Continuous Intrathecal Baclofen in Spinal Cord Spasticity

Meythaler, J M; Steers, William D.; Tuel, Stephen M.; Cross, Leland L.; Haworth, Charles

doi:10.1097/00002060-199212000-00003

Cited by 100 publications

(55 citation statements)

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“…76 However, studies have shown that intrathecal baclofen only reduces SCI pain when the pain is related to muscle spasms. 88,89 There is need for confirmatory research, due to the small sample size and lack of significant improvement in a later before and after trial. Oral baclofen has not been studied as an antinocioceptive agent in SCI.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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Objective-To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI).Data Sources-Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale.Study Selection-The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, prepost and post studies. Case studies were included only when there were no other studies found.Data Extraction-Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis-Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five Conclusions-Most studies did not specify participants' types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed individuals. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity related pain. Clonidine and morphine, when given together, had a significant synergistic neuropathic pain-relieving effect.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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“…Screening was performed as per usual protocols 14,17,18 to assess patients for intrathecal baclofen. Once the subject had a successful trial, the Codman 3000 pump was implanted.…”

Section: Implantation and Follow-up Proceduresmentioning

confidence: 99%

Intrathecal drug therapy using the Codman Model 3000 Constant Flow Implantable Infusion Pumps: experience with 17 cases

et al. 2004

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Objectives: The objective of this study was to evaluate the accuracy, reliability, safety, and efficacy of the Codman Model 3000 Constant Flow Implantable Infusion Pump for intrathecal baclofen delivery as a therapeutic option for the treatment of severe spasticity. The distinctive features of this pump include a raised, easily palpable septum, a safety valve protecting the bolus pathway, no programmer needed, and no battery to fail. Design: A total of 17 patients with spinal cord injury, multiple sclerosis, or cerebral palsy were implanted with this pump. The accuracy of the pump and drug treatment efficacy was determined at each visit and adjustments to the dosages were made as required. All the intrathecal drug delivery system complications were reviewed. Results: The expected efficacy was achieved. The accuracy of the implanted pumps ranged from 90-97% (average 94%). There were no complications due to primary pump problems. The complications reported are similar to other implantable infusion devices and include dehiscence of the suture line, pressure ulcer development, formation of seroma, inversion of the pump, baclofen overdose, and catheter failures. Conclusion: The Codman Model 3000 Constant Flow Implantable Infusion Pump is an accurate, reliable, and convenient option for patients needing intrathecal baclofen therapy, with complications similar to other available pumps.Spinal Cord (2005) 43, 214-218.

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“…31 Patients missing scheduled appointments for re®lls may present withdrawal symptoms as well. 26,27 Increased spasticity with a functioning system may be related to drug tolerance. Often, the daily doses must be increased over time.…”

Section: Discussionmentioning

confidence: 99%

Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients?

1998

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Objective: To present and discuss treatment of severe spasms related to spinal cord injury with botulinum toxin type A. Design: A 2-year follow-up study of an incomplete T12 paraplegic patient, who was reluctant to undergo intrathecal baclofen therapy, presenting severe painful spasms in his lower limbs treated with intramuscular injections of botulinum toxin type A. Setting: Department of Physical Medicine and Rehabilitation, HoÃ pital de Gravelone, Sion, Switzerland. Subject: Single patient case report. Main outcome measure: Spasticity, spasms and pain measured with the modi®ed Ashworth scale, spasm frequency score and visual analogue scale. Results: Treatment of spasticity with selective intramuscular injections of botulinum toxin type A resulted in subjective and objective improvement. Conclusion: Botulinum toxin type A has its place in the treatment of spasticity in spinal cord injury patients. This treatment is expensive and its e ect is reversible. It can complement intrathecal baclofen in treating upper limb spasticity in tetraplegic patients. Tolerance does occur to the toxin. Although high doses of the product are well tolerated, the quantity should be tailored to the patient's need. The minimal amount necessary to reach clinical e ects should be adhered to and booster doses at short period intervals should be avoided.

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Continuous Intrathecal Baclofen in Spinal Cord Spasticity

Cited by 100 publications

References 0 publications

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Intrathecal drug therapy using the Codman Model 3000 Constant Flow Implantable Infusion Pumps: experience with 17 cases

Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients?

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