Erfahrungen mit intrathekaler First-line-Therapie mit Ziconotide bei Patienten mit neuropathischen Gesichtsschmerzen

Lux, Eberhard A.; Rasche, Dirk

doi:10.1007/s00482-011-1080-x

Cited by 4 publications

(3 citation statements)

References 20 publications

(18 reference statements)

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“…Treatment was stopped in one patient (2.4 μg/day dose) due to side effects. The other two patients experienced reduction in their pain scores from numeric rating scale (NRS) 10 to NRS 4 and NRS 9 to NRS 6 21. Our case study is different from Lux and Rasche in a number of ways.…”

Section: Discussionmentioning

confidence: 80%

“…Intrathecal administration of ziconotide has had some efficacy in chronic-pain patients, ranging from pain secondary to nonmalignant conditions to cancer pain to refractory pain in AIDS patients. There has also been some documentation of its use for neuropathically mediated FP, including trigeminal neuralgia19,20 and a case series of three patients with PIFP 21…”

Section: Discussionmentioning

confidence: 99%

“…To date, only one case series has documented the use of intrathecal ziconotide specifically for PIFP 21. Lux and Rasche documented doses of 2.4, 3.9, and 6.0 μg/day for three patients that they treated for PIFP 21. Treatment was stopped in one patient (2.4 μg/day dose) due to side effects.…”

Section: Discussionmentioning

confidence: 99%

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<p>Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report</p>

Staub

Casini

Monaco

et al. 2019

JPR

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PurposePersistent idiopathic facial pain (PIFP) is a poorly defined and debilitating chronic pain state with a challenging and often inadequate treatment course. This is the first case report identifying the novel use of low-dose lumbar intrathecal ziconotide to successfully treat PIFP with nearly complete resolution of pain and minimal to no side effects.MethodsThe patient was a 37 year-old female whose PIFP was refractory to multimodal medication management and multiple neurovascular surgical interventions. A single-shot lumbar intrathecal trial of ziconotide (2.5 mL, equivalent 2.5 μg) was injected when she was at her baseline pain level — VAS 7/10. She received complete resolution of her pain for about 9 hours, concordant with ziconotide’s half-life. She was subsequently implanted with a lumbar intrathecal delivery system.ResultsThe patient experienced complete resolution of her facial pain with a single-shot intrathecal trial of ziconotide. The intrathecal pump system has provided nearly complete (VAS 1/10) pain relief. Two flares of pain occurred 10 and 18 months after pump placement, which subsequently resolved after increasing the ziconotide dose by 0.5 μg/day on each occasion. The patient is currently maintained on a dose of 2.0 μg/day and is pain-free.ConclusionThis is the first case report describing the use of a single-shot lumbar intrathecal trial of ziconotide and subsequent placement of lumbar (as opposed to thoracic) intrathecal ziconotide pump for PIFP. A single-injection intrathecal trial is a low-risk, viable option for patients with this debilitating and frustrating pain condition. Successful trials and subsequent intrathecal pump placement with ziconotide may supplant multimodal medication management and/or invasive orofacial surgical intervention for PIFP.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report</p>

Staub

Casini

Monaco

et al. 2019

JPR

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Intrathecal pain management with ziconotide: Time for consensus?

Matis

Negri²,

Dupoiron

et al. 2021

Brain and Behavior

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This article summarizes recommendations made by six pain specialists who discussed the rationale for ziconotide intrathecal analgesia (ITA) and the requirement for evidence‐based guidance on its use, from a European perspective. Riemser Pharma GmbH (Greifswald, Germany), which holds the European marketing authorization for ziconotide, hosted the meeting. The group agreed that ITA is under‐used in Europe, adding that ziconotide ITA has potential to be a first‐line alternative to morphine; both are already first‐line options in the USA. Ziconotide ITA (initiated using a low‐dose, slow‐titration approach) is suitable for many patients with noncancer‐ or cancer‐related chronic refractory pain and no history of psychosis. Adopting ziconotide as first‐line ITA could reduce opioid usage in these patient populations. The group advocated a risk‐reduction strategy for all candidate patients, including compulsory prescreening for neuropsychosis, and requested US–European alignment of the licensed starting dose for ziconotide: the low‐and‐slow approach practiced in the USA has a better tolerability profile than the fixed high starting dose licensed in Europe. Of note, an update to the European Summary of Product Characteristics is anticipated in early 2021. The group acknowledged that the Polyanalgesic Consensus Conference (PACC) treatment algorithms for ziconotide ITA provide useful guidance, but recommendations tailored specifically for European settings are required. Before a consensus process can formally begin, the group called for additional European prospective studies to investigate ziconotide in low‐and‐slow dosing strategies, in different patient settings. Such data would enable European guidance to have the most appropriate evidence at its core.

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Analgesic effects of the CTK 01512-2 toxin in different models of orofacial pain in rats

et al. 2020

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Erfahrungen mit intrathekaler First-line-Therapie mit Ziconotide bei Patienten mit neuropathischen Gesichtsschmerzen

Cited by 4 publications

References 20 publications

<p>Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report</p>

<p>Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report</p>

Intrathecal pain management with ziconotide: Time for consensus?

Analgesic effects of the CTK 01512-2 toxin in different models of orofacial pain in rats

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