title: The Pharmacology of Spinal Opioids and Ziconotide for the Treatment of Non-Cancer Pain.
abstract: BACKGROUND
  Intrathecal drug delivery has undergone a revitalization following a better understanding of this delivery route and its pharmacokinetics. Driven by patient safety and outcomes, clinicians are motivated to rethink the traditional spinal infusion pump patient selection criteria and indications. We review the current understanding of the pharmacology of commonly employed intrathecal agents and the clinical relevance.
  
  
  METHODS
  Search strategies for data acquisition included Medline database, PubMed, Google scholar, along with international and national professional meeting content, with key words including pharmacology of opioids, intrathecal therapy, ziconotide, pharmacokinetics, and intrathecal drug delivery. The search results were limited to the English language.
  
  
  RESULTS
  Over 300 papers were identified. The literature was condensed and digested to evaluate the most commonly used medications in practice, sto serve as a foundation for review. We review on-label medications: ziconotide and morphine, and off label medications including fentanyl, sufentail, and hydromorphine.
  
  
  CONCLUSIONS
  Intrathecal therapy has level-one evidence for use for malignant pain and nonmalignant pain, with continued cost savings and improved safety. To most effectively serve our patients, a clear appreciation for the pharmacology of these commonly employed medication is paramount.
authors: Center for Pain Relief, Charleston, WV, USA. United States.
authors: J E
authors: JE
authors: Pope
authors: T R
authors: TR
authors: Deer
authors: K
authors: K
authors: Amirdelfan
authors: W P
authors: WP
authors: McRoberts
authors: N
authors: N
authors: Azeem
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000378:metabolism*; D000818:Animals; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D013116:Spinal Cord / Q000378:metabolism*; D020960:omega-Conotoxins / Q000627:therapeutic use*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D020960:omega-Conotoxins; C078452:ziconotide