When do you consider intrathecal baclofen pump in patients with acquired spasticity?

I am a neurologist in Minneapolis and have directed a spasticity clinic for over 20 years. We typically have at least 100 intrathecal baclofen patients. It is an excellent therapy for selected patients but requires dose adjustments and refills of the Medtronic synchromed pumps. Problems may occur wi...

In general, intrathecal baclofen is helpful when the spasticity is mainly in the lower body, and the patient does not tolerate sufficient doses of oral baclofen or tizanidine.

Some patients also receive pain medications through their baclofen pump and may achieve greater pain relief than with oral ...

Dr. @Dr. First Last,

I am semi-retired and have not recently managed a baclofen pump patient. So, some of these thoughts may be "dated". I have considered a baclofen pump in those patients who:

1. have a high pill burden
2. may complain of sedation
3. good effect yet incomplete.

(Just to mention a few.)

I agree with the above answer.

I would add the following:

1. discuss and set expectations;
2. physical therapy and occupational therapy after placement are good rehabilitative options to maintain muscle tone and interesting can help psychologically and reduce some pain; and
3. send to a specialist that does...