ziconotide and Trigeminal-Neuralgia

Topics: Abdominal Pain; Adrenal Cortex Hormones; Analgesia; Analgesics; Analgesics, Non-Narcotic; Anesthesia, Conduction; Anesthetics; Catheters, Indwelling; Chronic Pain; Complex Regional Pain Syndromes; Headache Disorders; Humans; Injections, Epidural; Injections, Spinal; Narcotics; Neoplasms; Nerve Block; omega-Conotoxins; Phantom Limb; Post-Dural Puncture Headache; Post-Traumatic Headache; Quality of Life; Syndrome; Trigeminal Neuralgia; Vascular Headaches

We report a case of a 59-year-old female with severe TN who experienced satisfactory symptom relief from a single-shot trial of intrathecal ziconotide.. Performed a 1 μg single-shot trial of Prialt.. Report of satisfaction, no side effects, and complete face and back relief briefly but most notably relief from the TN.. Ziconotide should be considered for treatment of TN, although further investigation is recommended.

Topics: Analgesics, Non-Narcotic; Female; Humans; Injections, Spinal; Middle Aged; omega-Conotoxins; Trigeminal Neuralgia

We report on the intrathecal use of ziconotide in three patients with idiopathic facial pain after surgery of the mouth, jaw or face and one patient with neuropathic pain after damage of the lingual nerve. The therapy was successful in three patients but one patient with idiopathic facial pain had pain relief only during the test phase of ziconotide with an external pump and not after implanting the Synchromed® pump. With intrathecal morphine therapy this patient achieved good pain relief. We recommend that patients with neuropathic facial pain should be treated with ziconotide after implementation of guideline-based therapy. In the test phase the ziconotide dose should be increased by 0.6 µg/day per week after an initial dose of 0.6-1.2 µg/day to avoid side-effects.

Topics: Adult; Analgesics, Non-Narcotic; Dose-Response Relationship, Drug; Ethmoid Sinusitis; Facial Neuralgia; Female; Humans; Infusion Pumps, Implantable; Injections, Spinal; Lingual Nerve Injuries; Maxillary Sinusitis; Mucocele; omega-Conotoxins; Pain Measurement; Pain, Postoperative; Tooth Extraction; Treatment Outcome; Trigeminal Neuralgia; Young Adult

A 50-year-old female patient with chronic neuropathic pain in the distribution of the second branch of the trigeminal nerve was unsuccessfully treated over several years. Intrathecal therapy with ziconotide was administered at an initial dose of 0.33 microg/d, which was gradually increased by 0.7 microg/d. Subjective pain on the numeric rating scale was reduced from 9/10 to 3-4/10 at a dose of 6.3 microg/d. Long-term treatment was continued at a ziconotide concentration of 12.5 microg/mL and a daily dose of 3.9 microg/d by a SynchroMed Infusion System (Medtronic, Minneapolis, MN). Pain reduction was maintained in the follow-up observation period over 5 months.

Topics: Amitriptyline; Analgesics; Antidepressive Agents, Tricyclic; Azabicyclo Compounds; Calcium Channel Blockers; Female; Humans; Hypnotics and Sedatives; Injections, Spinal; Long-Term Care; Middle Aged; omega-Conotoxins; Pain Measurement; Peripheral Nervous System Diseases; Piperazines; Trigeminal Neuralgia