Disclosures: Edward J. Chang:

Case Diagnosis: Chronic pain secondary to spinal cord injury

Case Description: A 45-year-old male with a 10-year history of spinal cord injury from a motor vehicle accident while riding a bicycle presented for continued management for his chronic pain syndrome, lumbar radiculopathy, post-laminectomy syndrome, and pelvic pain. After a previous Ziconotide pump trial demonstrated positive results, the patient proceeded with a continuous intrathecal pump implantation which infused the T9-T10 intrathecal space. Hydromorphone and bupivacaine infusions were administered for pain until Ziconotide approval. Ziconotide was initially administered at 25 mcg/mL with a dose of 2.498 mcg/day. In intervals of 2 weeks, his dose was increased to 3.497 mcg/day to 4.438 mcg/day to 4.695 mcg/day.

Setting: Outpatient orthopedic center and pain clinicAssessment/

Results: The patient continued to experience pain alleviation when transitioning from hydromorphone and bupivacaine to Ziconotide. New side effects included confusion, dizziness, and short-term memory issues. Within 2 weeks of Ziconotide use, these symptoms began to subside, and he developed nerve sensations that were present before the spinal cord injury from below the knees to his toes bilaterally.

Discussion: Ziconotide, a neuronal calcium channel blocker, is an alternative treatment method for pain in spinal cord injury patients. Rodent studies have suggested neuroprotective characteristics for acute traumatic brain injuries and spinal cord ischemia due to Ziconotide’s mechanism of preventing neuronal damage led by calcium accumulation. Limited information exists on potential benefits of Ziconotide in patients with a longstanding history of spinal cord damage. In this case, Ziconotide provided an added benefit of nerve sensation recovery that, to our knowledge, has not been previously described.

Conclusion: While Ziconotide pump infusion should be continually considered for its pain-relieving properties, future studies should explore possible neuro-regenerative effects of Ziconotide, specifically in spinal cord injury patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nerve-sensation-recovery-implications-of-ziconotide-use-for-spinal-cord-injury-related-pain/