Ziconotide in severe, drug-resistant cancer pain. Preliminary experience

The Author reports the case of ziconotide intrathecal treatment in three terminal cancer patients, with nociceptive and neuropathic pain, unresponsive to the treatment with intrathecal opioid and adjuvant drugs.An external pump for continuous subarachnoid infusion was implanted to the three patients. The initial dose was 2,4 mcg/die, with increments of 1,2 mcg/die every three days till the maximum dose of 4,8 mcg/die in two patients (survival 61 and 45 days) and 7,2 mcg/die in a patient (survival 52 days). VAS reduction was 50% in the first patient, of 57% in the second one and 70% in the third one.In one case, at the dose of 4,8 mcg/die, the treatment was associated with important collateral effects, that requested the temporary suspension of the drug.