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Thread: baclofen pump vs. baclofen pills?

  1. #1
    Senior Member sci-co-pilot's Avatar
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    baclofen pump vs. baclofen pills?

    Dr. Young,
    I have taken the baclofen pill before. All it seem to do was give me a slight h/a everyday.But no noticeble results for helping the spasms. Then I tried zanaflex same results. Do you think the baclofen pump would be a better idea. My spasms seem to be getting worse all the time.

  2. #2
    sci-copilot,

    I am assuming that you are referring to spasms and not spasticity. While oral baclofen is usually effective against spasticity, it is generally not sufficient to stop severe spasms. Intrathecal baclofen can stop spasms if given in high enough doses but it will also make your muscles flaccid most of the time.

    I am sure that the SCI-Nurses may have some advice but I would suggest trying the following approaches before going to a baclofen pump and setting the baclofen at such a high level that it markedly suppresses all muscle activity.

    First, I would see if there is a cause of the increasing spasms. These may be due to the presence of any irritating sensory input, such as backpain (even though you can't feel it), decubitus, urinary tract infection, or bowel problems. Eliminating some of these causes may reduce the spasms. Sometimes, even seating and posture may be a source of significant sensory input into the spinal cord, increasing both spasticity and spasms. If your spasms are worse at nights, perhaps changing your sleeping posture may help.

    Second, if you have not already done so, I would consider standing for 30-60 minutes per day on a standing frame, trying functional electrical stimulation or other form of exercise.

    Third, add some clonidine or tizanidine to baclofen to see if it helps. If your spasms are worst at nights, you may want to try some valium to see if that reduces the spasms. I would not recommend long term use of valium or similar tranquilizers but sometimes a relatively low dose and at night may be sufficient without causing drowsiness or other side-effects.

    Wise.

  3. #3
    Senior Member sci-co-pilot's Avatar
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    Dr.Young,
    Thankyou for your quick reply. I have two pieces of exercise equipment I try and do everyday if possible.1.is a passive exercise bike that gives my legs some much needed movement. I try and ride it for an hour a day. The spasms seem to be better for a bit after I ride it.I find my legs are not as tight if I dont ride it. 2. I have an Easy Stand glider. I like this machine because your getting some weight bearing and some cardio. I try and ride this for at least 1/2 per day.I'm so greatful to have both these pieces. I also have a new set of kafo braces.The first set I had were opoorly built and was able to get a 2nd set.I'm not sure what decubitus is? I try and keep a close watch for uti's and my bowel routine seem fine. At night my spasms are bad at first but in the mornung they seem less. If I have a quick nap I find my legs are like to stiff boards they dont wanr to bend. When I'm in my chair for a normal period of time. My legs try to get my body to straighten itself. And for back pain I dont seem to have much pain. I have feeling to my mid hip area. I try and go for a massage and accupuncture treatment onces a week. I tried the componding pharmacies 4ap. But didnt see any noticeable inprovements. So I quite taking it. My family Dr. dosnt have alot of experince with sci. So hes learning as we go also. Ive sent my mri to Dr. Huang and waiting to hear back from him. Do you think its a wise idea to go to get the procedure done or wait 6 months like you said in another post?. Theres my story long enough and I apologies for the spelling. Thanks again for all your work on this site.
    Bryan or sci-co-piliot

  4. #4
    bryan,

    You seem to be doing all the right things. What you are describing, however, sounds more like spasticity than spasms. Spasticity is when the legs are stiff. Spasms are when your legs would kick out spontaneously, often with substantial force. If titrated properly, intrathecal baclofen should control spasticity of the type that you describe without producing flaccidity. You don't want to take such a high dose that you lose muscle tone. I really don't know whether they can program the baclofen pumps to deliver more during certain parts of the day or night when your spasticity is worse. Also, spasticity may change from day to day or week to week.

    Regarding 4-AP, I assume that you did not participate in the clinical trials of Fampridine SR. What dose did you take and was it the immediate release or the timed-release formulation? It may be that 4-AP does not have any effect on your spasticity but the effect is very dose dependent.

    You know all the information that I have concerning the OEG transplants. You did not mention your level or how long after injury you are but I assume that you have a thoracic level and a recent injury (from the fact that you say you have a new set of KAFO braces). Based on my very limited observations of patients in Beijing, I think that OEG's may reduce spasticity. Most of the people that I saw were after the transplants and I have the impression that they have less spasticity I am used to seeing in the U.S.

    Wise.

  5. #5
    The pump can be calibrated to deliver a lower or higher dose during a specified time period. Matt just had his dose lowered between 9-11 am, which is the time he does his fES on the bike; the original dose was hindering the FES from working.

    _____________
    Tough times don't last - tough people do.

  6. #6
    i had extreme spasms to the point of starting to cause heart problems i recently got the pump it took 6 times if it could go wrong it did but yes it was worth it by far

  7. #7
    Quote Originally Posted by Wise Young View Post
    bryan,

    You seem to be doing all the right things. What you are describing, however, sounds more like spasticity than spasms. Spasticity is when the legs are stiff. Spasms are when your legs would kick out spontaneously, often with substantial force. If titrated properly, intrathecal baclofen should control spasticity of the type that you describe without producing flaccidity. You don't want to take such a high dose that you lose muscle tone. I really don't know whether they can program the baclofen pumps to deliver more during certain parts of the day or night when your spasticity is worse. Also, spasticity may change from day to day or week to week.

    Regarding 4-AP, I assume that you did not participate in the clinical trials of Fampridine SR. What dose did you take and was it the immediate release or the timed-release formulation? It may be that 4-AP does not have any effect on your spasticity but the effect is very dose dependent.

    You know all the information that I have concerning the OEG transplants. You did not mention your level or how long after injury you are but I assume that you have a thoracic level and a recent injury (from the fact that you say you have a new set of KAFO braces). Based on my very limited observations of patients in Beijing, I think that OEG's may reduce spasticity. Most of the people that I saw were after the transplants and I have the impression that they have less spasticity I am used to seeing in the U.S.

    Wise.
    What is OEG?

  8. #8
    T-10 Para post 20 plus years. My spasms we're just out on control. Pump installed took about 6 trips to adjust dosage correctly. Changed my life very happy with outcome.

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