title: Successful reduction of neuropathic pain associated with spinal cord injury via of a combination of intrathecal hydromorphone and ziconotide: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report a novel management strategy for neuropathic pain management after spinal cord injury.
  
  
  METHODS
  Outpatient spinal cord injury (SCI) clinic.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Moss Rehab., Department of Rehabilitation Medicine, Thomas Jefferson University, Elkins Park, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Saulino
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage*; D007278:Injections, Spinal / Q000379:methods; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D013119:Spinal Cord Injuries / Q000150:complications*; D020960:omega-Conotoxins / Q000008:administration & dosage*
chemical_list: D000700:Analgesics; D020960:omega-Conotoxins; C078452:ziconotide; D004091:Hydromorphone