Guidelines for the Use of Intrathecal Baclofen Therapy Developed

Jennifer Doble, M.D., a physiatrist specializing in rehabilitation at St. Joseph Mercy Ann Arbor (SJMAA), a member of Saint Joseph Mercy Health System and WCMS, participated in a multi-disciplinary team to develop guidelines for the use of Intrathecal Baclofen Therapy in patients suffering from chronic pain and spasticity due to cerebral palsy, traumatic brain injury, spinal cord injury, multiple sclerosis and stroke.

The guidelines "Best Practices for Intrathecal Baclofen Therapy" were published in Neuromodulation in a series covering Patient Selection, Screening Test, Dosing and Long-Term Management and Troubleshooting. This guide enables physicians to care for patients with spasticity in their own local communities by referencing protocol created by an expert team of surgeons, neurologists and Physical Medicine and Rehabilitation specialists. The guidelines were created over three years, through the work of 21 multi-disciplinary physicians managing a total of 3,200 patients.

Spasticity is one of the biggest problems for patients that interfere with function and comfort. When left uncontrolled, the limbs, back and trunk muscles are contracting constantly and patients stiffen, curl up and can't move against the spasm. The spasms produce painful neuropathic pain and interfere with sleep, getting dressed, managing basic hygiene, gait and balance.

Over the last 30 years, treatment of spasticity has included Botox and oral medications, and, most recently, the use of the FDA-approved Intrathecal Baclofen pump for diagnoses of cerebral palsy, traumatic brain injury, spinal cord injury, multiple sclerosis and stroke.

"The delivery of the baclofen directly into the spinal fluid via the pump helps dramatically to decrease pain and keep patients functioning, walking and working longer," explained Dr. Doble. "It has made a dramatic difference in life of these patients—it's the difference between being bedridden and a functioning adult. It has proven to be very effective."

Considered an advanced manager of this therapy nationally, Dr. Doble developed a program to treat these patients when she joined SJMAA in 2000. SJMAA is a now considered a center of excellence for the care of patients with spasticity, treating about 200 patients a year with this issue.

The pump is inserted in the fluid space surrounding the spinal cord and the medication released stays within the spinal fluid, enabling results without causing drowsiness like oral medication. Candidates for this pump include any patient with severe spasticity that interferes with comfort, function and ambulation, ranging from a child of 25 pounds up to someone in their 90s.

Most patients continue lifelong use of the pump, only needing to change the battery approximately every eight years. The pump is covered by most insurance, including Medicare and Medicaid.

In 2000, Stephen Waldrop, a retired banker who lives in South Lyon, was diagnosed with a blockage in his spinal column prohibiting nerve impulses from traveling smoothly resulting in spasticity and difficulty walking. He was given oral medication to relax his muscles, but over time, the dosage needed became sedating and his muscles became too weak, again causing difficulty walking.

In 2006, Waldrop was referred to Dr. Doble, who evaluated him for an intrathecal baclofen pump with a test dose. He responded well and then had the pump implanted by Dr. Jason Brodkey, a neurosurgeon at SJMAA. Since then, he has fewer problems walking and has not experienced any adverse side effects.

"With the use of the pump, I was able to continue to work another nine years all the way through full retirement, and that has made a huge difference to my quality of life," said Waldrop, who enjoys traveling in his retirement, as well as caring for his active toddler grandson.

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