Managing Spasticity with an Intrathecal Baclofen Pump
Nahid Veit, RN, MSN, CRRN
What is spasticity?
Spasticity is an involuntary stiffness of the muscles or painful muscle spasms or cramps, and is a common side effect of MS. Low to moderate conditions of spasticity are often controlled by daily exercise and stretching routines. When spasticity becomes more severe providers might prescribe oral medications to help reduce the effects of muscle stiffness. If patients don’t respond to oral medications or they might not be able to safely tolerate the side effects of the medication, health care providers look for alternative approaches to help manage spasticity.
An alternative treatment option to help manage more severe forms of spasticity involves implanting a computerized pump that will deliver measured, consistent doses of spasticity reducing medication directly to the spinal canal. This device is called an Intrathecal Baclofen Pump. Intrathecal means “the space surrounding the spinal cord.” The pump delivers a medicine called Baclofen into the spinal canal that will help reduce the effects of spasticity. During a surgical procedure, the pump is placed in the body. The pump delivers the medication into the spinal canal through a small piece of tubing called a catheter. While Baclofen delivery is often the best option for treatment of severe spasticity that does not respond to oral medication, the decision to choose this option should be made by the patient and the health care provider.
Before patients can take this medication, a screening should be completed to determine if an individual will benefit from the pump. This test involves a small dose of medication to be injected into the fluid surrounding the spinal cord. It is common to receive a local anesthetic to numb the area around the injection site before the injection. Next, the health care provider monitors the patient’s response and checks muscle tone and spasticity. If the response is satisfactory (a reduction in spasticity) the individual will then be scheduled for surgery to implant the Baclofen pump.
Before the surgical procedure, the patient receives intravenous “into the vein” medicine for pain and sedation. Once sedated, the pump, about 1” by 3” metal disc, will then be implanted under the skin of the abdomen, and the catheter that delivers the spasticity medication will be threaded into the spinal canal. The pump will be adjusted to deliver a preset amount of medication to relieve spasticity. Patients generally need 2 or 3 days of bed rest after the implant surgery. Most patients begin feeling some relief from spasticity within 4 or 5 days post surgery.
Depending on the prescribed dose, the medication in the pump may last between 2 to 6 months. It is refilled in a simple procedure in the provider’s office or in the patient’s home. The pump is battery-operated. The pump and the battery can last up to 5 to 7 years. When the batteries wear out, a new pump must be inserted.
Using an Intrathecal Baclofen Pump reduces the side effects patients’ experience with oral medications, and it improves functional activities in a more consistent approach. When spasticity reducing medications deliver a more consistent and concise dose of medication in the spinal canal, then patients experience a more efficient mechanism to reduce involuntary muscle spasms and stiffness. The reduction in spasticity can also increase the likelihood of a better night’s sleep. However, as with all medications, there are risks, side effects, and possibility of complications using the pump. Be sure to discuss all of these factors with your health care provider to ensure you are making a good, informed decision to manage your spasticity.
Date Posted: November 2004