Baclofen is a muscle relaxant that is used to treat conditions that cause spasticity such as spinal cord injuries, cerebral palsy, multiple sclerosis, and other muscle-related conditions. An intrathecal baclofen pump is used to get the medication directly to the spinal cord, rapidly increasing relief.
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What is a baclofen pump?
A baclofen pump is a system comprising of a catheter and a pump that delivers the medication directly to the spinal cord. In order to use a baclofen pump, the patient will require surgery to insert a small round metallic disc (the pump) under the skin around the abdomen, which is controlled by a microprocessor.
The microprocessor controls the flow of the medication through the pump to a catheter which is also placed under the skin and connects to the spine at multiple locations, delivering the medication. This treatment is called intrathecal baclofen therapy.
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What is intrathecal baclofen therapy?
The process of using a baclofen pump is part of intrathecal baclofen (ITB) therapy, a treatment developed in the late 1980s to help those suffering from conditions that cause spasticity such as multiple sclerosis.
What causes spasticity?
Spasticity occurs in conditions that affect the spinal cord and brain such as multiple sclerosis, brain damage, spinal cord injuries, or stroke. Spasticity affects movement due to signals between the brain and spinal cord becoming unbalanced. These movement impairments include involuntary movements, hyperexcitable stretch reflexes, stiffness/tightness, spasms, and reduced voluntary movement.
These symptoms can be painful as well as being disruptive in day-to-day activities. They can also cause disturbed sleep and can have a negative impact on mental health. In extreme cases, spasticity can lead to limitations in movement, known as contractures, which can be debilitating.
How do I know if I need ITB?
If you have been taking baclofen or similar medications orally to treat a condition that results in spasticity and the drug is not having the desired effect, then you may be eligible for ITB treatment.
Patients will often be referred for a clinical assessment to be performed by a physician and physical/occupational health therapist. After an initial evaluation, the patient will have a trial injection of the drug, performed via a spinal tap where baclofen will be injected directly into the spine. After the results of the procedure have been evaluated, the medical team will decide whether ITB therapy is the right course of treatment.
What are the benefits of ITB?
- ITB is more effective in treating the symptoms of spasticity than oral baclofen as the drug interacts directly with the spinal cord.
There are also less severe side effects associated with ITB than oral baclofen.
ITB can be supplied directly throughout the day and night in a steady stream.
ITB is reversible, meaning that if spasticity symptoms reduce then the baclofen pump can be removed.
The microprocessor means that programming the administration of the drug is very flexible, meaning varying doses can be supplied at different times of the day (having a higher dose in the evening, for example).
What are the negatives of intrathecal baclofen treatment?
Receiving treatment for spasticity via a baclofen pump comes with a variety of complications that should be considered.
The procedure requires surgery under anaesthesia which comes with the same risks as any surgery.
There is also the risk of the area where the pump is located becoming infected if not properly treated.
Intrathecal baclofen treatment is also very invasive and can be uncomfortable initially.
There is a risk of malfunction from the machine which will need professional repair.
The drug can cause weakness/lethargy due to its muscle-relaxing qualities.
There are also reported doses of baclofen overdose and baclofen withdrawal from ITB, the latter being an indicator of addiction.
Can ITB treatment lead to baclofen addiction?
There has been little research into the long term effects of ITB treatment and addiction. Baclofen taken orally is not considered to lead to dependence and addiction. However, there have been reports of people having withdrawal symptoms from taking the substance orally, which is an observed symptom of physical dependence and addiction.
These withdrawal symptoms have also been observed in ITB treatment patients as have cases of baclofen overdose from patients self-medicating with too high a dose.
Further research is needed to confirm whether there is a direct correlation between ITB treatment and baclofen dependence as there is little evidence of other criteria for measuring addiction being present in those receiving treatment.
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