electrophysiological study. Pain 1999; 83: 259-273
• 95 Peyron R. Laurent B. García-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis. Neurophysiol Clin 2000; 30: 263-288
• 96 Rasche D. Ruppolt M. Stippich C. et al. Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience. Pain 2006; 121: 43-52
• 97 Velasco F. Carrillo-Ruiz JD. Castro G. et al. Motor cortex electrical stimulation applied to patients with complex regional pain syndrome. Pain 2009; 147: 91-98
• 98 Fontaine D. Hamani C. Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg 2009; 110: 251-256
• 99 Boccard SG. Pereira EA. Moir L. et al. Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery 2013; 72: 221-230
• 100 Boccard SG. Fitzgerald JJ. Pereira EA. et al. Targeting the affective component of chronic pain: a case series of deep brain stimulation of the anterior cingulate cortex. Neurosurgery 2014; 74: 628-635
• 101 Rasche D. Rinaldi PC. Young RF. et al. Deep brain stimulation for the treatment of various chronic pain syndromes. Neurosurg Focus 2006; 21: E8
• 102 Keifer Jr OP. Riley JP. Boulis NM. Deep brain stimulation for chronic pain: intracranial targets, clinical outcomes, and trial design considerations. Neurosurg Clin N Am 2014; 25: 671-692
• 103 Bazin C. Poirier AL. Dupoiron D. Influence of pH and temperature on ziconotide stability in intrathecal analgesic admixtures in implantable pumps and syringes. Int J Pharm 2015; 487: 285-291
• 104 Dupoiron D. Richard H. Chabert-Desnot V. et al. In vitro stability of low-concentration ziconotide alone or in admixtures in intrathecal pumps. Neuromodulation 2014; 17: 472-482
• 105 Shields D. Montenegro R. Ragusa M. Chemical stability of admixtures combining ziconotide with Morphine or Hydromorphone during simulated intrathecal administration. Neuromodulation 2005; 8: 257-263
• 106 Shields D. Montenegro R. Aclan J. Chemical stability of an admixture combining ziconotide and bupivacaine during simulated intrathecal administration. Neuromodulation 2007; 10 (Suppl. 01) 1-5
• 107 Shields D. Montenegro R. Chemical stability of ziconotide-clonidine hydrochloride admixtures with and without morphine sulfate during simulated intrathecal administration. Neuromodulation 2007; 10 (Suppl. 01) 6-11
• 108 Shields D. Montenegro R. Aclan J. Chemical stability of admixtures combining ziconotide with baclofen during simulated intrathecal administration. Neuromodulation 2007; 10 (Suppl. 01) 12-17
• 109 Smith TJ. Staats PS. Deer T. et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: Impact on pain, drug-related toxicity and survival. J Clin Oncol 2002; 20: 4040-4049
• 110 Staats PS. Yearwood T. Charapata SG. et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS. JAMA 2004; 291: 63-70
• 111 Alicino I. Giglio M. Manca F. et al. Intrathecal combination of ziconotide and morphine for refractory cancer pain: a rapidly acting and effective choice. Pain 2012; 153: 245-249
• 112 Ballantyne JC. Carwood CM. Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev 25.01.2005; CD005178
• 113 Rauck RL. Wallace MS. Leong MS. et al. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manage 2006; 31: 393-406
• 114 Wallace MS. Charapata SG. Fisher R. et al. Intrathecal ziconotide in the treatment of chronic nonmalignant pain: a randomized, double-blind, placebo-controlled clinical trial. Neuromodulation 2006; 9: 75-86
• 115 Hassenbusch SJ. Stanton-Hicks M. Covington E. et al. Long-term intraspinal infusions of opioids in the treatment of neuropathic pain. J Pain Symptom Manage 1995; 10: 527-543
• 116 Krames ES. Lanning RM. Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine. J Pain Symptom Manage 1993; 8: 539-548
• 117 Winkelmüller M. Winkelmüller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg 1996; 85: 458-467
• 118 Deer T. Prager J. Levy R. et al. Polyanalgesic Consensus Conference 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 2012; 15: 436-466
• 119 Tronnier V. Hofacker W. Ilias W. et al. Empfehlungen zum klinischen Einsatz von Ziconotid zur intrathekalen Therapie chronischer Schmerzen. MMW Fortschr Med 2010; 152 (Suppl. 03) 106-109
• 120 Mohammed SI. Eldabe S. Simpson KH. et al. Bolus intrathecal injection of ziconotide (Prialt®) to evaluate the option of continuous administration via an implanted intrathecal drug delivery (ITDD) system: a pilot study. Neuromodulation 2013; 16: 576-581
• 121 Webster LR. Fakata KL. Charapata S. et al. Open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of morphine in patients receiving ziconotide for severe chronic pain. Pain Med 2008; 9: 282-290
• 122 Obafemi A. Roth B. Prolonged delirium with psychotic features from omega conotoxin toxicity. Pain Med 2013; 14: 447-448
• 123 Wallace MS. Rauck RL. Deer T. Ziconotide combination intrathecal therapy: rationale and evidence. Clin J Pain 2010; 26: 635-644
• 124 Deer TR. Levy R. Prager J. et al. Polyanalgesic Consensus Conference 2012: recommendations to reduce morbidity and mortality in intrathecal drug delivery in the treatment of chronic pain. Neuromodulation 2012; 15: 467-482
• 125 Webster LR. The relationship between the mechanism of action and safety profiles of intrathecal morphine and ziconotide: A review of the literature. Pain Med 2015; 16: 1265-1277