Intrathecal Baclofen For Spasticity-Related Pain in Amyotrophic Lateral Sclerosis: Efficacy and Factors Associated With Pain Relief

Shearwood McClelland III M.D.¹, Francois A. Bethoux M.D.², Matthew H. Sutliff P.T.², Darlene K. Stough R.N.², Kathleen M. Schwetz R.N.², Danuta M. Gogol R.N.², Michelle Harrison P.T.², Erik P. Pioro M.D., Ph.D.², Nicholas M. Boulis M.D.³

¹Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN; ²Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH; ³Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH.

Introduction:

Spasticity is a condition of involuntary muscle contraction resulting from excess motor neuron excitation, characterized clinically by hypertonicity, clonus, fixed joints, and often spasm-related pain. When spasticity is refractory to medical management, patients are often referred for intrathecal baclofen (ITB) pump placement. We reviewed a cohort of amyotrophic lateral sclerosis (ALS) patients with intractable spasticity requiring ITB to further define the impact of ITB on pain relief in this patient population.

Methods:

From 2003-2005, eight patients (average age = 43.8 years; 5M, 3F) with ALS received ITB for pain associated with intractable spasticity at our institution. Average duration of ALS preoperatively was 47.4 months, and pain was evaluated using a 0-10 scoring system. Mean follow-up was 9.8 months. All patients experienced spasticity relief in response to preoperative ITB test injection (25-50 mcg) via lumbar puncture.

Results:

Following ITB pump placement, the average reduction of pain was 54 percent. Six patients (75 percent) experienced pain relief, of which three received complete pain relief. The degree of postoperative pain relief correlated with the degree of pain relief following preoperative ITB test injection.

Conclusion:

In this, the first report of ITB for pain relief in this patient population, ITB provides effective and consistent pain relief for intractable ALS-associated spasticity. Following ITB, 75 percent of patients experienced pain relief, half of whom received complete pain relief. The degree of pain relief following preoperative ITB test injection was predictive of postoperative pain relief. These results support ITB as a treatment modality for pain associated with spastic ALS.

Keywords:

Spasticity, Amyotrophic Lateral Sclerosis, Intrathecal Baclofen, Pain Relief