Cone Snail Venom Effective Remedy For Pain
By Dr. Richard Gayles // June 21, 2013
PAIN MANAGEMENT
ARTICLE COURTESY OF SPACE COAST MEDICINE & ACTIVE LIVING MAGAZINE
Broadly speaking, there are two types of pain. There is nociceptive pain, which is caused by tissue injury or inflammation. This pain tends to be temporary, lessening as the tissues heal.
The second type of pain is far more difficult to manage and is called neuropathic pain. This pain is caused by trauma to the nervous system that directly injures nerves or interferes with the ability of nerves to process pain signals.
The intrathecal pump delivers Prialt directly into the spinal space. The entire pump system is placed under the skin, and the pump is refilled every 60- 90 days by placing a needle through the skin into the pump.
Neuropathic Pain
For patients with neuropathic pain, oral medications are often unsatisfactory. The typical patient with severe neuropathic pain has failed trials of physical therapy, TENS units, anti seizure medications (neurotin, lyrica, topamax, lamictal), anti depressant medications (Elavil, pamelor, cymbalta, effexor), and eventually may be placed on narcotics.
Prialt (or Zoconitide) is a non-narcotic synthetic form of a naturally occurring venom (neurotoxin) found in the Conus Magus snail. The snail’s venom was known since antiquity as a topical remedy for burns, abscesses and other wounds.
Neuropathic pain often does not respond well to oral narcotics, resulting in some patients being placed on escalating doses.
The most concerning aspects of high dose narcotics are side effects (which increase with the dose), tolerance (loss of effect with time requiring increasing doses), hyperalgesia (escalating doses paradoxically increasing pain), physical dependence (withdrawal if narcotics are suddenly stopped) and, rarely, addiction (uncontrolled use and craving).
Naturally Occuring Venom
Prialt (or Zoconitide) is a non-narcotic synthetic form of a naturally occurring venom (neurotoxin) found in the Conus Magus snail. The snail’s venom was known since antiquity as a topical remedy for burns, abscesses and other wounds.
Cone snails are hunting animals, which use neurotoxins to paralyze their prey. The snails use their harpoon like limb to grab, inject, and then consume the fish after it is paralyzed. Prialt is now FDA approved specifically for neuropathic pain.
In fish, prialt is a paralyzing agent, but in humans it reduces or stops pain transmission.
If taken by mouth prialt would be rapidly and completely destroyed by our digestive enzymes. Therefore, Prialt is only delivered by the Medtronic pain pump directly into the spinal canal fluid.
In the spinal fluid the Prialt molecules block pores on pain sensing nerve cells, which stops the flow of calcium into the cells. This reduction of calcium flow prevents the nerve cells from sending signals to the brain, reducing the perception of pain.
When used in the pain pump, Prialt can often reduce neuropathic pain allowing the patient to significantly reduce or wean off narcotics.
The pain management physician determines that a patient is a good candidate for Prialt by administering a test dose in which a small amount of Prialt is injected into the spine under x-ray guidance.
The patient is then observed closely and pain levels are recorded for the next several hours. Then the patient is asked to perform specific exercises to determine the drug’s effect on the pain. If greater than 70-80 percent of the pain is reduced, the trial of Prialt is considered successful.
After the successful test dose with Prialt, the patient may be scheduled for implantation of a Medtronic intrathecal pump.
Pump Implantation
The pump implantation is a minor outpatient surgical procedure, which provides the patient with a constant infusion of the pain relieving Prialt. After implantation, the pump is programmed to deliver slowly increasing amounts of Prialt to minimize drug side effects.
As the Prialt dose increases and pain is reduced, narcotics are simultaneously weaned.
If you have a severe pain condition that has failed all other standard conservative therapies, consider undergoing evaluation by a pain management specialist to determine if this mode of direct intrathecal medication therapy is appropriate for you.
Facts About Cone Snail
Less than one percent of the more than 500 species of cone snails have been studied. Each snail produces multiple neurotoxins in its venom. Some scientists feel the cone snails hold more promise for new medicines than any other species in nature.
Different snail toxins in preclinical trials already hold promise for new treatments for pain, Parkinson’s Disease, and depression. The snails are found in the warm tropical coral reefs.
Unfortunately the coral reefs are being destroyed; over 26 percent of the reefs are damaged beyond repair and between 30 to 50 percent are severely degraded. If the reefs are lost, we also lose the potential cure for many diseases.
To contact Dr. Gayles call 321-784-8211 or log on to FloridaPain.net
Florida Pain Doctor, Richard Gayles, MD
Dr. Richard Gayles brings a wealth of training and experience to Florida Pain. He received a Bachelor of Science in Psychobiology from the University of Michigan in 1987 and his Doctor of Medicine in 1991 at the University of Michigan’s School of Medicine. After graduation, Richard completed a residency and Pediatric Anesthesia Fellowship in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Maryland.
Dr. Gayles obtained further clinical experience in anesthesiology at St. Bartholomew’s Hospital in London, England. He completed a Chronic Pain Fellowship at the Cleveland Clinic Foundation in Ohio, where he was awarded the “Fellow of the Year Award” in June of 1997. He currently utilizes his expertise at Florida Pain, Merritt Island Surgical Center and Space Coast Surgery Center (located at our facility).
In addition to his clinical experience, Dr. Gayles has participated in research over the past fourteen years, both here at home and abroad. Dr. Gayles is Board Certified by the American Board of Anesthesiology and a Diplomat of the American Academy of Pain Management. He is also certified by the American Board of Pain Medicine, National Board of Medical Examiners and by the American Heart Association in Basic and Advanced Cardiac Life Support. Dr. Gayles holds the Following Special Affiliations: Member of Coast Guard Auxiliary and FAA (an Aero Medical Examiner) ANGEL Flight.
FLORIDA PAIN HAS TWO LOCATIONS IN BREVARD COUNTY
We have a local pain management Dr. who is interested in prescribing Prialt or other similar medication. He asked me to look into how to obtain this medicine. Australia is the only place I have seen it listed as available. We live in Delaware, USA. Should we check with a pharmacist locally?
I believe there is another brand which may not require a medtronic pump. What is the name and availability of it? Thank you. Kathy
i live in nelson co. va.. i have paralysis & spastic paralysis and rsd. since 1998. there is not a drug on your list plus MANY MORE including methadone and morphine that have been tried. one med at a time i ween myself way down on and then back up when all i can do is lay in a distorted ball of tears for days. the cold in va. doesn’t help. is it possible this could be an answer for me?