Intrathecal baclofen in pain management

Slonimski, Marc; Abram, Stephen E.; Zuniga, Robert

doi:10.1016/j.rapm.2004.01.005

Cited by 50 publications

(42 citation statements)

References 57 publications

(64 reference statements)

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“…Of particular interest are the respective contributions of the baclofen-responsive and the DAMGO-responsive lamina II neurons to intrathecal antinociception. Our observations suggest that overlapping but distinct spinal circuits mediate the antinociceptive effects of intrathecal opioids and baclofen and may explain why modulating both circuits in intrathecal drug therapy is most effective for treating certain patients and certain types of pain (Slonimski et al, 2004).…”

Section: Discussionmentioning

confidence: 80%

Distinct Populations of Spinal Cord Lamina II Interneurons Expressing G-Protein-Gated Potassium Channels

Marker¹,

Luján²,

Colón

et al. 2006

J. Neurosci.

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Noxious stimuli are sensed and carried to the spinal cord dorsal horn by A␦ and C primary afferent fibers. Some of this input is relayed directly to supraspinal sites by projection neurons, whereas much of the input impinges on a heterogeneous population of interneurons in lamina II. Previously, we demonstrated that G-protein-gated inwardly rectifying potassium (GIRK) channels are expressed in lamina II of the mouse spinal cord and that pharmacologic ablation of spinal GIRK channels selectively blunts the analgesic effect of high but not lower doses of intrathecal -opioid receptor (MOR) agonists. Here, we report that GIRK channels formed by GIRK1 and GIRK2 subunits are found in two large populations of lamina II excitatory interneurons. One population displays relatively large apparent whole-cell capacitances and prominent GIRK-dependent current responses to the MOR agonist [D-Ala 2 ,N-MePhe 4 ,Gly-ol 5 ]-enkephalin (DAMGO). A second population shows smaller apparent capacitance values and a GIRK-dependent response to the GABA B receptor agonist baclofen, but not DAMGO. Ultrastructural analysis revealed that GIRK subunits preferentially label type I synaptic glomeruli, suggesting that GIRK-containing lamina II interneurons receive prominent input from C fibers, while receiving little input from A␦ fibers. Thus, excitatory interneurons in lamina II of the mouse spinal cord can be subdivided into different populations based on the neurotransmitter system coupled to GIRK channels. This important distinction will afford a unique opportunity to characterize spinal nociceptive circuitry with defined physiological significance.

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Section: Discussionmentioning

confidence: 80%

Distinct Populations of Spinal Cord Lamina II Interneurons Expressing G-Protein-Gated Potassium Channels

Marker¹,

Luján²,

Colón

et al. 2006

J. Neurosci.

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show abstract

“…In addition, GABA B agonists cause inhibition of calcium conductance across voltage-gated Ca 2+ channels and decrease the evoked release of excitatory neurotransmitters. Also, baclofen can attenuate pain perception by affecting pain transmission systems, suppress neuropathic pain, down-regulate the sympathetic nervous system, and decrease pain associated with muscle spasms [4]. Intrathecal infusion of baclofen has been used to treat spasticity since the 1980s [10].…”

Section: Discussionmentioning

confidence: 99%

“…Intrathecal baclofen (ITB) pumps have been used to ameliorate global pain in patients with CRPS and dystonia based on the anti-nociceptive effects of ITB [2][3][4][5]. Furthermore, several studies have reported the clinical effectiveness of combined SCS and ITB pump therapy as a multimodal therapeutic approach [3,5].…”

mentioning

confidence: 99%

Intrathecal baclofen pump implantation for complex regional pain syndrome in a patient with a spinal cord stimulator: consideration about optimal location of intrathecal catheter tip - A case report -

Lee

et al. 2018

Anesth Pain Med

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Complex regional pain syndrome (CRPS) is a chronic pain condition that most often affects one of the limbs, generally after an injury or trauma to that limb; it is characterized by pain and sensitivity, swelling, temperature and skin changes, and motor dysfunction in the affected area [1]. CRPS is associated with dysregulation of the central nervous system (CNS), peripheral nervous system, and autonomic nervous system. Intrathecal baclofen (ITB) pump implantation can be used to control dystonia and severe pain associated with complex regional pain syndrome (CRPS) with or without a spinal cord stimulator (SCS). A 45-year-old female patient had gotten an SCS to control the pain of CRPS. However, she suffered from chronic intractable pain in her left ankle and foot despite paresthesia in the entire painful area because the effectiveness of the SCS gradually diminished over time. In a trial of intrathecal drug administration, baclofen was superior to morphine for pain relief, had fewer side effects, and was superior in terms of patient satisfaction. To achieve the greatest degree of pain relief from the ITB pump, the tip of the intrathecal catheter was carefully placed in relation to the SCS. Over a oneyear follow-up period, the patient experienced mild pain without any adverse effects.

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“…The antispastic properties of baclofen are mediated by the suppression of release of excitatory neurotransmitters and inhibition of excitatory afferent terminals involved in monosynaptic and polysynaptic reflex activity at the spinal cord level [16][17]. Only recently, the antinociceptive effects of intrathecal baclofen, independent of motor blockade, have been suggested [18][19]. Zuniga et al [18] reported two cases of advanced CRPS successfully treated with intrathecal baclofen.…”

Section: Discussionmentioning

confidence: 99%

“…Zuniga et al [18] reported two cases of advanced CRPS successfully treated with intrathecal baclofen. A recent review by Slonimski et al [19] suggests efficacy of intrathecal baclofen for nociceptive and neuropathic pain, particularly in combination with opioid and/or clonidine.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Intractable Low Back and Pelvic Pain Caused by Advanced Prostate Cancer with Intrathecal Clonidine and Baclofen Infusion

Liu¹

2012

J Pain Relief

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Background: Intrathecal opioid infusion therapy has been increasingly utilized in patients with severe malignant and nonmalignant pain syndromes in the past few decades. By infusing small amount of analgesics directly into the cerebrospinal fluid (CSF) in close proximity to the receptor site in the spinal cord, spinally mediated analgesia may be achieved while sparing some of the side effects due to systemic opioids. Traditionally, the most commonly infused analgesic for intrathecal infusion is an opioid. Morphine represents the only FDA-approved opioid for intrathecal administration, although other opioids may also be used off-label. However, in patients who have demonstrated intolerance to oral opioid(s), alternative analgesics may be tried to achieve satisfactory analgesia.

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Intrathecal baclofen in pain management

Cited by 50 publications

References 57 publications

Distinct Populations of Spinal Cord Lamina II Interneurons Expressing G-Protein-Gated Potassium Channels

Distinct Populations of Spinal Cord Lamina II Interneurons Expressing G-Protein-Gated Potassium Channels

Intrathecal baclofen pump implantation for complex regional pain syndrome in a patient with a spinal cord stimulator: consideration about optimal location of intrathecal catheter tip - A case report -

Successful Treatment of Intractable Low Back and Pelvic Pain Caused by Advanced Prostate Cancer with Intrathecal Clonidine and Baclofen Infusion

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