gms | German Medical Science

Objective: In a selected group of chronic pain patients invasive treatment options like intrathecally applied pharmacological analgesics are required if conservative and non-invasive therapies have failed. As a gold standard morphine has been used for many years. Since two years a new analgesic drug is legalized in Europe for intrathecal pain therapy – ziconotide. The clinical experiences of the authors and a patient group are presented.

Methods: Since two years 13 patients (5 female, 8 male) were treated with ziconotide intrathecally. All patients suffered from chronic pain with neuropathic or mixed neuropathic/nociceptive symptoms. In all patients a de-novo testing with an externalized lumbar drain for up to 14 days was initiated. In case of pain reduction of more than 50%, measured with a visual analogue scale (VAS), a pump delivery system was internalized.

Results: Starting dose of ziconotide varied from 0.5 to 1.5µg/d. In all patients dose escalation was performed until pain reduction or side effects were documented. In nine patients a positive effect and pain reduction was noted and pump implantation performed. Side effects of ziconotide, like dizziness, gait disturbances, headache, diplopia or psychiatric disorders were observed, more or less, in all patients during the titration phase. After a follow-up of three and six months after pump implantation a positive effect was recorded in four and respectively three patients. Daily dosage of ziconotide varied from 5 to 20µg/d. In one case pump explantation due to wound infection was necessary.

Conclusions: Ziconotide is an alternative pharmacological agent for intrathecal pain therapy. Due to its biochemical profile complex and sensitive testing and dose titration is necessary. The rate of side effects is high. Based on the clinical experience of the authors ziconotide is currently not recommended as a first line treatment option for intrathecal pain therapy.