Intrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome.
OBJECTIVE
We present 2 case reports that illustrate that chronic intrathecal (IT) baclofen administration may be efficacious in treating patients with long-standing complex regional pain syndrome, type I (CRPS I) who have failed treatment with multiple drugs and procedures.


METHODS
Both cases presented were women who developed CRPS I following multiple lower extremity surgeries. One patient had had symptoms for 5 years and had continued symptoms despite multiple sympathetic blocks, sympathectomy, spinal cord stimulation, and various medication trials. The other patient had had chronic lower extremity pain for 30 years and symptoms of CRPS for about 5 years. Her symptoms continued despite multiple sympathetic blocks, sympathectomy, and many medications. Neither patient had motor dysfunction (dystonia, tremors, spasticity) associated with their painful disorder. One patient experienced good control of pain, allodynia, and autonomic dysfunction with a combination of IT baclofen and clonidine after failing treatment with IT morphine. Baclofen alone produced intolerable side effects at the doses required to produce adequate analgesia. The other patient experienced long-term control of pain, allodynia, and autonomic symptoms with IT baclofen alone.


CONCLUSIONS
IT baclofen appears to be an option for patients with intractable CRPS who have failed other modalities, including IT morphine.
Zuniga
Robert E
RE
Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131-5216, USA.
Perera
Sardha
S
Abram
Stephen E
SE
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D003000:Clonidine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008875:Middle Aged; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy*
D000700:Analgesics; D001418:Baclofen; D003000:Clonidine