Disclosures: Colton A. Besett, BS: No financial relationships or conflicts of interest
Case Description: The patient is a 23-year-old male with a C6 ASIA A tetraplegia secondary to a gunshot wound with diffuse spasticity and neuropathic pain who presented to acute inpatient rehabilitation for comprehensive rehabilitation. The patient arrived with diffuse spasticity and neuropathic pain that was refractory to conventional therapy. The patient was initially started on high dose oral baclofen for spasticity management and subsequently weaned off after successful intrathecal baclofen (ITB) pump placement. Soon after, intractable neuropathic pain returned in the extremities, and his pain remained refractory to conventional therapies. Oral baclofen was restarted which resulted in pain reduction and an increased tolerance of rehabilitation therapies.
Setting: Inpatient rehabilitation hospital
Patient: A 23-year-old male with ASIA A C6 tetraplegia secondary to a gunshot wound Assessment/
Results: Oral baclofen treatment resulted in a reduction of the patient’s pain score and increased tolerance/endurance of therapies.
Discussion: Central neuropathic pain can occur after disruption of the spinothalamic tract in spinal cord injury (SCI) patients. One proposed mechanism of central neuropathic pain involves central disinhibition, in which the GABAergic neuronal connections are disrupted causing unopposed activation of the cortical pain areas. This case demonstrates how supplementation of GABA with oral baclofen can be beneficial in treating patients with central neuropathic pain.
Conclusion: Central neuropathic pain can be difficult to treat in many patients. This case highlights the importance of a physiatry led comprehensive rehabilitation program for SCI patients with central neuropathic pain. In this case, baclofen was hypothesized to relieve central neuropathic pain presumably due to its GABAergic properties. Before this treatment modality can become standard of care, more research is needed to demonstrate its efficacy in treating central neuropathic pain.
Level of Evidence: Level V
To cite this abstract in AMA style:
Besett CA, Shah R, Singh JA, Davis M. Central Neuropathic Pain Treatment with Oral Baclofen in a Spinal Cord Injury Patient: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/central-neuropathic-pain-treatment-with-oral-baclofen-in-a-spinal-cord-injury-patient-a-case-report/. Accessed May 16, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/central-neuropathic-pain-treatment-with-oral-baclofen-in-a-spinal-cord-injury-patient-a-case-report/