863 - Intrathecal Ziconitide as a treatment for Chronic Pelvic Pain

Case Diagnosis: A 49-year old G2P1001 woman presented to her OBGYN physician with a history of painful bladder syndrome and chronic pelvic pain. She had been non-responsive to conservative management. Diagnostic cystoscopy and laparoscopy were inconclusive in identifying a pain source. The OBGYN provider referred the patient to our clinic as a candidate for interventional pain treatment.

Case Description: The patient presented to our pain management clinic with a referral for chronic pelvic pain management. She rated her pain 10/10 on the Visual Analog Scale (VAS) and reported constant symptoms limiting her daily activities. Past unsuccessful treatments included botulinum toxin A, gabapentin, amitriptyline and hydrocodone. We discussed interventional options and the patient elected to proceed with an Intrathecal (IT) Ziconotide trial. The trial was successful at reducing pain with an improvement in functional activities. The patient decided to proceed with an Intrathecal Drug Delivery Device (ITDD) with a continuous IT Ziconotide infusion. ITDD was implanted under fluoroscopic guidance. The 20 milliliter ITDD was set to deliver at 2.5 microgram per milliliters per day. At 1 month follow up she noted significant improvement of her formerly refractory pain without any side effects. Her pain was reduced to 0/10 on the VAS at this visit along with improved mobility and ADLs.

Discussions: Chronic pelvic pain affects millions of patients, approximately 4-16% of all women. We believe that this report records the first documented case of successful IT Ziconotide for chronic pelvic pain. Review of the literature mentions the use of IT Ziconotide for pelvic pain but no actual reported cases have been documented.

Conclusions: < ! This 49-year old female had substantial pain reduction from 10/10 to 0/10 after receiving an IT Ziconotide ITDD system. It is our hope that this case encourages further research and controlled studies of the use of IT Ziconotide for chronic pelvic pain.