Lanzillo, B.a , Loreto, V.a , Calabrese, C.a , Estraneo, A.a , Moretta, P.a , Trojano, L.b
Does pain relief influence recovery of consciousness? A case report of a patient treated with ziconotide
(2016) European Journal of Physical and Rehabilitation Medicine, 52 (2), pp. 263-266.
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84971408202&partnerID=40&md5=3e5b65d6c4d2d61ec2514a2b21c90914
AFFILIATIONS: a.Department of Neurorehabilitation, S. Maugeri IRCCS Foundation, Centro di Telese Terme Telese Terme, Via Bagni Vecchi 82037, Telese Terme (BN), Italy;
b.Second University of Naples, Faculty of Psychology, Naples, Italy
ABSTRACT: For people with cervical spinal cord injury (SCI), access to computers can be difficult, thus several devices have been developed to facilitate their Disorders of consciousness (DOC) are difficult to classify. The degree of consciousness varies from coma to vegetative state or unresponsive wakefulness syndrome (UWS) and minimally conscious state. Correct diagnosis has important ethical and legal implications, and pain may be cause of misdiagnosis. We describe here a patient with traumatic brain injury, classified as UWS. His clinical picture was dominated by spasticity, and pain. He underwent intrathecal treatment of spasticity with baclofen. Improvement was not that expected. However, there was a dramatic improvement when ziconotide was added to relieve pain; the patient began to eat by mouth, talk, and his tracheal tube could be removed and he is currently classified as having severe disability. The suspension of ziconotide caused a clear re-worsening of clinical condition, reverted by his reintroduction. Pain is an important factor in patients with DOC. Anecdotal reports of improved consciousness with intrathecal baclofen therapy may be due to pain relief. Reduction of pain in DOC is important and drugs should not interfere with cognition, and must be effective and manageable. Ziconotide may be one of the possible candidate due to its synergistic antispastic action in combination with baclofen when an intratecal pump has been implanted. © 2015 EDIZIONI MINERVA MEDICA.
AUTHOR KEYWORDS: Baclofen; Brain injuries; Consciousness Disorders; Pain; Ziconotide; Injections, spinal
DOCUMENT TYPE: Article
