ziconotide and Spinal-Cord-Injuries

This is a comprehensive review of the current literature on central neuropathic pain mechanisms that is secondary to spinal cord injury. It reviews recent and seminal findings on the pathophysiology, diagnosis, and treatment and compares treatment options and recommendations.. Neuropathic pain (NP) is a common complication of spinal cord injury (SCI). Chronicity of NP is attributed to increased abundance of inflammatory mediators and ion channel dysfunction leading to afferent nerve sensitization; nerve damage and nerve-glia cross talk have also been implicated. Conventional treatment is medical and has had limited success. Recent studies have made headway in identifying novel biomarkers, including microRNA and psychosocial attributes that can predict progress from SCI to chronic NP (CNP). Recent advances have provided evidence of efficacy for two promising drugs. Baclofen was able to provide good, long-lasting pain relief. Ziconotide, a voltage-gated calcium channel blocker, was studied in a small trial and was able to provide good analgesia in most participants. However, several participants had to be withdrawn because of worrisome creatine phosphokinase (CPK) elevations, and further studies are required to define its safety profile. Non-medical interventions include brain sensitization and biofeedback techniques. These methods have recently had encouraging results, albeit preliminary. Case reports of non-conventional techniques, such as hypnosis, were also reported. CNP is a common complication of SCI and is a prevalent disorder with significant morbidity and disability. Conventional medical treatment is limited in efficacy. Recent studies identified baclofen and ziconotide as possible new therapies, alongside non-medical interventions. Further research into the pathophysiology is required to identify further therapy candidates. A multidisciplinary approach, including psychosocial support, medical and non-medical interventions, is likely needed to achieve therapeutic effects in this difficult to treat syndrome.

Topics: Analgesics; Calcium Channel Blockers; Humans; Neuralgia; Neuroglia; omega-Conotoxins; Pain Management; Spinal Cord Injuries

Central neuropathic pain related to spinal cord injury is notoriously difficult to treat. So far most pharmacological and surgical options have shown but poor results. Recently ziconotide has been approved for use both neuropathic and non-neuropathic pain. In this cohort study, we assessed responder rate and long-term efficacy of intrathecal ziconotide in patients with pain related to spinal cord injury.. Patients presenting chronic neuropathic related to spinal cord lesions that was refractory to medical pain management were considered for inclusion. Those accepting were tested by lumbar puncture injection of ziconotide or continuous intrathecal infusion and if a significant decrease in pain scores (>40%) was noted they were implanted with a continuous infusion pump. They were then followed up for at least 1 year with constant assessment of the evolution of pain and side effects.. Out of the 20 patients tested 14 had a decrease in pain scores of more than 40% but only 11 (55%) were implanted with permanent pumps due to side effects and patient choice. These were followed up on average for 3.59 years (±1.94) and in eight patients an above threshold decrease in pain scores was maintained. Overall in patients that responded to the test baseline VAS was 7.91 and 4.31 at last follow-up with an average dose of 7.2 μg of ziconotide per day. Six patients (30%) did not respond to any test and in three patients side effects precluded pump implantation. No significant long-term effects of the molecule were noted.. This study shows response to intrathecal ziconotide test in 40% of the patients of a very specific population in whom other therapeutic options are not available. This data justifies the development further studies such as a long-term randomized controlled trial.. Intrathecal Ziconotide is a posible alternative for the treatment of pain in patients with spinal cord injury and below level neuropathic pain.

Topics: Analgesics, Non-Narcotic; Cohort Studies; Female; Humans; Injections, Spinal; Male; Middle Aged; Neuralgia; omega-Conotoxins; Pain Management; Pain Measurement; Spinal Cord Injuries

Case report.. To report a novel management strategy for neuropathic pain management after spinal cord injury.. Outpatient spinal cord injury (SCI) clinic.. The patient demonstrated two neuropathic pain syndromes, namely at- and below-level pain. These syndromes were recalcitrant to conservative measures and a decision was made to proceed with intrathecal therapies.. The patient's at-level pain was responsive to intrathecal hydromorphone but the below-level pain was unaffected by this intervention. Intrathecal ziconotide provided an opposite response with a positive effect observed on the below-level pain and minimal effect on the at-level pain. The combination of intrathecal ziconotide and hydromorphone provided effective relief for both components of the patient's SCI associated neuropathic pain.. The combination of intrathecal ziconotide and hydromorphone has the potential to provide significant pain relief for patients with neuropathic pain associated with spinal cord injury.

Topics: Adult; Analgesics; Drug Therapy, Combination; Female; Humans; Hydromorphone; Injections, Spinal; Neuralgia; omega-Conotoxins; Pain Measurement; Spinal Cord Injuries

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