Spinal cord injury (SCI) is accompanied by intractable pain as well as loss of motor and visceral control. As
part of an overall strategy in patient rehabilitation and improvement in quality of life, pain management is crucial. Interestingly,
SCI patients report pain below the level of injury that has characteristics of neuropathic-type pain. Preclinical
studies suggest that a key substrate that underlies the symptoms of neuropathic pain such as spontaneous pain and belowlevel
cutaneous hypersensitivity is aberrant activity of spinal dorsal horn neurons. While pharmacotherapies for peripheral
neuropathic pain exist, these treatments may lead to adverse side effects in SCI patients, such as muscle weakness and
constipation, which may exacerbate existing dysfunctions. Thus, novel therapeutic strategies are needed. One way to limit
the adverse effects associated with systemically administered drugs is intrathecal delivery. Intrathecal delivery also directs
drug to dorsal horn neurons. Another way to reduce the severity of side effects and to potentially enhance drug efficacy is
to utilize combination drug therapy. While the conopeptide ziconotide has demonstrated clinical efficacy for severe
chronic pain, a limitation of this drug is its potential for significant side effects. Combinations of conopeptides with currently
available drugs as well as with other conopeptides could be an effective means of reducing neuropathic SCI pain.
Keywords: Allodynia, combination drug therapy, hyperalgesia, intrathecal drug delivery, conotoxin, synergism.
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