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

Abstract

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.

Intrathecal Administration of Ziconotide as a Potential Treatment for Chronic Migraines

“…In the second case, a 59-year-old female had a single-shot intrathecal ziconotide trial of 1 μg at T12-L1, which decreased her pain due to trigeminal neuralgia from 9/10 to 6/10 [ 12 ]. One case report of a patient who experienced temporary albeit complete resolution of her facial pain (PIFP) upon a single injection of the intrathecal trial of Ziconotide a the L3-L4 level [ 13 ]. In one case of a 59-year-old female, Ziconotide therapy at the rate of 1 microgram per day was successful in effectuating complete resolution of chronic refractory migraine headaches [ 10 ].…”