ziconotide and Muscle-Spasticity

Targeted intrathecal (IT) drug delivery systems (IDDS) are well established as an effective treatment of patients with chronic nonmalignant or malignant pain, and as a tool for management of patients with severe spasticity. The risk to benefit ratio of IDD makes it a relatively safe therapy for both cancer- and noncancer-related pain, but it is not free of risks, so it should be managed at specific centers. Recent technological advances, new therapeutic applications, reported complications, and the costs as well as maintenance required for this therapy require the need to stay up to date about new recommendations that may improve outcomes. This chapter reviews all technological issues regarding IDDS implantation with follow-up and pharmacological recommendations published during recent years that provide evidence-based decision-making process in the management of chronic pain and spasticity in patients.

Topics: Analgesics, Non-Narcotic; Analgesics, Opioid; Baclofen; Cancer Pain; Chronic Pain; Drug Delivery Systems; GABA-B Receptor Agonists; Humans; Infusion Pumps, Implantable; Muscle Relaxants, Central; Muscle Spasticity; Neuroprotective Agents; omega-Conotoxins; Pain Management; Risk Factors

Spasticity can be very debilitating and painful. We present a case of severe spasticity from primary lateral sclerosis refractory to intrathecal baclofen in doses up to 1100 μg/d. Baclofen was weaned down and switched to intrathecal ziconotide at 0.6 μg/d. The dose was then titrated up to 3 μg/d with excellent control of spasticity. This case suggests that low-dose intrathecal ziconotide should be considered in patients with lower extremity spasticity refractory to intrathecal baclofen.

Topics: Adult; Baclofen; Female; Humans; Injections, Spinal; Motor Neuron Disease; Muscle Spasticity; omega-Conotoxins; Pain; Treatment Outcome

Seven cases of combination of intrathecal (IT) ziconotide and baclofen therapy in patients with refractory neuropathic pain and spasticity were reviewed. Five of the seven adult patients were receiving IT baclofen treatment when ziconotide was initiated. All five patients had experienced at least one previous failed IT treatment regimen. Pain intensity scores improved by a mean of 50.3% with the use of ziconotide-baclofen therapy. Mean time to onset of pain relief was 15 weeks, at a mean ziconotide dose of 3.7 microg/day. Within this group of patients, adverse events were observed in one patient, but they were not considered to be ziconotide related and subsequently resolved. The remaining two patients were receiving ziconotide treatment when baclofen was initiated. Pain intensity scores improved by 75% and 30%, respectively. Pain relief was evident at two weeks and one week, with corresponding ziconotide doses of 2.4 microg/day and 14.4 microg/day, respectively. One patient in this group reported adverse events, but all resolved during continued treatment with the study drugs. Treatment regimens varied between patients in these case series; each regimen used a different titration strategy and different concentrations of ziconotide and baclofen. Combination IT ziconotide and baclofen therapy may be a treatment option for patients with neuropathic pain and spasticity. Future studies are warranted to determine the optimal dosing and titration schedules for ziconotide-baclofen usage.

Topics: Adult; Baclofen; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Muscle Relaxants, Central; Muscle Spasticity; Neuralgia; Neuroprotective Agents; omega-Conotoxins; Pain; Pain Measurement; Treatment Outcome

Spasticity is a major clinical manifestation of spinal cord injury and upper motor neuron syndrome.

Topics: Adult; Analgesics, Opioid; Baclofen; Calcium Channel Blockers; Drug Resistance; Humans; Male; Morphine; Muscle Relaxants, Central; Muscle Spasticity; omega-Conotoxins; Paraplegia; Quadriplegia; Spinal Cord Injuries