Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report
Brandon P Staub,1 Gianna P Casini,2 Edward A Monaco III,3,4 Raymond F Sekula Jr,3,4 Trent D Emerick4,5 1Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Pain Management, Parkview Health, Fort Wayne, IN, USA; 3Department of Neurosurgery, University of Pitts...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-03-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/near-resolution-of-persistent-idiopathic-facial-pain-with-low-dose-lum-peer-reviewed-article-JPR |
| _version_ | 1818278037996699648 |
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| author | Staub BP Casini GP Monaco III EA Sekula Jr RF Emerick TD |
| author_facet | Staub BP Casini GP Monaco III EA Sekula Jr RF Emerick TD |
| author_sort | Staub BP |
| collection | DOAJ |
| description | Brandon P Staub,1 Gianna P Casini,2 Edward A Monaco III,3,4 Raymond F Sekula Jr,3,4 Trent D Emerick4,5 1Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Pain Management, Parkview Health, Fort Wayne, IN, USA; 3Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 4University of Pittsburgh Physicians, Pittsburgh, PA, USA; 5Division of Chronic Pain, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Purpose: Persistent idiopathic facial pain (PIFP) is a poorly defined and debilitating chronic pain state with a challenging and often inadequate treatment course. This is the first case report identifying the novel use of low-dose lumbar intrathecal ziconotide to successfully treat PIFP with nearly complete resolution of pain and minimal to no side effects. Methods: The patient was a 37 year-old female whose PIFP was refractory to multimodal medication management and multiple neurovascular surgical interventions. A single-shot lumbar intrathecal trial of ziconotide (2.5 mL, equivalent 2.5 μg) was injected when she was at her baseline pain level — VAS 7/10. She received complete resolution of her pain for about 9 hours, concordant with ziconotide’s half-life. She was subsequently implanted with a lumbar intrathecal delivery system. Results: The patient experienced complete resolution of her facial pain with a single-shot intrathecal trial of ziconotide. The intrathecal pump system has provided nearly complete (VAS 1/10) pain relief. Two flares of pain occurred 10 and 18 months after pump placement, which subsequently resolved after increasing the ziconotide dose by 0.5 μg/day on each occasion. The patient is currently maintained on a dose of 2.0 μg/day and is pain-free. Conclusion: This is the first case report describing the use of a single-shot lumbar intrathecal trial of ziconotide and subsequent placement of lumbar (as opposed to thoracic) intrathecal ziconotide pump for PIFP. A single-injection intrathecal trial is a low-risk, viable option for patients with this debilitating and frustrating pain condition. Successful trials and subsequent intrathecal pump placement with ziconotide may supplant multimodal medication management and/or invasive orofacial surgical intervention for PIFP. Keywords: allodynia, chronic pain, neuropathic pain, pain disorder, pain management, persistent pain |
| first_indexed | 2024-12-12T23:11:04Z |
| format | Article |
| id | doaj.art-2d38e9b7e09948f4a7543c7439127cfa |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-12T23:11:04Z |
| publishDate | 2019-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-2d38e9b7e09948f4a7543c7439127cfa2022-12-22T00:08:35ZengDove Medical PressJournal of Pain Research1178-70902019-03-01Volume 1294594944509Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case reportStaub BPCasini GPMonaco III EASekula Jr RFEmerick TDBrandon P Staub,1 Gianna P Casini,2 Edward A Monaco III,3,4 Raymond F Sekula Jr,3,4 Trent D Emerick4,5 1Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Pain Management, Parkview Health, Fort Wayne, IN, USA; 3Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 4University of Pittsburgh Physicians, Pittsburgh, PA, USA; 5Division of Chronic Pain, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Purpose: Persistent idiopathic facial pain (PIFP) is a poorly defined and debilitating chronic pain state with a challenging and often inadequate treatment course. This is the first case report identifying the novel use of low-dose lumbar intrathecal ziconotide to successfully treat PIFP with nearly complete resolution of pain and minimal to no side effects. Methods: The patient was a 37 year-old female whose PIFP was refractory to multimodal medication management and multiple neurovascular surgical interventions. A single-shot lumbar intrathecal trial of ziconotide (2.5 mL, equivalent 2.5 μg) was injected when she was at her baseline pain level — VAS 7/10. She received complete resolution of her pain for about 9 hours, concordant with ziconotide’s half-life. She was subsequently implanted with a lumbar intrathecal delivery system. Results: The patient experienced complete resolution of her facial pain with a single-shot intrathecal trial of ziconotide. The intrathecal pump system has provided nearly complete (VAS 1/10) pain relief. Two flares of pain occurred 10 and 18 months after pump placement, which subsequently resolved after increasing the ziconotide dose by 0.5 μg/day on each occasion. The patient is currently maintained on a dose of 2.0 μg/day and is pain-free. Conclusion: This is the first case report describing the use of a single-shot lumbar intrathecal trial of ziconotide and subsequent placement of lumbar (as opposed to thoracic) intrathecal ziconotide pump for PIFP. A single-injection intrathecal trial is a low-risk, viable option for patients with this debilitating and frustrating pain condition. Successful trials and subsequent intrathecal pump placement with ziconotide may supplant multimodal medication management and/or invasive orofacial surgical intervention for PIFP. Keywords: allodynia, chronic pain, neuropathic pain, pain disorder, pain management, persistent painhttps://www.dovepress.com/near-resolution-of-persistent-idiopathic-facial-pain-with-low-dose-lum-peer-reviewed-article-JPRAllodyniaChronic painNeuropathic PainPain DisorderPain ManagementPersistent Pain |
| spellingShingle | Staub BP Casini GP Monaco III EA Sekula Jr RF Emerick TD Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report Journal of Pain Research Allodynia Chronic pain Neuropathic Pain Pain Disorder Pain Management Persistent Pain |
| title | Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report |
| title_full | Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report |
| title_fullStr | Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report |
| title_full_unstemmed | Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report |
| title_short | Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report |
| title_sort | near resolution of persistent idiopathic facial pain with low dose lumbar intrathecal ziconotide a case report |
| topic | Allodynia Chronic pain Neuropathic Pain Pain Disorder Pain Management Persistent Pain |
| url | https://www.dovepress.com/near-resolution-of-persistent-idiopathic-facial-pain-with-low-dose-lum-peer-reviewed-article-JPR |
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