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Intrathecal Baclofen Monotherapy and Polyanalgesia for Treating Chronic Pain in Patients with Severe Spasticity

  • Neuromodulation (A Abd-Elsayed, Section Editor)
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A Correction to this article was published on 26 February 2022

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Abstract

Purpose of Review

Intrathecal drug delivery is a well evidenced strategy for the treatment of many chronic pain syndromes. While opioids, anesthetics, and ziconotide are the most commonly used agents, intrathecal baclofen (ITB), which is indicated to treat spasticity, is also thought to have some analgesic properties that are poorly understood. These analgesic benefits have been reported with ITB use in treating patients with central neurological disorders who suffer from severe spasticity and chronic pain. Our review aims to characterize ITB’s effects on pain, function, and quality of life in patients with severe spasticity. We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The primary outcome parameters were analgesic relief and functional improvements. Secondarily, quality of life and adverse effects were also recorded.

Recent Findings

After an initial survey identified 393 studies, 20 studies met final inclusion criteria. Of these, 16 utilized ITB monotherapy and 4 utilized ITB polyanalgesia. Overall, there was a paucity of high-powered studies. Mean titrated ITB doses ranged from 140 to 627.9 μg daily. Nineteen studies reported improved pain and spasticity. Seven studies reported improved functional outcomes and quality of life.

Summary

Our results show that ITB may be an effective agent for the treatment of chronic pain in patients with severe spasticity independent of its spasmolytic effects. Although this evidence was largely derived from studies lacking clearly defined outcomes of pain relief, ITB is reasonable to consider for concurrent spasticity and pain management. Well-designed studies are still needed to characterize ITB’s analgesic efficacy when used in patients with severe spasticity.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA

    Anuj Marathe & Jay Karri

  2. TCU & UNTHSC School of Medicine, Fort Worth, TX, USA

    Sameer Allahabadi

  3. Department of Anesthesia, Division of Pain Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Alaa Abd-Elsayed

  4. Department of Rehabilitation Medicine, Moss Rehab and Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Michael Saulino

  5. Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA

    Jonathan M. Hagedorn

  6. Department of Anesthesia, Division of Pain Medicine, University of Pittsburgh Medical Center, Susquehanna, PA, USA

    Vwaire Orhurhu

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Conflict of Interest

Michael Saulino is a clinical investigator for Flowonix, Medtronic, and Bioness, receives in-kind speaker’s fees from Ipsen and Medtronic, and holds two neuromodulation patents. Jonathan M. Hagedorn is a consultant for Abbott, Boston Scientific, Nevro, and Speranza Therapeutics. Alaa Abd-Elsayed is a consultant for Medtronic, StimWave, Avanos, and Sollis. PhR is supported by Clinical Mandate from the Belgian Foundation against Cancer (Stichting tegen Kanker) and receives speaking and consultancy fees from MSD Belgium. GC and JW declare no conflict of interest.

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Marathe, A., Allahabadi, S., Abd-Elsayed, A. et al. Intrathecal Baclofen Monotherapy and Polyanalgesia for Treating Chronic Pain in Patients with Severe Spasticity. Curr Pain Headache Rep 25, 79 (2021). https://doi.org/10.1007/s11916-021-00994-9

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