An implanted pump delivering the medication baclofen to a person’s spinal cord can have life-changing impacts for patients with spasticity. Patients with chronic conditions such as cerebral palsy, multiple sclerosis, spinal cord injury, brain injury and stroke often face challenges with muscle tightness and stiffness brought on by spasticity.
Benjamin R. Scoblionko, MD, is a physiatrist specializing in spasticity and dystonia management and leads Good Shepherd’s baclofen pump management program and bracing clinic. He also provides patient evaluations, medication management, chemodenervation and chemoneurolysis.
In this Q&A, Dr. Scoblionko shares his knowledge of baclofen pumps and explains how it helps treat spasticity.
What is a baclofen pump?
Dr. Scoblionko: A baclofen pump is an implantable device that delivers baclofen in liquid form directly into spinal fluid, which helps relax muscles and relieve spasms, cramping and tightness in the body. Implanted into the abdomen, the small pump has a catheter that winds around the abdomen and feeds into the spinal canal to deliver the medication.
What type of patients benefit from a baclofen pump?
Dr. Scoblionko: A baclofen pump may benefit any patient withanupper motor neuron lesion, which is an insult to the central nervous system. This includes injuries to the brain or spinal cord, cerebral palsy, strokes, neurodegenerative disorders such as multiple sclerosis and Parkinson’s, and hereditary spastic paraparesis. The pump can help any patient at risk of developing complications related to their spasticity, including mobility impairments, pain, infections and skin breakdown.
Baclofen pumps work best at addressing spasticity in the lower limbs, and the medication can have a dramatic impact on those patients. There are some benefits to the upper limbs; however, catheter placement is more limited because the cervical spinal canal is smaller and results are more variable.
How are baclofen pumps managed at Good Shepherd?
Dr. Scoblionko: Our program is highly individualized to address patient needs. We provide comprehensive management, including screening patients for trials, coordinating implantation, dose adjustments and troubleshooting.
A baclofen pump typically holds medication that lasts for several months and is refilled in the office by a physician. Doses often require frequent titrations early on until the dose becomes therapeutic, at which point patients typically come in every few months for refills and smaller adjustments.
Can a baclofen pump result in the reduced use of oral medications for spasticity?
Dr. Scoblionko: For the optimal treatment of spasticity, we often create an integrated, personalized drug therapy plan that may also include chemodenervation with botulinum toxin or chemoneurolysis. Chemodenervation temporarily blocks the communication between nerves to muscles to reduce spasms. Chemoneurolysis uses a chemical agent to degrade a motor nerve and similarly block communication, though it has more permanent effects.
For patients, this integrated therapy approach often results in lower doses of oral medications, which have significant side effects.
What baclofen pump services does Good Shepherd provide?
Dr. Scoblionko: Our program continues to identify patients who would benefit from baclofen therapy and as well as provide management of the pump and medication after the surgical implantation of the device. That includes treating patients at all stages of their recovery.
We offer unique understanding of the complex programming features of the pump to provide individualized therapy. We are also expanding our ability to diagnose, treat, and monitor issues related to pump malfunctions. The next step in our development and expansion is to initiate baclofen trials for inpatients at Good Shepherd Rehabilitation Hospital to see how they respond to the therapy.
Why is Good Shepherd’s baclofen pump and spasticity treatment different?
Dr. Scoblionko: Good Shepherd’s spasticity management services offer the most comprehensive and personalized treatment in the greater Lehigh Valley region. I completed a fellowship in spasticity management at Thomas Jefferson University Hospital in Philadelphia, which was the first –– and now only one of three –– fellowships of its kind in the country. This highly focused training provided me with a unique skillset to grow and expand on industry standards.
It is common for physiatrists to focus on a type of injury, such as stroke, brain injury or spinal cord injury. That results in spasticity being managed by physicians who are also focusing on a variety of additional complications and complaints. In contrast, I am able to have a more highly specialized and in-depth discussion on a patient’s functional deficits as related to their mobility impairments to create an individualized therapy plan that meets the patient’s needs.
Good Shepherd has a multidisciplinary approach to managing movement disorders. A patient in or outside the hospital may be cared for in our network by physicians, nurses, physical therapists, occupational therapists, aquatic therapists, speech therapists, care managers, and orthotists (who provide splinting and bracing). We work together to provide the most integrated care in the region.
We offer a bracing clinic at Good Shepherd, where each patient is evaluated by me, a physical therapist and an orthotist simultaneously, working together to come up with the best bracing options.
Providing highly focused care and in-depth management of movement disorders elevates our overall spasticity management, which ultimately benefits patients.
To learn more about baclofen pump management and spasticity treatment or to schedule an appointment, call 610.778.1050 or fill out this form.