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24th Annual Meeting February 13-16, 2008 Orlando, FL |
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© 2006 American Academy of Pain Medicine |
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Thursday, February 14, 2008
162
Single-Shot Intrathecal Ziconotide to Predict Its Pump Infusion Effect
Ziconotide (PRIALT TM, Elan Pharmaceuticals, Inc.) is a synthetic conopeptide with N-type calcium channel blocker property. It works as non-opioid analgesic and is indicated for the management of severe chronic pain patients who have failed to respond to intrathecal (IT) opioids, or other adjunct medications. Conventional trials for Ziconotide in established IT pump patients usually require weaning existing pump medications off and then adding Ziconotide to IT pump. Here we report our experience with single-shot intrathecal Ziconotide trial to predict its effects with continuous infusion.
Methods:
Eleven established IT pump patients received single-shot Ziconotide trials. Each patient received single-shot trial using a 22-G spinal needle above the level of IT catheter (either at L2-3 or L3-4). Fluoroscopy was utilized to locate the site of entry and to avoid damage to the pre-existing IT catheter. Two patients received 5 μg Ziconotide, 5 patients received 2.4 μg and 4 patients received 1.2 μg respectively. Patients were evaluated in clinic in 2 weeks. Those who showed significant pain relief had Ziconotide added to their IT pump mixture.
Results:
Eight out of 11 patients had significant pain relief (more than 50% from preprocedure level) with the single-shots. Serious side effects included urinary retention in one patient, hallucination in one patient and one case of motor weakness. Urinary retention and motor weakness were seen in the patients who received 5 μg dosages. Seven out of 8 patients still experienced pain relief 6 months after the addition of Ziconotide to the IT pump infusion.
Conclusion:
Single-shot intrathecal trial can effectively predict the response to IT infusion. It can also reduce withdrawals and waiting time, improve cost-efficiency and provide a simple alternative to the continuous trial especially for patients without IT pump.
References: Rauck RL, Wallace MS et al. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manage. 2006 May;31(5):393-406
Saulino M. Successful reduction of neuropathic pain associated with spinal cord injury via of a combination of intrathecal hydromorphone and ziconotide: a case report. Spinal Cord. 2007 Feb:1-4
Stanton-Hicks M, Kapural L. An effective treatment of severe complex regional pain syndrome type 1 in a child using high doses of intrathecal ziconotide. J Pain Symptom Manage. 2006 Dec;32(6):509-11
Turner JA, Sears JM, Loeser JD. Programmable intrathecal opioid delivery systems for chronic noncancer pain: a systematic review of effectiveness and complications. Clin J Pain. 2007 Feb;23(2):180-95
Wallace MS. Ziconotide: a new nonopioid intrathecal analgesic for the treatment of chronic pain. Expert Rev Neurother. 2006 Oct;6(10):1423-8
Klotz U. Ziconotide--a novel neuron-specific calcium channel blocker for the intrathecal treatment of severe chronic pain--a short review. Int J Clin Pharmacol Ther. 2006 Oct;44(10):478-83
Thompson JC, Dunbar E, Laye RR. Treatment challenges and complications with ziconotide monotherapy in established pump patients. Pain Physician. 2006 Apr;9(2):147-52
Wermeling DP. Ziconotide, an intrathecally administered N-type calcium channel antagonist for the treatment of chronic pain. Pharmacotherapy. 2005 Aug;25(8):1084-94
Funding: None
Nothing to disclose.
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