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Ziconotide: A rapid detoxification protocol for the conversion from intrathecal morphine--the Raffaeli Detoxification Model.
J Opioid Manag. 2011 Jan-Feb; 7(1):21-6.JO

Abstract

OBJECTIVES

To assess the efficacy and the safety of our rapid detoxificationprotocol in preventing signs and symptoms of withdrawal and pain severity.

DESIGN

Prospective, open-label case series study.

SETTINGS

Public primary care at the Pain and Palliative Care Unit of the Infermi Hospital of Rimini, Italy.

PATIENTS

The authors studied 10 consecutive patients suffering from chronic noncancer pain who were refractory to intrathecal (IT) morphine, and hence indicated for ziconotide therapy.

INTERVENTIONS

IT pump was refilled with saline solution, and each patient received endovenous morphine, oral clonidine, ketoprofen, and lorazepam for the first 3 days, and slow-release tramadol, oral clonidine, and ketoprofen for 10 days. Ziconotide therapy was started at the end of the 2-week detoxification treatment.

MAIN OUTCOME MEASURES

The observer-rated opioid withdrawal scale (OOWS) was used for the assessment of withdrawal signs, visual analogue scale was used for pain intensity assessment, and also adverse events were recorded.

RESULTS

Withdrawal symptoms were experienced by 3 patients (30 percent). Their average OOWS decreased significantly (p < 0.05) from 4.3 +/- 2.5 to 1.7 +/- 0.6 at days 3 and 14 of protocol, respectively, with no increment of pain intensity. Withdrawal symptoms were resolved in 4 days on average without the need of adjuvant medications. One patient with high morphine dosage (20 mg/d), interestingly, did not show any withdrawal symptoms.

CONCLUSIONS

The detoxification protocol was effective in preventing withdrawal signs without increasing pain severity, allowing to rapidly convert IT morphine to ziconotide monotherapy in patients who are refractory to morphine.

Authors+Show Affiliations

Raffaeli W
Department of Palliative Care and Pain Therapy, Infermi Hospital, Rimini, Italy.
Righetti D
No affiliation info available
Sarti D
No affiliation info available
Balestri M
No affiliation info available
Ferioli I
No affiliation info available
Monterubbianesi MC
No affiliation info available
Caminiti A
No affiliation info available

MeSH

AgedAnalgesics, Non-NarcoticAnalgesics, OpioidFemaleHumansInjections, SpinalMaleMorphinePainPain MeasurementProspective StudiesSubstance Withdrawal SyndromeTreatment Outcomeomega-Conotoxins

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21434581

Citation

Raffaeli, William, et al. "Ziconotide: a Rapid Detoxification Protocol for the Conversion From Intrathecal Morphine--the Raffaeli Detoxification Model." Journal of Opioid Management, vol. 7, no. 1, 2011, pp. 21-6.
Raffaeli W, Righetti D, Sarti D, et al. Ziconotide: A rapid detoxification protocol for the conversion from intrathecal morphine--the Raffaeli Detoxification Model. J Opioid Manag. 2011;7(1):21-6.
Raffaeli, W., Righetti, D., Sarti, D., Balestri, M., Ferioli, I., Monterubbianesi, M. C., & Caminiti, A. (2011). Ziconotide: A rapid detoxification protocol for the conversion from intrathecal morphine--the Raffaeli Detoxification Model. Journal of Opioid Management, 7(1), 21-6.
Raffaeli W, et al. Ziconotide: a Rapid Detoxification Protocol for the Conversion From Intrathecal Morphine--the Raffaeli Detoxification Model. J Opioid Manag. 2011 Jan-Feb;7(1):21-6. PubMed PMID: 21434581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ziconotide: A rapid detoxification protocol for the conversion from intrathecal morphine--the Raffaeli Detoxification Model. AU - Raffaeli,William, AU - Righetti,Donatella, AU - Sarti,Donatella, AU - Balestri,Marco, AU - Ferioli,Isabella, AU - Monterubbianesi,Maria Cristina, AU - Caminiti,Alessandro, PY - 2011/3/26/entrez PY - 2011/3/26/pubmed PY - 2011/4/9/medline SP - 21 EP - 6 JF - Journal of opioid management JO - J Opioid Manag VL - 7 IS - 1 N2 - OBJECTIVES: To assess the efficacy and the safety of our rapid detoxificationprotocol in preventing signs and symptoms of withdrawal and pain severity. DESIGN: Prospective, open-label case series study. SETTINGS: Public primary care at the Pain and Palliative Care Unit of the Infermi Hospital of Rimini, Italy. PATIENTS: The authors studied 10 consecutive patients suffering from chronic noncancer pain who were refractory to intrathecal (IT) morphine, and hence indicated for ziconotide therapy. INTERVENTIONS: IT pump was refilled with saline solution, and each patient received endovenous morphine, oral clonidine, ketoprofen, and lorazepam for the first 3 days, and slow-release tramadol, oral clonidine, and ketoprofen for 10 days. Ziconotide therapy was started at the end of the 2-week detoxification treatment. MAIN OUTCOME MEASURES: The observer-rated opioid withdrawal scale (OOWS) was used for the assessment of withdrawal signs, visual analogue scale was used for pain intensity assessment, and also adverse events were recorded. RESULTS: Withdrawal symptoms were experienced by 3 patients (30 percent). Their average OOWS decreased significantly (p < 0.05) from 4.3 +/- 2.5 to 1.7 +/- 0.6 at days 3 and 14 of protocol, respectively, with no increment of pain intensity. Withdrawal symptoms were resolved in 4 days on average without the need of adjuvant medications. One patient with high morphine dosage (20 mg/d), interestingly, did not show any withdrawal symptoms. CONCLUSIONS: The detoxification protocol was effective in preventing withdrawal signs without increasing pain severity, allowing to rapidly convert IT morphine to ziconotide monotherapy in patients who are refractory to morphine. SN - 1551-7489 UR - https://www.unboundmedicine.com/medline/citation/21434581/Ziconotide:_A_rapid_detoxification_protocol_for_the_conversion_from_intrathecal_morphine__the_Raffaeli_Detoxification_Model_ L2 - https://medlineplus.gov/pain.html DB - PRIME DP - Unbound Medicine ER -