Intrathecal baclofen for spasticity-related pain in amyotrophic lateral sclerosis: efficacy and factors associated with pain relief.
Clinical signs and symptoms of spasticity include hypertonia, involuntary movements (spasms, clonus), decreased range of motion, contractures, and often spasm-related pain. When spasticity is refractory to medical management, patients may be referred for intrathecal baclofen (ITB) pump placement. We reviewed a cohort of amyotrophic lateral sclerosis (ALS) patients with intractable spasticity requiring ITB to further define the impact of ITB on pain relief in this patient population. From 2003 to 2005, eight patients (mean age 43.8 years; 5 men, 3 women) with ALS received ITB for pain associated with intractable spasticity at our institution. Mean disease duration preoperatively was 47.4 months, mean follow-up was 9.8 months, and pain was evaluated using a 0-10 scoring system. All patients experienced spasticity relief in response to a preoperative bolus test injection of ITB (25-50 microg) via lumbar puncture. Following ITB pump placement, the average reduction of pain was 54% (P = 0.0082). Six patients (75%) experienced pain score reduction, three of whom had complete pain relief. Postoperative pain reduction was predicted by the degree of pain reduction following preoperative ITB test injection. These results support ITB as a treatment modality for pain associated with spasticity in ALS.
McClelland
Shearwood
S
Department of Neurosurgery, University of Minnesota Medical School, Mayo Mail Code 96, 420 Delaware Street SE, Minneapolis, MN 55455, USA. mccl0285@umn.edu
Bethoux
Francois A
FA
Boulis
Nicholas M
NM
Sutliff
Matthew H
MH
Stough
Darlene K
DK
Schwetz
Kathleen M
KM
Gogol
Danuta M
DM
Harrison
Michelle
M
Pioro
Erik P
EP
D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000188:drug therapy; D001418:Baclofen / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal / Q000379:methods; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000150:complications* / Q000209:etiology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D012189:Retrospective Studies
D009125:Muscle Relaxants, Central; D001418:Baclofen