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Thread: Spasms vs Spasticity question for Dr Young

  1. #1

    Spasms vs Spasticity question for Dr Young

    I suffer from constant spasms day & night but I have excellent range of motion. I am currently on
    80 mg baclofen/day
    24 mg tizanidine/day
    1200 mg neurontin/day

    The spasms cause contractures in my hands and central pain in my hands/arms and legs. The onlt thing left that my dr has to offer is the clonidine patch, which can create BP problems. I think his next suggestion is the bsclofen pump. I am 10 mon post injury and do not want to face such an invasive surgery. You mentioned in the overnight leg issue post that baclofen doesn't help spasms. What avenue would you suggest? These spasms inpact meday/night and right now prevent me frrom driving or going back to work. In fact I am at the end of my rope in dealing with these spasms.

  2. #2
    ElaineG,

    What you describe is a common problem for many people with spinal cord injury. In my experience, baclofen and clonidiine do not prevent spasms of the type that you describe. It is often associated with neuropathic pain. I wish that there were more studies of this problem and that I knew a solution, particularly for the spasms/spasticity that occur above the injury site and is associated with pain. Has your doctor considered increasing the dose of neurontin (gabapentin) to see if it will help?

    The mechanism(s) of spasms is (are) not understood and there are relatively few places that are doing research on the subject. One of the places is Miami Project. Christine Thomas, for example, has been studying spasms and I have great respect for her work. Thomas & Ross, 1997 published one of the first neurophysiological studies on spasms in humans. Unfortunately, there are no good animal models of muscle spasms (see Eaton, 2003). Hornby, et al. (2001) have a very interesting article on the subject. Art Sherwood has had a longstanding interest in the subject and published a good review of spasticity and motor control after spinal cord injury.

    Let me think about this and see if I can come up with some suggestions. Thanks.

    Wise.

  3. #3
    Thanks for your reply Dr Young. I will ask my Dr about taking more neurontin. I am already on 1200mg day. What amount do you think is reasonable? I know that this med impacts memory
    and that concerns me, because I hope to return to work. Are you saying that the baclofen pump probably would not solve my problems? I really don't want to consider that option unless there is absolutely no other was to escape this misery!!

    Thanks,

    Elaine

  4. #4
    Elaine,

    People react differently to drugs. I do not know whether increasing the dose of neurontin (gabapentin) would be more effective for spasms. Although there have been some reports that taking higher doses of neurontin (up to 4800 mg per day) may be necessary for neuropathic pain, the optimal dose and efficacy of neurontin for spasms have been been studied or at least published. It might be worthwhile trying it before doing the balcofen pump. While baclofen pump will reduce spasms, it does so by weakening reflexes and muscles.

    Wise.

  5. #5
    Thanks for the information. I looked for an
    e-mail on the Miami Project website for Dr Christine Taylor, I was hoping for a dept or individual for her. I am hoping to glean any kowledge or avenues to explore.

    As you can tell by my post I dealing with constant pain day/night. I am looking for any suggestions to help me solve this problem. I don't think my Dr really know how how to treat my situation.

    You Dr Young have been more responsive & supportive than any of my Drs

  6. #6
    I was under the impression that Neurontin was only for my nerve pain. I was taking around 3000 mg a day when I left the hospital July 24, 2003. 3000 mg was making me tired and dumb. I was surprised when my spasms increased dramatically when my dose went below 2000 mg. 2100 mg a day seems to be the right balance for myself, between nerve pain/spasticity and alertness.

    Brian C/5
    http://bspill1.home.comcast.net

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