Intracisternal ziconotide infusion. Clinical case of an inoperable pharynx cancer patient with severe cervico-facial pain syndrome

The authors describe the clinical case of a patient suffering from severe cervico-facial pain syndrome with great incident component from inoperable pharynx cancer. The patient that was poorly responding to systemic therapy with high doses of opioids, benefited from intrathecal administration of ziconotide in combination with morphine and bupivacaine. After a long period of effectiveness (16 months), the patient complained of pain recurrence. The increase of ziconotide dose caused a serious adverse effect (psychosis), which led to the suspension of the drug. After four weeks washout, lower doses of the drug (1/4) administered at cervical segmental level; the patient achieved again a good pain relief.