Intrathecal Ziconotide in Chemotherapy Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy is a painful condition that significantly impacts quality of life following a patient's cancer treatment. This condition is often irreversible and fails to respond well to commonly utilized medications (most frequently Gabapentin, Lyrica, and Cymbalta) (Piccolo & Kolesar, 2014). While spinal cord stimulation is approved for the treatment of painful diabetic neuropathy, it is not approved for the treatment of chemotherapy-induced neuropathy. This often leaves a void in treatment options for those not responding to topical treatments or oral medications. Data from prior clinical studies have shown targeted drug delivery (TDD), using an implanted Medtronic Synchromed Intrathecal Pain Pump, has successfully treated patients with chemotherapy-induced peripheral neuropathy using opioids such as morphine (Potocnik et al., 2025). However, no study as of yet has focused on the potential role ziconotide, a non-opioid treatment given intrathecally, may play in the pain management of these patients.

Inclusion criteria

• Adult patients, ages 18-100, with chemotherapy-induced peripheral neuropathy as a primary source of pain
• The patient is already scheduled to be treated with TDD using ziconotide (no reported allergies to ziconotide or drug-drug interactions expected)
• Patient will have, or is scheduled to have, Medtronic Synchromed Intrathecal Pump implanted by Dr. Beuer (outside of the research)
• Patients already taking nonopioid analgesics will be allowed to continue their prescribed medication regimen.
• Patients currently taking opioid analgesics must undergo a washout period of 2 weeks (prior to device implant) before participating in this study. Those unable to adhere to this washout period will be excluded

Exclusion criteria

• Patients with other forms of neuropathy (diabetic, idiopathic) will be excluded
• Patients with a spinal cord stimulator will be excluded
• Patients with contraindications to intrathecal ziconotide will be excluded
• Patients who cannot sign the consent, participate in research activities, or those who require a legally authorized representative (LAR) will be excluded
• Patients who are pregnant and/or nursing or planning to become pregnant are excluded
• Also excluded are those inaccessible for follow-up, participation is excluded by local law, or a patient is currently enrolled or plans to enroll in a concurrent drug/device study