An effective treatment of severe complex regional pain syndrome type 1 in a child using high doses of intrathecal ziconotide.

To the Editor: Ziconotide (Prialt, Elan Pharmaceuticals Inc., San Diego, CA) is a calcium channel blocker approved by the U.S. Food and Drug Administration for treatment of chronic pain by the intrathecal (IT) route. Although ziconotide has been used for a considerable time in clinical practice, there are only a few reports on its effectiveness and associated side effects. Three published double-blind and placebocontrolled trials demonstrated significant improvement in control of refractory pains and warned of the numerous potential side effects from infusion of IT ziconotide. There are no reports on effectiveness and side effects of IT ziconotide treatment in a pediatric patient population. Here, we present a difficult case of a now 17-year-old female with long-standing, severe Complex Regional Pain Syndrome (CRPS) type 1, already in trophic phase and with persistent, severe allodynia, who had full resolution of allodynia, improvement of functional capacity, and diminished pain scores when IT infusion of ziconotide was optimized.