Intrathecal baclofen as adjuvant therapy to enhance the effect of spinal cord stimulation in neuropathic pain: a pilot study.
Only about 60-70% of well selected patients with neuropathic pain syndromes of peripheral origin enjoy sufficient pain relief with spinal cord stimulation (SCS). Since recent animal experiments have demonstrated that the GABA-B receptor is pivotal in the effect of SCS on certain neuropathic symptoms, the use of baclofen as an adjunct to stimulation emerged as an option in patients not responding satisfactorily to SCS. Forty-eight patients with neuropathic pain of peripheral origin responding poorly to SCS were enrolled in a study with intrathecal baclofen; in a few cases adenosine was also tried. Twenty patients reported significant pain reduction at bolus trials and were offered implantation of a drug pump. Seven patients subsequently had pumps implanted together with SCS and four had pumps alone. Three patients had only peroral baclofen therapy as an adjunct to SCS. The 14 patients continuing with baclofen therapy as an adjunct to SCS, or alone, were followed for an average of 35 months after pump implant. The group with SCS+pump n=5; 2 explanted) reported an average decrease of pain ratings from VAS 82 to 33. The group with i.t. baclofen only had a pain decrease from VAS 63 to 33, while the three patients with peroral baclofen+SCS had less benefit from drug therapy. Adjunctive drug therapy for patients with unsatisfactory pain relief by SCS may offer a possibility to enhance pain alleviation.
Lind
Göran
G
Department of Neurosurgery, Karolinska Hospital, SE-171 76 Stockholm, Sweden. gorand.lind@ks.se
Meyerson
Björn A
BA
Winter
Jaleh
J
Linderoth
Bengt
B
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D001418:Baclofen / Q000008:administration & dosage*; D004599:Electric Stimulation Therapy / Q000706:statistics & numerical data*; D005260:Female; D018755:GABA Agonists / Q000008:administration & dosage; D058786:GABA-B Receptor Agonists; D006801:Humans; D007260:Infusion Pumps; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology / Q000628:therapy*; D010148:Intractable Pain / Q000503:physiopathology / Q000628:therapy*; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D018080:Receptors, GABA-B / Q000378:metabolism; D013116:Spinal Cord / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D016896:Treatment Outcome
D000700:Analgesics; D018755:GABA Agonists; D058786:GABA-B Receptor Agonists; D018080:Receptors, GABA-B; D001418:Baclofen