{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T19:50:08Z","timestamp":1710359408813},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,1,7]],"date-time":"2015-01-07T00:00:00Z","timestamp":1420588800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ziconotide is an intrathecally administered nonopioid analgesic for the treatment of severe chronic pain. Previous reports have noted rhabdomyolysis in patients receiving ziconotide during the initial single\u2010shot trial or due to concurrent medical problems. We present a case of an acute rhabdomyolysis following an intrathecal bolus injection of ziconotide on a patient who had long\u2010term exposure to the drug.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>The patient suffered from chronic neuropathic pain with diagnosis of failed back surgery syndrome and received intrathecal ziconotide for 2\u00a0years. Moderate side effects resulting from dose escalation led to a discontinuation of the drug. The pump medication was changed to morphine, which failed to provide adequate analgesia even with dose titration. A single intrathecal bolus of ziconotide, as an adjunctive therapy, resulted in good pain control. Two months later, the patient received a second ziconotide injection. Sixteen hours after the injection, she presented to local emergency center with nausea, vomiting, diarrhea, and myalgia. She had significantly increased <jats:styled-content style=\"fixed-case\">CK<\/jats:styled-content> levels and was admitted for intravenous hydration and close observation. Her serum <jats:styled-content style=\"fixed-case\">CK<\/jats:styled-content> level peaked at 4940\u00a0IU\/L. The patient was discharged on hospital day 3 with a <jats:styled-content style=\"fixed-case\">CK<\/jats:styled-content> level of 808\u00a0IU\/L. Her symptoms resolved without renal impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The clinical scenario described is a case of acute rhabdomyolysis from an intrathecal bolus injection of ziconotide in a patient with prior long\u2010term exposure to the drug. The decrease in <jats:styled-content style=\"fixed-case\">CK<\/jats:styled-content> levels coincided well with the average half\u2010life of ziconotide; however, the rhabdomyolysis may have been potentiated by hypokalemia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12273","type":"journal-article","created":{"date-parts":[[2015,1,7]],"date-time":"2015-01-07T09:28:01Z","timestamp":1420622881000},"source":"Crossref","is-referenced-by-count":8,"title":["Acute Rhabdomyolysis in a Patient with Long\u2010Term Exposure to Intrathecal Ziconotide: A Case Report"],"prefix":"10.1111","volume":"15","author":[{"given":"Christian","family":"Horazeck","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Duke University Medical Center Durham North Carolina U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert S.","family":"Huh","sequence":"additional","affiliation":[{"name":"Medical College of Georgia Augusta Georgia U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Billy K.","family":"Huh","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine The University of Texas MD Anderson Cancer Center Houston Texas U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,1,7]]},"reference":[{"key":"e_1_2_4_2_1","first-page":"61","article-title":"Intrathecal ziconotide and baclofen provide pain relief in seven patients with neuropathic pain and spasticity: case reports","volume":"45","author":"Saulino M","year":"2009","journal-title":"Eur J Phys Rehab Med."},{"key":"e_1_2_4_3_1","volume-title":"Highlights of Prescribing Information","author":"Azur Pharma, Inc","year":"2010"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.10.003"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(99)00254-7"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e3181606fad"},{"key":"e_1_2_4_7_1","unstructured":"National PBM Drug Monograph Ziconotide for Intrathecal Infusion (Prialt\u00ae). 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