CASE REPORTS   Free access

European Journal of Physical and Rehabilitation Medicine 2009 March;45(1):61-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports

Saulino M. ¹, Burton A. W. ², Danyo D. A. ³, Frost S. ⁴, Glanzer J. ⁴, Solanki D. R. ⁵

¹ MossRehab, Thomas Jefferson University Elkins Park, PA, USA 2 University of Texas M.D. Anderson Cancer Center Houston, TX, USA 3 Atlanta Spine and Brain Rehabilitation, Roswell, GA, USA 4 Regional Pain Management Center Regional Rehabilitation Institute, Rapid City, SD, USA 5University of Texas Medical Branch, Galveston, TX, USA

Seven cases of combination of intrathecal (IT) ziconotide and baclofen therapy in patients with refractory neuropathic pain and spasticity were reviewed. Five of the seven adult patients were receiving IT baclofen treatment when ziconotide was initiated. All five patients had experienced at least one previous failed IT treatment regimen. Pain intensity scores improved by a mean of 50.3% with the use of ziconotide-baclofen therapy. Mean time to onset of pain relief was 15 weeks, at a mean ziconotide dose of 3.7 mg/day. Within this group of patients, adverse events were observed in one patient, but they were not considered to be ziconotide related and subsequently resolved. The remaining two patients were receiving ziconotide treatment when baclofen was initiated. Pain intensity scores improved by 75% and 30%, respectively. Pain relief was evident at two weeks and one week, with corresponding ziconotide doses of 2.4 mg/day and 14.4 mg/day, respectively. One patient in this group reported adverse events, but all resolved during continued treatment with the study drugs. Treatment regimens varied between patients in these case series; each regimen used a different titration strategy and different concentrations of ziconotide and baclofen. Combination IT ziconotide and baclofen therapy may be a treatment option for patients with neuropathic pain and spasticity. Future studies are warranted to determine the optimal dosing and titration schedules for ziconotide-baclofen usage.