Simultaneous treatment of intractable pain and spasticity: observations of combined intrathecal baclofen-morphine therapy over a 10-year clinical experience
European Journal of Physical and Rehabilitation Medicine,  Clinical Article

Saulino M – Reduction is pain intensity with combined therapy was variable. Intrathecal morphine can be a safe and effective adjunct pain therapy to patients utilizing intrathecal baclofen for spasticity.

Methods
  • Pain intensity was assessed via VASPI; 183 individuals participated in ITB therapy from January 1998 to December 2007.
  • Forty–seven individuals elected to add ITM to their intrathecal therapy regimen.
  • Three patients were intolerant to ITM/ITB combination therapy.
  • No significant demographic differences between the two groups existed with respect to gender and race.
  • Non–traumatic and traumatic spinal cord injury patients were more likely to participate in combination therapy compared to other diagnoses.
  • The average stabilized ITB dose for the monotherapy group was not statistically different for the combination therapy group.

Results
  • The average stabilized ITM for the combination therapy group was 1 730 μg/day (range 27–10 500, SD 2 350).
  • The average decrement in VASPI was 35%.
  • Thirty out of 47 patients experienced a decrease greater than 30% in VASPI while 13 of the 47 patients experienced a decrease greater than 50% in Visual Analogue Scale of Pain Intensity (VASPI).
  • There was no significant relationship between percent improvement in VASPI and morphine dosing.
  • Eight of 47 combination patients experienced adverse events attributable to intrathecal morphine but were capable to utilize the combination therapy for a least one year.

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