To treat spasticity after a neurological injury, individuals may utilize an intrathecal baclofen pump. While this method of treatment can provide long-term spasticity relief, it’s important to understand its associated complications and maintenance requirements. Additionally, there are less invasive treatments that are worth considering before committing to a baclofen pump implantation surgery.
To help you weigh the pros and cons of intrathecal baclofen pumps, this article will discuss:
- How baclofen works
- What are the benefits of using an intrathecal baclofen pump?
- Baclofen pump side effects & complications
- Non-invasive spasticity treatments
How Baclofen Works
Following a neurological injury such as a stroke, individuals may develop spasticity.
Spasticity refers to involuntary muscle contractions caused by disrupted communication between the central nervous system and muscles. Without proper management, it can significantly restrict range of motion and cause pain.
Therefore, doctors often prescribe a muscle relaxant called baclofen to provide spasticity relief. Baclofen works by binding to the GABA receptors in the brain and spinal cord. This inhibits the release of excitatory neurotransmitters that cause muscle contractions.
As a result, the muscles are less hypersensitive to stimulation, which can help improve range of motion, reduce energy expenditure, and make it easier for individuals to participate in rehabilitative therapies.
Baclofen is ideal for treating spasticity caused by neurological injuries such as:
- Traumatic brain injury
- Spinal cord injury
- Cerebral palsy
- Multiple sclerosis
It can be taken orally (in pill form) or administered directly to the fluid surrounding the spinal cord via an intrathecal baclofen pump. While oral baclofen can effectively reduce spasticity, its effects typically only last a few hours and must be taken multiple times a day.
Additionally, when baclofen is taken orally, it can only cross the blood-brain barrier to enter the central nervous system in small amounts. As a result, it must be used in high doses to provide therapeutic relief, which increases the risk of adverse side effects.
The following section will discuss why individuals with spasticity may prefer to use an intrathecal baclofen pump over oral baclofen.
What are the Benefits of Using an Intrathecal Baclofen Pump?
An intrathecal baclofen pump provides a continuous source of baclofen for individuals whose spasticity does not respond to oral baclofen or for those who experience severe side effects to oral baclofen.
The pump must be surgically implanted under the skin of the abdomen. It stores and distributes baclofen to the fluid surrounding the spinal cord through a catheter. Because the intrathecal baclofen pump allows the drug to be administered directly to the central nervous system, it can effectively relieve spasticity in smaller doses than oral baclofen, thus reducing the risk of side effects.
Additionally, intrathecal baclofen pumps can be programmable, which allows the physician to adjust the dosage and rate of distribution from an external device. As a result, individuals can receive the ideal amount of baclofen to manage various severities of spasticity.
To determine if the implantation of an intrathecal baclofen pump is ideal for you, a test dose should be administered before implantation. For many, intrathecal baclofen pump therapy is effective in treating spasticity and can be a viable long-term treatment. However, some patients do not have any response while others don’t respond significantly enough to justify the procedure.
Up next, we’ll discuss risks and side effects associated with intrathecal baclofen therapy.
Intrathecal Baclofen Pump Side Effects & Complications
Intrathecal baclofen therapy was introduced to minimize to side effects of oral baclofen.
The most commonly reported side effects of oral baclofen include:
- Muscle weakness
- Mental confusion
The risk of side effects is substantially lower with intrathecal baclofen pump therapy. However, complications may still occur. These are more frequently attributed to malfunction of the implant, which can lead to insufficient dosing.
Potential complications that may arise when using an intrathecal baclofen pump include:
- No/low drug supply
- Mechanical failure of the pump
- Battery failure
- Catheter kinks or fractures
- Disconnection of the catheter from the pump
- Migration of the catheter
- Refill error
Additional considerations to keep in mind are that the pump must be refilled every few months and that its battery must be replaced every 5-7 years.
Of note, regardless of the mode of baclofen administration used, withdrawal symptoms including seizures may occur if you stop taking baclofen suddenly.
Before committing to baclofen pump implantation surgery, it may be worth trying less invasive spasticity treatments. These will be discussed in the following section.
Non-Invasive Spasticity Treatments
While baclofen can temporarily relieve high muscle tone, it does not target the underlying cause of spasticity. As a result, when individuals stop using baclofen, spasticity will return.
As mentioned earlier, spasticity is a result of damage to the brain and/or spinal cord that disrupts the transmission of messages between the central nervous system and muscles. Because signals from the brain cannot pass through the damage, the muscles of individuals with spasticity become hyperactive and remain contracted.
One way to promote more permanent spasticity relief is to focus on activating neuroplasticity. Neuroplasticity is the central nervous system’s ability to make adaptive changes by rewiring its neural circuitry. It makes it possible for functions affected by neurological injury to be reorganized to areas unaffected by damage. This creates the potential for communication between the brain and muscles to be restored, resulting in permanent spasticity relief.
The most effective way to promote neuroplasticity is through highly repetitive, task-specific practice. A physical therapist can help assess which muscles are affected by spasticity and create a personalized exercise regimen to target them. Continuously practicing those exercises will help reinforce demand for those functions and encourage neuroadaptive changes.
A great way to stay motivated to accomplish the high repetition necessary to promote neuroplasticity is to use interactive rehab exercise equipment like Flint Rehab’s FitMi. It includes 40 PT-recommended exercises that adapt to your ability level to provide the perfect amount of challenge. Even individuals with severely limited mobility are often able to accomplish hundreds of repetitions per workout, making it a great way to spark neuroplasticity and improve spasticity.
Another problem individuals may face when trying to promote neuroplasticity is that spasticity restricts their range of motion, making it difficult to practice exercises correctly. In such cases, it can help to utilize oral baclofen to temporarily relieve spasticity and create a window of opportunity to practice exercises with correct form and better mobility. This way, the progress made while using baclofen can carry over into long-term improvements through neuroplasticity.
Using an Intrathecal Baclofen Pump to Treat Spasticity: Key Points
Intrathecal baclofen pumps can help treat spasticity after neurological injuries like stroke, spinal cord injury, and traumatic brain injury.
Because they administer baclofen directly to the central nervous system, intrathecal baclofen pumps require lower doses of the drug, which significantly reduces the risk of side effects.
However, these pumps do require surgery and regular maintenance every few years, which may not be ideal. Fortunately, there are other ways to promote spasticity relief, including highly repetitive, task-specific exercise that activates neuroplasticity.
We hope this article helps you understand the risks and benefits associated with intrathecal baclofen pumps, as well as other options that may be worth considering.
image credits: iStock/Victor_69