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The Appropriate PRIALT Patient

Is PRIALT right for your patient?

Oral and systemic analgesics may help to control your patient’s pain initially, but over time patients may become refractory or intolerant, limiting their ability to continue with these treatments.1 In some patients, targeted delivery of intrathecal (IT) narcotics may initially decrease the overall dose of analgesics required for pain relief, but the phenomenon of tolerance may occur.2,3

PRIALT is an N-type calcium antagonist indicated for the management of severe chronic pain in adult patients for whom IT therapy is warranted, and who are intolerant or refractory to other treatments.4

PRIALT is a PACC-preferred monotherapy option5

The 2016 Polyanalgesic Consensus Conference (PACC) Guidelines recommend PRIALT as a first-line option for the treatment of both nociceptive and neuropathic pain.2 PRIALT has been recognized, alongside morphine, as having the highest level of clinical evidence to support its use as a first-in-pump IT monotherapy option—Level 1, Grade A.5

Patient Identification

Determine if your patient is a candidate for an IT pump1,4

  • Confirm a diagnosis of severe chronic pain.
  • Determine whether they are refractory – have reasonable trials of conservative therapies (oral or systemic) failed?

Establish the patient’s IT needs1

  • Establish realistic expectations so the patient understands that IT analgesia will not “cure” their pain, though it may be able to reduce it.
  • Evaluate the patient’s psychological state to identify if there are any issues that may interfere with IT therapy.
  • Evaluate the patient’s caregiver support during IT therapy.
  • Determine the patient’s willingness and commitment to undergo IT therapy.

Identify your patient’s pain type

  • Neuropathic
  • Nociceptive
  • Mixed
  • Cancer
  • Non-cancer

Review your patient’s previous treatments1

  • Review previous treatments and how he or she responded to them.
  • Determine if patient is a candidate for IT therapy.

Review your patient’s current treatments1

  • If the patient has an existing pump, evaluate the patient’s response to current IT therapy.

REFERENCES:

  1. Saulino M, Kim PS, Shaw E, et al. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain. J Pain Res. 2014; 7: 628-631.
  2. Pope JE, Deer TR, Bruel BM, et al. Clinical uses of intrathecal therapy and its placement in the pain care algorithm. Pain Pract. 2016; 8: 2-3.
  3. Bolash R, Mekhail N. Intrathecal pain pumps indications, patient selection, techniques, and outcomes. Neurosurg Clin N Am. 2014; 25: 735-736.
  4. PRIALT® (ziconotide) solution, intrathecal infusion [package insert]. Palo Alto, CA; Jazz Pharmaceuticals.
  5. Deer TR, Pope JE, Hayek S, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation. 2017; 2: 5-16