What is a Baclofen Pump?
A baclofen pump is an implantable device used to deliver baclofen, a muscle relaxant, to manage severe spasticity. The pump is surgically implanted under the skin, typically in the abdomen, and delivers a continuous dose of baclofen directly into the cerebrospinal fluid via a small catheter placed in the spinal cord.
Spasticity is the uncontrolled tightening of muscles. This makes movement, particularly of the arms and legs difficult or uncontrollable. Muscle tightness can prevent one from performing everyday tasks such as walking, holding a cup, and sometimes even talking. Muscle tightness can also cause pain in some patients. Baclofen is one of the most effective medications for spasticity. It can make it easier for the patient to move their muscles and can also relieve some of the pain that muscle tightness causes. Treatment with a baclofen pump is also called intrathecal baclofen therapy (ITB).
Indications for a Baclofen Pump
A baclofen pump is typically indicated to treat spasticity caused by conditions like cerebral palsy, multiple sclerosis, spinal cord injury, or stroke. The first line of treatment for spasticity is typically oral baclofen. However, if oral baclofen has not been effective in managing spasticity or if higher doses of baclofen have been causing side effects such as nausea, drowsiness, and weakness, your physician may recommend intrathecal baclofen therapy for effective management of spasticity. Delivering small, controlled amounts of baclofen directly into the intrathecal space (around the spinal cord) using a baclofen pump is much more effective than oral baclofen because it bypasses the digestive system, allowing for lower doses and reduces side effects like drowsiness or weakness.
Who Benefits from a Baclofen Pump?
- Patients with severe spasticity who do not respond well to oral medications
- Individuals with various brain and spinal cord conditions such as:
- Cerebral palsy
- Multiple sclerosis (MS)
- Spinal cord injury
- Stroke-induced spasticity
- Brain injuries
Procedure for a Baclofen Pump
The implantation of a baclofen pump is a surgical procedure performed under general or regional anesthesia by a neurosurgeon and generally involves the following steps:
- A small incision (about 2–4 inches) is made in the abdomen to create a pocket for the pump.
- A second incision is made in the lower back, where a thin catheter is inserted into the intrathecal space of the spinal cord.
- The catheter is tunneled under the skin and connected to the pump, which is then secured in the abdominal pocket.
- The surgeon fills the pump with baclofen and programs the initial dosage using an external device.
- The incisions are sutured, and sterile dressings are applied.
Postoperative Care and Recovery
Post procedure, the patient will usually stay in the hospital for 1–3 days to monitor for complications and adjust the medication dose. Some discomfort at incision sites is expected, which is managed with oral pain relievers. Patients should avoid strenuous activities and heavy lifting for 4–6 weeks. Most patients resume normal activities within 4-6 weeks. The pump must be refilled with baclofen every 1-6 months, depending on dosage. Patients should watch for signs of infection, catheter blockage, or pump malfunction.
Benefits of a Baclofen Pump
Benefits of a baclofen pump include:
- Better muscle control and reduced spasms
- Less reliance on oral medications
- Improved comfort and mobility
- Fewer side effects compared to high-dose oral baclofen
- Reversible and adjustable therapy
Risks and Complications
Risks and complications associated with baclofen pump include:
- Infection
- Bleeding
- Pump malfunction
- Catheter issues
- Overdose or underdose of baclofen
- Need for revision surgery
