Use of Intrathecal Use of Intrathecal Baclofen in Combination Baclofen in Combination

Therapy for Pain Therapy for Pain Management Management

Kim Spinelli MSN, RN-BC, CNSKim Spinelli MSN, RN-BC, CNSPain Management Clinical Nurse SpecialistPain Management Clinical Nurse Specialist

Memorial Hospital-University of Colorado HealthMemorial Hospital-University of Colorado Health

Colorado Springs, COColorado Springs, CO

Efficacy of Intrathecal Efficacy of Intrathecal Drug Delivery Pain TherapyDrug Delivery Pain Therapy

• Reduction in pain

• Discontinued or greatly reduced consumption of oral analgesics

• Enhanced performance of daily activities and increased activity

Addition of Baclofen to Current IT Addition of Baclofen to Current IT Therapy for Pain ManagementTherapy for Pain Management

• Added to current therapy as an adjunct

• Patients typically already on a combination of opioid and bupivacaine

• Starting dose of Baclofen 50-75 mcg/day

PaulPaul• 63 y/o Hx DDD & post laminectomy

syndrome (L4-5, S1 fusion)• Intrathecal pump with hydromorphone and

bupivacaine controlling pain, but;• Muscle spasms in bilateral lower

extremities, especially in his calves• Unable to tolerate PO muscle relaxants• Added Baclofen 75 mcg/day in the pump• Was up to 100 mcg/day, now at 40

mcg/day (past 3 years)

MayMay• 65 y/o Hx Multiple Sclerosis, spinal stenosis and

DDD• On PO Baclofen- ineffective for lower extremity

spasticity• Increasing cognitive decline with oral pain meds

for low back pain• IT Pump implanted- Hydromorphone (80

mcg/day), bupivacaine (5 mg/day), and baclofen (70 mcg/day)

• Currently on 350 mcg/day with ongoing titration• Hydromorphone dose is 1.7 mg/day currently

ElaineElaine• 51 y/o Hx breast CA with post mastectomy

syndrome and radiation fibrosis.• Intractable chest wall pain• Unable to tolerate any opioid medication• IT pump with hydromorphone, bupivacaine,

droperidol• Pain well controlled, but having muscle tightness

and spasms• Added Baclofen at 50 mcg/day• Currently at 170 mcg/day and titrating

• Thanks!