by Michael Saulino, MD

Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Philadelphia, PA.

STUDY DESIGN: Case report.

OBJECTIVES: To report a novel management strategy for neuropathic pain management after spinal cord injury.

SETTING: Outpatient spinal cord injury (SCI) clinic.

METHODS: The patient demonstrated two neuropathic pain syndromes, namely at- and below-level pain. These syndromes were recalcitrant to conservative measures and a decision was made to proceed with intrathecal therapies.

RESULTS: The patient’s at-level pain was responsive to intrathecal hydromorphone but the below-level pain was unaffected by this intervention. Intrathecal ziconotide provided an opposite response with a positive effect observed on the below-level pain and minimal effect on the at-level pain. The combination of intrathecal ziconotide and hydromorphone provided effective relief for both components of the patient’s SCI associated neuropathic pain.

CONCLUSIONS: The combination of intrathecal ziconotide and hydromorphone has the potential to provide significant pain relief for patients with neuropathic pain associated with spinal cord injury.

Spinal Cord. 2007 Nov;45(11):749-52. Epub 2007 Feb 20.