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335 Case report: Positive clinical experience of treating chronic non-cancer pain with ziconotide
Poster Presentations / Clinical – Case Studies / European Journal of Pain 11(S1) (2007) S59–S207
pain in a double-blind, cross over trial; trials were one week apart. Results. The Figure illustrates the significant increase in pain on nicotine compared to placebo. Conclusions. There has been nothing published in the SCI literature about a relationship between nicotine and neuropathic pain. Anecdotally, this is reported with nicotine patches and chewing tobacco also. We have begun a larger trial investigating this phenomenon.
S149
Pain scores were reduced by 40%; apart from headache there were no AEs. A Medtronic IT drug delivery system was implanted and ziconotide was titrated in increments of up to 0.2 lg/day from 0.25 to 2.4 lg/day over 11 days. Other than headache and postoperative wound pain, no AEs occurred. Ziconotide was increased to the present dose of 8 lg/day with good pain relief with no AEs; fentanyl, morphine and gabapentin were titrated down and stopped. Conclusion. Ziconotide provided effective analgesia with few AEs in a patient with difficult non-cancer pain, using slow dose titration. doi:10.1016/j.ejpain.2007.03.350
336 TREATMENT OPTIONS IN PATIENTS AFFECTED BY PERSISTENT VEGETATIVE N. Stefani *, G. Rea, D. Mangeruga, P.V. Nardi Neurochirurgia, Policlinico Casilino, Rome, Italy doi:10.1016/j.ejpain.2007.03.349
335 CASE REPORT: POSITIVE CLINICAL EXPERIENCE OF TREATING CHRONIC NON-CANCER PAIN WITH ZICONOTIDE K.H. Simpson The Leeds Teaching Hospitals, St. James’s University Hospital, Leeds, West Yorkshire, UK Background. Ziconotide was licensed for the treatment of severe, chronic pain in the European Union in February 2005. Ziconotide must be administered intrathecally (IT); it blocks N-type voltage-sensitive calcium channels to prevent pre-synaptic release of glutamate. Case report. JN was diagnosed with cervical spondylosis in 1969. By 1991 he had low back pain, increased neck pain and bilateral occipital neuralgia. A variety of therapies including cervical discectomy, lumbar root decompression, neurectomy, transcutaneous electrical nerve stimulation and strong opioids, were unsuccessful. In 2002, aged 59 years, he was referred to the Leeds Pain Service. Initial treatment with celecoxib, amitriptyline and gabapentin reduced pain on the visual analogue scale (VAS) from 10/10 to 2/10 in 2 months. Pain then increased and adverse drug events (AEs) of weight gain and sedation occurred. In 2004, JN received ziconotide titrated from 0.48 to 0.54 lg/day over 9 days, in increments of up to 0.02 lg/day via an external IT catheter.
Background and aims. The use of Lioresal (Baclofen) in implantable pumps, for its continuous release in the subarachnoid lumbar space, is an innovative method to reduce doses and potential secundary effects for treatment of spasticity in patients affected by persistent vegetative status. Methods. All patients were tested before the operation. Test procedure regarded the response to the intratecal baclofen injected in bolus for three consecutive days at increasing doses. Patients who presented a good response were submitted to the definitive implant. From March 2000 to May 2005 30 patients affected by a persistent vegetative status, all males with age ranging from 15 to 40 (mean 29), secundary to head trauma (60%), spinal cord traumatisms (35%), hemorrhagic events (15%) were treated with the positioning of an implantable pump of baclofen in the subarachnoid lumbar space. Each patient was exhamined for its personal grade of spasticity. The Ashworth scale varied from 3 to 5 (mean 4.6), spasm index varied from 1 to 3 (mean 2.2). Results. All patients treated with the intratecal baclofen have had an initial amelioration in the spasms beneath the persistence of the hypertonic status. In the long time follow up (mean 12 months) the hypertonic status improved following the initial good response in the spasms. The drop of the Ashworth scale was from 4.6 to 3.5 and, the spasm index, from 2.2 to 1.5. Conclusions. Our experience declare that intratecal baclofen is an useful tool for the treatment of spasticity in the persistent vegetative status. doi:10.1016/j.ejpain.2007.03.351
pain in a double-blind, cross over trial; trials were one week apart. Results. The Figure illustrates the significant increase in pain on nicotine compared to placebo. Conclusions. There has been nothing published in the SCI literature about a relationship between nicotine and neuropathic pain. Anecdotally, this is reported with nicotine patches and chewing tobacco also. We have begun a larger trial investigating this phenomenon.
S149
Pain scores were reduced by 40%; apart from headache there were no AEs. A Medtronic IT drug delivery system was implanted and ziconotide was titrated in increments of up to 0.2 lg/day from 0.25 to 2.4 lg/day over 11 days. Other than headache and postoperative wound pain, no AEs occurred. Ziconotide was increased to the present dose of 8 lg/day with good pain relief with no AEs; fentanyl, morphine and gabapentin were titrated down and stopped. Conclusion. Ziconotide provided effective analgesia with few AEs in a patient with difficult non-cancer pain, using slow dose titration. doi:10.1016/j.ejpain.2007.03.350
336 TREATMENT OPTIONS IN PATIENTS AFFECTED BY PERSISTENT VEGETATIVE N. Stefani *, G. Rea, D. Mangeruga, P.V. Nardi Neurochirurgia, Policlinico Casilino, Rome, Italy doi:10.1016/j.ejpain.2007.03.349
335 CASE REPORT: POSITIVE CLINICAL EXPERIENCE OF TREATING CHRONIC NON-CANCER PAIN WITH ZICONOTIDE K.H. Simpson The Leeds Teaching Hospitals, St. James’s University Hospital, Leeds, West Yorkshire, UK Background. Ziconotide was licensed for the treatment of severe, chronic pain in the European Union in February 2005. Ziconotide must be administered intrathecally (IT); it blocks N-type voltage-sensitive calcium channels to prevent pre-synaptic release of glutamate. Case report. JN was diagnosed with cervical spondylosis in 1969. By 1991 he had low back pain, increased neck pain and bilateral occipital neuralgia. A variety of therapies including cervical discectomy, lumbar root decompression, neurectomy, transcutaneous electrical nerve stimulation and strong opioids, were unsuccessful. In 2002, aged 59 years, he was referred to the Leeds Pain Service. Initial treatment with celecoxib, amitriptyline and gabapentin reduced pain on the visual analogue scale (VAS) from 10/10 to 2/10 in 2 months. Pain then increased and adverse drug events (AEs) of weight gain and sedation occurred. In 2004, JN received ziconotide titrated from 0.48 to 0.54 lg/day over 9 days, in increments of up to 0.02 lg/day via an external IT catheter.
Background and aims. The use of Lioresal (Baclofen) in implantable pumps, for its continuous release in the subarachnoid lumbar space, is an innovative method to reduce doses and potential secundary effects for treatment of spasticity in patients affected by persistent vegetative status. Methods. All patients were tested before the operation. Test procedure regarded the response to the intratecal baclofen injected in bolus for three consecutive days at increasing doses. Patients who presented a good response were submitted to the definitive implant. From March 2000 to May 2005 30 patients affected by a persistent vegetative status, all males with age ranging from 15 to 40 (mean 29), secundary to head trauma (60%), spinal cord traumatisms (35%), hemorrhagic events (15%) were treated with the positioning of an implantable pump of baclofen in the subarachnoid lumbar space. Each patient was exhamined for its personal grade of spasticity. The Ashworth scale varied from 3 to 5 (mean 4.6), spasm index varied from 1 to 3 (mean 2.2). Results. All patients treated with the intratecal baclofen have had an initial amelioration in the spasms beneath the persistence of the hypertonic status. In the long time follow up (mean 12 months) the hypertonic status improved following the initial good response in the spasms. The drop of the Ashworth scale was from 4.6 to 3.5 and, the spasm index, from 2.2 to 1.5. Conclusions. Our experience declare that intratecal baclofen is an useful tool for the treatment of spasticity in the persistent vegetative status. doi:10.1016/j.ejpain.2007.03.351