Disclosures: Denesh Ratnasingam, MD: No financial relationships or conflicts of interest

Case Diagnosis: Combination of Intrathecal Baclofen and Analgesic Medication to Manage Spasticity and Pain in Patients with Pediatric onset disability

Case Description: We present a series of patients (n=10) with pediatric onset disability who underwent placement of intrathecal baclofen pumps initially for management of severe spasticity. Despite titration of dose and use of oral analgesia, their uncontrolled pain persisted. Each patient was transitioned to a combination of baclofen and analgesic intrathecal therapy. The outcome in pain improvement and quality of life, as reported by patients and/or caregivers, were retrospectively reviewed.

Setting: Children’s Hospital of Michigan, Detroit, MIAssessment/

Results: Retrospective review of the background and decision making related to transition to combination intrathecal therapy identified patient selection characteristics. Each patient and/or caregivers completed a survey treatment of pain, spasticity, as well as quality of life before and after initiation of combination intrathecal medications. Results revealed improvements in functional and pain assessments after initiation of combination baclofen and analgesic intrathecal medication.

Discussion: The use of intrathecal medications for the management of spasticity and various pain syndromes in the adult population has been previously reported. However, minimal evidence-based guidelines exist in the pediatric population. We present a case series of patients with pediatric onset disability whose spasticity and pain were managed with the initiation of combination baclofen and analgesic intrathecal infusions.

Conclusion: Use of mixed pumps with antispasmodic and analgesic medication for combination intrathecal medication delivery should be considered in the management of patients with childhood onset disabilities who have both severe spasticity and pain.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/utilization-of-mixed-pumps-a-combination-of-intrathecal-baclofen-and-analgesic-medication-to-manage-spasticity-and-pain-in-patients-with-pediatric-onset-disability/