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Use of Intrathecal Baclofen in Combination Therapy for Pain Management

Use of Intrathecal Baclofen in Combination Therapy for Pain Management. Kim Spinelli MSN, RN-BC, CNS Pain Management Clinical Nurse Specialist Memorial Hospital-University of Colorado Health Colorado Springs, CO. Efficacy of Intrathecal Drug Delivery Pain Therapy. Reduction in pain

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Use of Intrathecal Baclofen in Combination Therapy for Pain Management

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  1. Use of Intrathecal Baclofen in Combination Therapy for Pain Management Kim Spinelli MSN, RN-BC, CNS Pain Management Clinical Nurse Specialist Memorial Hospital-University of Colorado Health Colorado Springs, CO

  2. Efficacy of Intrathecal Drug Delivery Pain Therapy • Reduction in pain • Discontinued or greatly reduced consumption of oral analgesics • Enhanced performance of daily activities and increased activity

  3. Addition of Baclofen to Current IT Therapy 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

  4. Paul • 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)

  5. May • 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

  6. Elaine • 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

  7. Thanks!

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