Therapy-resistant pain

Dr. med. Wolfgang Welke

Chief of

Special Pain Medicine

Chronic pain that is resistant to therapy is widespread and can have various causes. These include, for example, nerve pain caused by tumors or facial neuralgia. A proven method of treating therapy-resistant pain is the administration of painkillers directly to the spinal cord. In this way, pain is suppressed - both in the case of non-tumor pain and
tumor pain in palliative care. As a result, the dose of morphine and morphine derivatives can be greatly reduced.

We regularly treat patients with an implanted pain pump in our outpatient pain clinic and fill it. We carry out the implantations and revisions of the pump-catheter system ourselves.

Ziconotide therapy - an alternative to morphine?

Ziconotide therapy is often requested by patients with treatment-resistant pain. This substance is extracted from the South Pacific cone snail and is a peptide consisting of 25 amino acids. It is around 1000 times more potent than morphine, but so far only works in the cerebrospinal fluid via a pump system. Patients receive approx. 2-8 µg of the substance after careful titration.

Ziconotide is used in particular for nerve pain and tumor pain. Ziconotide is not addictive, but must be closely monitored during dosing. Mixtures with added ziconotide are also sometimes used to relieve pain. Ziconotide is titrated in low doses until relief results. This phase can last several weeks.
We have many years of experience in ziconotide therapy and were one of the first pain centers in Germany to treat patients with ziconotide after its European market launch in 2006. The substance is specifically requested by patients who have problems with morphine therapy via a pain pump.

When medication no longer helps

Of course, pain pump therapy is a back-up method that is only used when the usual medication methods have failed. The principle always applies: as little invasive as possible and if necessary - always with the aim of improving the patient's quality of life. Many patients are already helped if oral drug therapy is adapted and optimized.