It Professional

Location:

New York, NY

Salary:

13 hr

Posted:

December 22, 2014

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Baclofen Pump

Reference Summary

Introduction

Spasticity or abnormal tightening of the muscles, can greatly limit your

ability to move and work.

If other treatments fail to control it, placing the drug baclofen around the

nerves in the spine may relieve the spasticity. A baclofen pump placed

in the body can be very effective in controlling spasticity.

Doctors may recommend surgery to place a baclofen pump in the body

of a patient suffering from severe spasticity. If your doctor recommends

surgical treatment for your condition, the decision whether or not to

have surgery is also yours.

This reference summary will help you understand better the benefits

and risks of this surgery.

Anatomy

The spine protects the spinal cord and nerves that go to different

parts of the body. The spine is formed of solid sections of bone

called vertebrae.

Nerves travel from the brain down the spinal cord and through the

spine to the legs and all parts of the body.

When the brain orders body parts to move, or if it gives other orders

to body parts, these orders are carried through the nerves. These

orders travel by electrical impulse in the nerves.

The nervous system is usually very coordinated. When it orders a

muscle to tighten, it causes the muscle that opposes it to relax.

Brain and Nerves

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

For example if you want to straighten your leg at the knee, the brain orders your

quadriceps muscle, the muscle located in the front of the thigh, to tighten. At the same

time, it orders your hamstring, the muscle in the back of the thigh to relax.

Symptoms and Their Causes

Spasticity or abnormal tightening of the muscles can happen in different situations.

Multiple sclerosis is a disease of the nervous system. It may cause the muscles to

become very tight and very difficult to relax. Spinal cord injury can also result in

spasticity.

When a person has spasticity or is spastic, she or he is unable to relax the muscles.

This can cause problems with moving or using limbs. It can also cause pain.

However, some patients with severe weakness are able to use the stiffness that comes

with spasticity to their advantage. The stiffness can allow them to bear weight and

walk, for example.

Alternative Treatments

A baclofen pump is recommended only when the spasticity is severe and cannot be

managed by regular medication or other treatments. This type of treatment for

spasticity does not help in all cases. Baclofen is a medication that is very often used to

treat spasticity. It is taken by mouth and along with other muscle relaxants can be

used to help the patient overcome spasticity.

Physical therapy, occupational therapy and other forms of

therapies can help the patient relax and cope with the

spasticity.

At times, if a specific muscle or muscle group is very tight, the

physician may suggest injecting that muscle with Botox®.

Botox paralyses the muscle for a period of weeks or months. It

helps relieve some cases of spasticity.

Rarely an operation to cut the nerves close to the spinal cord

may be proposed in some patients. This operation is called a

rhizotomy. A baclofen pump placement is not as drastic as a rhizotomy.

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

Surgical Treatment

Before doing actual surgery to implant a baclofen pump, your doctor will give you a test

dose of baclofen through a spinal tap. This is done to make sure the baclofen helps

reduce the spasticity. It is also done to make sure that you can tolerate the baclofen

without any nausea or allergic reaction.

The operation can be done under either local or general

Baclofen Pump

anesthesia. This depends on your doctor's preference.

The pump will be placed under the skin of the abdomen

and connected to the spine by a tube called a catheter.

First an incision is made in the middle of the back. A

catheter or flexible tube is inserted from the back incision down to the spine. X-ray

pictures are used to find the best place to insert the catheter.

To place the baclofen pump, the second incision is usually made below the rib cage in

the front. Your doctor may recommend a different location for the pump. The baclofen

pump is placed under the skin in the front. The spinal catheter is tunneled under the

skin from the incision in the back to the incision in the front where it is connected to the

pump. All incisions are closed at the end of the operation.

The whole system is under the skin. It may not show at all under regular clothes, but it

may bulge under fitted clothes.

Risks and Complications

This operation is very safe. There are, however, several risks and complications which

are unlikely but possible. You need to know about them just in case they happen. By

being informed you may be able to help your doctor detect complications early.

The risks and complications include those related to anesthesia and those related to

any type of surgery.

Risks of general anesthesia include nausea, vomiting, urinary retention, cut lips,

chipped teeth, sore throat, and headache. More serious risks of general anesthesia

include heart attacks, strokes, and pneumonia. Your anesthesiologist will discuss

these risks with you and ask you if you are allergic to certain medications.

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

Blood clots in the legs can occur due to inactivity during and after the surgery. These

usually show up a few days after surgery. They cause the leg to

swell and hurt.

Blood clots can become dislodged from the leg and go to the lungs

where they will cause shortness of breath, chest spasticity and

possibly death. It is extremely important to let your doctors know if

any of these symptoms occur. Sometimes the shortness of breath

can happen without warning.

Getting out of bed shortly after surgery may help decrease the risk

of blood clots in the legs.

Some of the risks are seen in any type of surgery. These include:

1. Infection, deep in the spine or abdomen or at the skin level.

2. Bleeding.

3. Skin scars that may be painful or ugly.

Other risks and complications are related specifically to this surgery. These again are

very rare. However, it is important to know about them.

Spinal fluid may leak from around the nerves and cause a headache.

An infection called meningitis may happen around the nerves and spinal cord. If you

notice high fever, headache, and extreme tiredness call your doctor.

There is a very slight chance of weakness or even paralysis.

At times the baclofen relaxes the muscles to such an extent that if the patient

depended on some muscular stiffness to be able to walk, she or he may not be able to

do so. In these cases the dosage of the medication may have to be reduced.

There is a slight possibility of new bowel or bladder dysfunction. However, this is very

rare.

Other risks specific to this surgery are related to the use of a mechanical device. The

catheter may pull out of place or break and have to be replaced. The pump may stop

working or become infected and have to be replaced. The battery lasts 3 to 4 years,

after which the entire pump may have to be replaced.

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

Baclofen is the only drug approved by the FDA for this use.

Any other drug used here would be experimental. Baclofen

injection around the spine is a relatively new treatment.

Therefore, the long-term effects of baclofen injection are not

known.

In extreme rare cases, scar tissue can form at the tip of the

catheter around the nerves and spinal cord. This scar can

become big enough to put pressure on the nerves or spinal

cord. It can cause pain, weakness and possible paralysis. In

these rare cases surgery is often needed to take that scar

tissue off the nerves and spinal cord.

The body may get used to gradually higher doses of baclofen. It is therefore very

important to stay with the LOWEST possible effective dose. If the body gets used to

more and more baclofen, the drug may stop being effective in controlling spasticity.

The longer the patient expects to use the pump, the more important it is to keep a dose

low.

After the Surgery

No repetitive bending or twisting or heavy lifting is allowed in the few weeks following

the operation.

After this period of relative rest, physical therapy may be necessary to allow you to

resume your previous activities. Whether or not you will be able to resume ALL

previous activities depends on how well you are doing at the time of your follow-up.

Your doctor will tell you how long it will take before your back is healed and when you

can go back to work. This depends on your age, type of work, and medical condition

as well as other factors.

The pump needs to be refilled with baclofen every three to four months depending on

how much of it is used. The pump is entered with a special needle through the skin.

Refilling does not hurt. There is, however, a small needle prick.

The pump can be programmed from the outside to deliver the desired amount of

baclofen to the nerves. Remember, it is important to always use the lowest possible

amount of baclofen.

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

Your pump has a low volume alarm which will go off when it stops working. It also

goes off when the pump needs to be refilled with baclofen.

When the supply of baclofen to the nerves is cut off, you may have withdrawal

symptoms. Withdrawal symptoms could include feeling ill with flu-like

symptoms, fever, and itching.

If you hear the alarm, have worsening spasticity, or feel suddenly

upset or nervous, call your doctor or an available doctor right away.

You should tell your family to call a doctor right away if you become

too sleepy and difficult to arouse. You may be having an overdose

that could be deadly.

When you pass through a metal detector (for example at an airport),

you may set off the alarm. It is important to carry your registration

card with you to prove you have an implanted medical device.

You should tell ALL your healthcare providers that you have a pump. This not only

includes doctors and nurses, but also chiropractors, physical and massage therapists,

pharmacists and other health care providers. Some treatments and procedures may

need to be changed or may be dangerous for people with a

pump.

Summary

Baclofen pump placement can help relieve your spasticity

when other treatments fail.

This operation is safe with good results. However, as you

have learned, complications may happen. Knowing about

them will help you detect them early if they happen.

This document is for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a

recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the

advice of a doctor or a healthcare professional for your specific condition.

Last Reviewed: 08/11/2010

Contact this candidate