printer-friendly version (PDF) - Reflex Sympathetic Dystrophy ...

More documents

Recommendations

Info

EMERGING TREATMENT AND DIAGNOSIS | WEBSTER & FAKATA skeletal muscle, was common in 40% of patients participating mostly in open-label studies. Elevated CK-MM usually occurred within the first 2 months of therapy. Other isoenzymes were rarely affected. Of all patients studied in clinical trials, there was one case of symptomatic myopathy and two acute renal failures associated with rhabdomyolysis and extreme CK elevation (17, 000-27,000 IU/L) (12). A baseline CK should be obtained with another CK at 2 months, and every 6 months thereafter. CKs should be obtained if the patient is exhibiting any new neuromuscular symptoms. Conclusion ZICONOTIDE MAY BE MOST EFFECTIVE in reducing pain and preventing central sensitization by its mechanism of action. As a result, it may be useful in many patients with CRPS. Ziconotide will likely not be first-line therapy for CRPS but will have a role when less invasive therapies have been exhausted and the pain becomes chronic and severe enough to warrant an IT pump. Some clinicians are discussing their success treating CRPS through an earlier utilization of ziconotide by external catheter. However, prolonged use of external catheters increases the risk of meningitis. Immediate pain relief should not be expected with the recommended slow titration. Treatment with ziconotide will need to be based on the individual’s response. Ziconotide has the potential of becoming an important analgesic in our armamentarium to treat CRPS. REFERENCES 1. Ziconotide: Use in Reflex Sympathetic Dystrophy, PRI031_ Use_in_Reflex_Sympathetic Dystrophy 03 Ref Number:1-6462160, Elan Pharmaceutical Inc. 2. Miljanich GP. Ziconotide: Neuronal Calcium Channel Blocker for Treating Severe Chronic Pain. Current Medicinal Chemistry, 2004. 11: 3029-3040. 3. Ribbers, GM, Geurts AC, Stam HJ, Mulder T. Pharmacologic Treatment of Complex Regional Pain Syndrome I: A Conceptual Framework. Archives of Physical Medicine and Rehabilitation 2003; 84: 141-146. 4. Harden RN. Chronic Neuropathic Pain. The Neurologist 2005 11(2): 111- 122. 5. Miljanich GP. Ziconotide: Neuronal Calcium Channel Blocker for Treating Severe Chronic Pain. Current Medicinal Chemistry, 2004. 11: 3029-3040. 6. Hassenbusch SJ , Portenoy RK, Cousins M et al. Polyanalgesic Consensus Conference 2003: An Update on the Management of Pain by Intraspinal Drug Delivery-Report of an Expert Panel. Journal of Pain and Symptom Management. 2004, 27(6):540-563. 7. Shields D, Montenegro R . The Chemical Stability of Admixtures Combining Ziconotide and Hydromorphone during Simulated Intrathecal Administration. (Abstract) Neuromodulation 2005 Vol 8(in press). 8. Shields D, Montenegro R, Ragusa M. The Chemical Stability of Admixtures Combining Ziconotide and Morphine Sulfate during Simulated Intrathecal Administration. (Abstract) Neuromodulation 2005. Vol 8(in press). 9. Shields D, Montenegro R, The Chemical Stability of Admixtures Combining Ziconotide and Clonidine during Simulated Intrathecal Administration. (Abstract) Neuromodulation 2005. Vol 8(in press). 10. Shields D, Montenegro R, Ragusa M . The Chemical Stability of Admixtures Combining Ziconotide and Bupivacaine during Simulated Intrathecal Administration. (Abstract). Neuromodulation 2005 Vol 8(in press). 11. Webster LR, Fakata KL, Ziconotide for Severe Chronic Pain. Practical Pain Management May 2005. 12. Prialt (ziconotide intrathecal infusion) prescribing information. Elan Pharmceutical Inc. 2/2005. LYNN R. WEBSTER, MD, is Medical Director, CEO, Lifetree Pain Clinic, Salt Lake City, Utah KERI L. FAKATA, PHARMD, Lifetree Research and Pain Clinic, Clinical/Research Pain Management Pharmacist, Salt Lake City, UT 66 | T H E PA I N P R A C T I T I O N E R | S P R I N G 2 0 0 6
D O YO U G E T I T ? Subscribe to The Pain Practitioner If you are a member of the American Academy of Pain Management you are entitled to many benefits, including The Pain Practitioner, our quarterly magazine. If you are not an Academy member, but would like to subscribe to this information-filled publication or buy a subscription for a colleague or your office, you can do so for only $35 a year. Each issue contains practical information on a current pain topic from an interdisciplinary perspective, interviews with patients and practitioners, advocacy information, and resources. Get it now! Just fill out the form below, include a check or money order, and send to Jillian Manley, American Academy of Pain Management, 13947 Mono Way #A, Sonora, CA 95370. I would like to subscribe to The Pain Practitioner. Enclosed is my check/money order in the amount of $35. Please send the magazine to: Name: Address: Telephone/email: / Card Visa Mastercard Discover expiration date Card # – – – / verification code
Page 1 and 2:
A M E R I C A N A C A D E M Y O F P
Page 3 and 4:
A M E R I C A N A C A D E M Y O F P
Page 6 and 7:
EDITORS’ CORNER | COMPLEX REGIONA
Page 8 and 9:
EDITORS’ CORNER | COMPLEX REGIONA
Page 10 and 11:
COMMENTARY | GIORDANO Comprehending
Page 16 and 17: FEATURE | BROATCH RSDSA: Expanding
Page 18 and 19: FEATURE | BROATCH We are acutely aw
Page 20 and 21: FEATURE | BROATCH information, such
Page 22 and 23: FEATURE | PATIENT PROFILE PEOPLE WI
Page 24 and 25: PEOPLE WITH CRPS | THEIR STORIES AN
Page 26 and 27: PEOPLE WITH CRPS | THEIR STORIES AN
Page 32 and 33: FEATURE | GALER 32 | T H E PA I N P
Page 34 and 35: FEATURE | GALER TABLE 1 | IASP Diag
Page 36 and 37: FEATURE | GALER Although there is s
Page 38 and 39: FEATURE | GALER 10. Gammaitoni A, G
Page 40 and 41: INTERVIEW | COVINGTON LIFEBOAT mixe
Page 42 and 43: INTERVIEW | COVINGTON Q. Have any s
Page 45 and 46: Reap the Rewards of Membership Beco
Page 47 and 48: with depression. However, they foun
Page 49 and 50: It is common for patients in pain i
Page 51 and 52: There are multiple forms of amplifi
Page 53 and 54: Okay for Vegas. Not your Practice.
Page 55 and 56: especially opioids. Opioids should
Page 57 and 58: Subscribe to Currents Today! The Ac
Page 59 and 60: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 61 and 62: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 63 and 64: ZICONOTIDE: Promising New Treatment
Page 65: UNRIVALED INDEPENDENCE COMING SOON
Page 69 and 70: SCS as Part of the CRPS Treatment A
Page 72 and 73: OPINION | GETSON The Use of Thermog
Page 74 and 75: IN CONCLUSION | MOSKOVITZ A Theory
Page 76 and 77: IN CONCLUSION | MOSKOVITZ even thin
Page 78 and 79: IN CONCLUSION | MOSKOVITZ Comorbidi
Page 80 and 81: IN CONCLUSION | MOSKOVITZ empathy e
Page 82 and 83: AC ADEMY NEWS | AMERICAN ACADEMY OF
Page 84 and 85: CL ASSIFIED ADS & DIRECTORY | AMERI
Page 86 and 87: RESOURCES | CRPS RESOURCES FOR CRPS
Page 88: A m e r i c a n A c a d e m y o f P
show all

printer-friendly version (PDF) - Reflex Sympathetic Dystrophy ...

Create successful ePaper yourself

Delete template?

Save as template?