Abstract
Chronic refractory pain can be difficult to manage. Intrathecal Ziconotide has proven to be effective at treating refractory nociceptive and neuropathic pain. Ziconotide’s analgesic effect is via selective blockade of N-type calcium channels. Ziconotide is trialed with a bolus of 3 mcg or 5 mcg. After intrathecal pump implant, therapy is initiated at 1.2-2.4 mcg/day. After 7-14 days the medication is exchanged and the dose kept the same. Subsequently, the dose is titrated every 7-14 days by 0.5-1.2 mcg/day.
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