title: Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports.
abstract: 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.
authors.affiliation: MossRehab, Thomas Jefferson University Elkins Park, PA, USA. docsaulino@msn.com
authors.forename: M
authors.initials: M
authors.lastname: Saulino
authors.forename: A W
authors.initials: AW
authors.lastname: Burton
authors.forename: D A
authors.initials: DA
authors.lastname: Danyo
authors.forename: S
authors.initials: S
authors.lastname: Frost
authors.forename: J
authors.initials: J
authors.lastname: Glanzer
authors.forename: D R
authors.initials: DR
authors.lastname: Solanki
mesh_terms: D000328:Adult; D001418:Baclofen / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy*; D009437:Neuralgia / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D016896:Treatment Outcome; D020960:omega-Conotoxins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D009125:Muscle Relaxants, Central; D018696:Neuroprotective Agents; D020960:omega-Conotoxins; C078452:ziconotide; D001418:Baclofen