Mitchell Alisia A, Sapienza-Crawford Anne J, Hanley Kari L, Lokey Kristi J, Wells Linda, McDowell Gladstone C, Stanton-Hicks Michael
Integrated Pain Solutions, Westerville, OH 43081, USA.
Pain Manag Nurs. 2013 Sep;14(3):e84-94. doi: 10.1016/j.pmn.2011.05.004. Epub 2011 Nov 29.
Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.
一些对全身性镇痛药不耐受或治疗无效的慢性疼痛患者可能从鞘内治疗中获益。齐考诺肽是美国食品药品监督管理局批准的首个用于鞘内给药的非阿片类镇痛药。多项随机、双盲、安慰剂对照临床试验已证明齐考诺肽的有效性和安全性。然而，处方信息中提供的最大推荐剂量和滴定方案对一些患者来说可能过于激进，并且经验表明，以较慢的速度滴定至较低的最大剂量时，齐考诺肽的耐受性更好。疗效可通过评估疼痛、功能和生活质量的变化来评估。认知不良事件可能很细微；因此，医疗保健专业人员不仅要监测患者是否有认知不良事件的体征和症状，还要教导家庭成员如何进行同样的监测，这一点很重要。仔细的患者评估和监测有助于优化齐考诺肽治疗的潜在益处。
