gms | German Medical Science

Objective: Ziconotide, a new nonopioid drug recently approved for the intrathecal treatment of chronic pain, inhibits the N-type calcium channels in the superficial dorsal horn of the spinal cord. Some randomized, placebo-controlled clinical trials in more than 500 patients with cancer or AIDS suggest potent analgesia with a narrow therapeutic window. For other severe chronic pain syndromes to date firm indications for Ziconotide are lacking and only few case report experiences are available. We summarize our first clinical data and try to point out both special indications and notable pitfalls.

Methods: 10 patients with diverse chronic neuropathic pain syndromes like postzosteric neuralgia, trigeminal neuropathy and CRPS refractory to systemic or intrathecal opioid medication were included to get a intrathecal test stage with Ziconotide. Follow-up parameters consist of pain numeric rating scale (NRS), quality of life data, side effects and both perception and end dose of intrathecal drug.

Results: Nearly half of the patients exit the test stage because of intolerable side effects already in early titration steps. Especially older patients with postzosteric neuralgia seems to be affected. Good clinical effects could obtained in approximately thirty to fourty percent (e.g. CRPS, trigeminal neuropathy) with subsequent implantation of medication pump.

Conclusions: Our data suggest for special indications a good to excellent pain relief so that acceptance of Ziconotide as first-line drug for intrathecal therapy seems to be warrantable. Nevertheless much more data have to be collected. Particularly for older patients facing the side effects only firm indications and both slow and small titration steps should be recommended.