Lumbar neuropathic pain of lower limbs treated by spinal infusion of ziconotide - a case report

The Author reports the case of a patient with severe lumbar pain unresponsive to NSAIDs. Initial treatment with tramadol gave poor results and a new protocol with hydromorphone-pregabalin was started. The analgesic response was observed only following high hydromorphone doses, associated with unacceptable side effects.A spinal device for continuous intrathecal infusion was then implanted, in order to administer ziconotide, a new opioid drug. Associated therapy included hydromorphone-pregabalin. At the 4 mcg/die dose ziconotide resulted highly effective (with a VAS reduction pain 6-7 to 2-3) even at 1st day after implantation; in addition at day 10, opioid dose was strongly reduced and pregabalin withdrawn.The treatment was associated with a good tolerability.The encouraging results prompted the Author to test ziconotide in further cases of severe chronic pain.