[Ziconotide: an innovative alternative for intense chronic neuropathic pain].
BACKGROUND
Intense chronic pain is a very important health problem, as it has a high prevalence (5-10%), a multifactorial aetiology and its management is very often a very complex affair. Treatment of severe cases sometimes requires interventional approaches, such as continuous intrathecal infusion of opioids.


METHODS
We report the case of a 38-year-old female with intense neuropathic pain in the lower back and the lower limbs secondary to three operations on the L5-S1 lumbar segment. After implementing several different pharmacological regimes involving both oral and implanted systems (spinal cord stimulation and subarachnoid infusion pump with different pharmacological combinations) with no clinical improvement, intrathecal infusion with ziconotide was included in the protocol.


CONCLUSIONS
Ziconotide is the first specific neuronal blocker that acts on the calcium channel by blocking the N-type voltage-dependent calcium channels. It is a new non-opioid analgesic with approved indication in the treatment of intense chronic pain, in patients who require intrathecal analgesics and are refractory to other analgesic treatments. Therefore, we shall have to consider this drug as a therapeutic alternative in patients do not experience sufficient relief with the pharmacological agents and means currently available to treat them.
Servicio de Anestesia, Reanimación y Terapéutica del Dolor, Unidad Multidisciplinar de Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Espana.
J C
JC
Valía-Vera
V L
VL
Villanueva
J M
JM
Asensio-Samper
M D
MD
López-Alarcón
J A
JA
de Andrés
D000328:Adult; D015360:Analgesia, Epidural; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D020878:Device Removal; D005260:Female; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects / Q000382:microbiology; D015918:Infusion Pumps, Implantable; D017116:Low Back Pain / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D008581:Meningitis / Q000209:etiology; D009437:Neuralgia / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D010149:Postoperative Pain / Q000188:drug therapy* / Q000628:therapy; D011552:Pseudomonas Infections / Q000209:etiology; D012008:Recurrence; D013123:Spinal Fusion; D013126:Spinal Nerve Roots / Q000503:physiopathology / Q000601:surgery; D013346:Subarachnoid Space; D004561:Transcutaneous Electric Nerve Stimulation; D020960:omega-Conotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D018712:Analgesics, Non-Narcotic; D002121:Calcium Channel Blockers; D020960:omega-Conotoxins; C078452:ziconotide