I have been treated for severe pain from complex regional pain syndrome with a special pump that delivers a drug called baclofen to the spinal cord. Everything was going really well, and then all of a sudden, I stopped getting the good results I had hoped for. Now my pain is starting to come back. I can't do even the simple things I was doing like pick up a pot of coffee and pour. Have I reached some kind of plateau? Will I continue to get better with a little more time?

Posted May 7th, 2009 by Matt

Pain Management

Baclofen is a drug that has been used to reduce spasticity by stopping the messages that go from the muscles to the spine. They do this by inhibiting the GABA receptors in the nervous system. The result is to prevent the release of neurotransmitters. Neurotransmitters are chemicals that send and receive signals between a neuron (nerve cell) and the rest of the body.

Baclofen can be delivered through a pump into the subarachnoid space of the spine. The subarachnoid space refers to an area between a layer of spongy tissue that covers and protects the spinal cord and the spinal cord. Cerebrospinal fluid is contained within the space. The brain and spinal cord float in cerebrospinal fluid. The fluid is designed to act as a cushion or buffer for the nervous system.

The pump used to deliver the baclofen can be placed in the patient's abdomen just under the skin. A thin tube called a catheter goes from the device to the subarachnoid space in the spinal canal. A special X-ray called fluoroscopy is used to help guide the surgeon when putting the device in place.

Although this device works well in reducing pain and the debilitating symptoms of complex regional pain syndrome (CRPS), there have been many pump-related problems reported. An infection can develop in the pocket where the device is implanted under the skin. Pump migration (movement of the pump) with failure of drug delivery has reported in obese patients.

The first thing to look for when the drug seems to help but then the patients get worse is a problem with the catheter. A little trouble-shooting may be all that's needed. The catheter may be kinked or blocked. Sometimes it gets disconnected from the pump.

It could be something even simpler than that. You may just need an adjustment in the dosage being delivered by the pump. The best thing to do is to call the surgeon who implanted the device right away. Although this may not be an emergency, it should be treated with urgency until the exact cause of the problem is determined.

M. A. van Rijn, et al. Intrathecal Baclofen for Dystonia of Complex Regional Pain Syndrome. In PAIN. April 2009. Vol. 143. No. 1-2. Pp. 41-47.

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