ReviewPain medicine (Malden, Mass.)2019
Intrathecal Therapy for Chronic Pain: A Review of Morphine and Ziconotide as Firstline Options.
Review in Pain medicine (Malden, Mass.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
61 citing papers in PubMed.
- Seizure after IDDS implantation - unrecognized intracranial hypertension associated with intracranial metastases: A case report.Medicine · 2026Article
- Advancing Personalized Intrathecal Therapy: A Quasi-Experimental Study for the Evaluation of Patient Satisfaction and Pain in Ultrasound-Guided Versus Template-Guided Refill Techniques.Journal of personalized medicine · 2026Article
- Intrathecal Ziconotide Long-Term Management in Chronic Postamputation Pain.Case reports in anesthesiology · 2026Article
- Inhibition of Chikungunya virus nsP2 protease in vitro by scorpion venom peptide pantinin-1.PloS one · 2026Article
- Morphine Tolerance Gated through EZH2-Mediated Suppression of Trpc5 in Spinal GABAergic Interneurons in Male Mice.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Intrathecal Drug Delivery Systems for Chronic Pain Management: A Narrative Review of Pharmacologic Agents, Clinical Applications, and Considerations.Pharmacy (Basel, Switzerland) · 2025Review
- Ultrasound-Guided Localization of the Refill Port for Intrathecal Infusion Pump Recharge: A Systematic Review.Journal of clinical medicine · 2025Review
- The Missing Link: Integrating Interventional Pain Management in the Era of Multimodal Oncology.Pain and therapy · 2025Review
- Hyperpolarization Modulation of the T-Type hCaAngewandte Chemie (International ed. in English) · 2025Article
- Therapeutic Peptides: Recent Advances in Discovery, Synthesis, and Clinical Translation.International journal of molecular sciences · 2025Review
- Activation of G protein gated inwardly rectifying potassium (GIRK) channels in keratinocytes mediates peripheral kappa opioid receptor-mediated antinociception.Neuropharmacology · 2025Article
- Molecular Insights into the Marine GastropodInternational journal of molecular sciences · 2025Article
- Structural information in therapeutic peptides: Emerging applications in biomedicine.FEBS open bio · 2025Review
- Article
- Article
- Can Ziconotide Be Used to Replace Opioids? Exploratory Clinical Experience in 5 Patients Treated in the Pain Unit.Journal of pain research · 2025Article
- A comprehensive review on ziconotide.Heliyon · 2024Review
- Review
- A Benefit/Risk Assessment of Intrathecal Ziconotide in Chronic Pain: A Narrative Review.Journal of clinical medicine · 2024Review
- Targeted Drug Delivery for the Treatment of Abdominal Pain in Chronic Pancreatitis: A Retrospective Case Series.Cureus · 2024Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the evidence for morphine and ziconotide as firstline intrathecal (IT) analgesia agents for patients with chronic pain.
methodsMedline was searched (through July 2017) for "ziconotide" or "morphine" AND "intrathecal" AND "chronic pain," with results limited to studies in human populations.
resultsThe literature supports the use of morphine (based primarily on noncontrolled, prospective, and retrospective studies) and ziconotide (based on randomized controlled trials and prospective observational studies) as first-choice IT therapies. The 2016 Polyanalgesic Consensus Conference (PACC) guidelines recommended both morphine and ziconotide as firstline IT monotherapy for localized and diffuse chronic pain of cancer-related and non-cancer-related etiologies; however, one consensus point emphasized ziconotide use, unless contraindicated, as firstline IT therapy in patients with chronic non-cancer-related pain. Initial IT therapy choice should take into consideration individual patient characteristics (e.g., pain location, response to previous therapies, comorbid medical conditions, psychiatric history). Trialing is recommended to assess medication efficacy and tolerability. For both morphine and ziconotide, the PACC guidelines recommend conservative initial dosing strategies. Due to its narrow therapeutic window, ziconotide requires careful dose titration. Ziconotide is contraindicated in patients with a history of psychosis. IT morphine administration may be associated with serious side effects (e.g., respiratory depression, catheter tip granuloma), require dose increases, and cause dependence over time.
conclusionBased on the available evidence, morphine and ziconotide are recommended as firstline IT monotherapy for cancer-related and non-cancer-related pain. The choice of first-in-pump therapy should take into consideration patient characteristics and the advantages and disadvantages of each medication.
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