Baclofen Pump Therapy: Device Used For Patients Suffering From Spasticity

Baclofen pump is a medical device used for delivering baclofen in patients suffering from spasticity. In United States at least 5 to 6 lac people suffer from spasticity. Spasticity is a medical condition characterized by stiffness and spasms of muscles. Spasticity can affect regular physical activity and movement. Spasticity can occur due to causes like stroke, cerebral palsy, injury to brain and spinal cord, multiple sclerosis etc.

Spasticity occurs when the nerves that carry electrical signals from spinal cord to the muscles are damaged. In a normal person muscle spasm and relaxation is controlled by nerves. When the signals are disturbed, the muscles become tense. Baclofen is a medicine which helps in restoring the normal signal and hence it helps the muscles to move normally. The medicine acts in spinal cord. Let us now know more about baclofen and baclofen pump.

What is Baclofen?

Baclofen is a medicine that is used in treatment of spasticity. The action of baclofen starts in spinal cord. It reduces hyperactive reflexes and increased muscle tone. Because of the action of baclofen, the spastic muscles can relax.

Baclofen can be taken in pill form. However, it has many side effects such as drowsiness, headache, nausea, weakness. Nowadays the more preferred route of administration is through measured release of baclofen through a pump called baclofen pump into the intrathecal space of the spine. It is the area that surrounds the spinal cord and roots of spinal nerves. The type of treatment is called intrathecal baclofen (ITB). This treatment is suggested in people having severe spasticity or those having intolerance of oral baclofen. Oral medicine and injections are always tried before considering baclofen pump.

How Does the Pump Work?

Baclofen pump involves surgical implantation of the device into the body. Baclofen pump therapy has 3 phases. The first phase is screening where the patient is checked if his spasticity responds well to the drug delivered through intrathecal route. To find this doctors use trial dose of administering baclofen around the spinal cord. They check whether the spasticity is reduced and patient is feeling comfortable and walking easily. Doctors also keep a watch on the side effects of the pump therapy in the patient. If the test dose suits the patient, he can be chosen for baclofen pump therapy.

The second phase is surgical implantation of the pump. Baclofen pump is made up of catheter and the pump. Catheter is a small tube. It is flexible tube. The pump is a metallic disc that is almost one inch thick and 3 inches in diameter. This pump is inserted under the skin around the waistline. The catheter which is linked to the pump is inserted into the spinal column. The pump stores medicine which is released in right amount through the catheter from time to time in a controlled manner. There is a tiny motor present in the pump regulates the movement of medicine into the catheter and in the spine. The doctor from outside can control the dose, time and rate of the medicine with the help of computer. When not required the pump can be turned off.

The Third Phase is Long Term Maintenance:

Patient has to regularly visit his doctor for refilling the medicine into the pump; usually after 3 months or as suggested by the physician. The lifespan of battery of baclofen pump is 5 to 7 years. Hence the pump may need to be removed and the battery replaced if the battery power gets over.

Risks and Complications:

It may have its own risk and complications. They may arise from surgery while implanting the device, any mechanical failure of the pump, or from the medication delivery. Risks include:

  • In case of infection, the pump may need to be removed.
  • Blood clotting around the pump.
  • Nerve damage
  • Leakage of the cerebrospinal fluid.
  • Pain in the incised area.
  • Dislodgement of the catheter from its site in the spine.
  • Increased dose or decreased dose delivery leading to various side effects such as weakness in muscles, nausea, drowsiness, headache etc.