ID: 219398 Intrathecal Ziconotide for Refractory Trigeminal Neuralgia: A Case Report

Trigeminal neuralgia is a rare condition characterized by episodes of debilitating facial pain. There are multiple treatment options available for trigeminal neuralgia, ranging from conservative medical management to invasive surgical procedures. One of the emerging treatment options for refractory trigeminal neuralgia is the use of intrathecal ziconotide infusions. Ziconotide is a new generation non-opioid analgesic used for chronic neuropathic pain. Its mechanism of action involves reversibly binding to N-type voltage gated calcium channels and preventing the influx of Ca2+ into the presynaptic terminal. This ultimately blocks neurotransmitter release and halts synaptic transmission of pain. As a non-opioid analgesic, ziconotide presents a favorable lack of tolerance and withdrawal effects. Despite a lack of studies, few authors have reported successful use of intrathecal ziconotide for chronic refractory trigeminal neuralgia. We report a case of a 54-year-old female with severe trigeminal neuralgia who experienced significant pain relief after placement of a ziconotide intrathecal pump.