Simultaneous treatment of intractable pain and spasticity: observations of combined intrathecal baclofen-morphine therapy over a 10-year clinical experience

Aim. Intrathecal therapy has separate indications for refractory pain and spasticity. Both entities have a relatively high prevalence in neurologic diseases. This study examines the potential efficacy of utilizing additive intrathecal morphine (ITM) therapy to a group of patients who had previously stabilized on intrathecal baclofen (ITB) therapy. 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 pg/day (range 2710 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. Conclusion. Reduction is pain intensity with coin- bined therapy was variable. Intrathecal morphine can be a safe and effective adjunct pain therapy to patients utilizing intrathecal baclofen for spasticity.