Ho JK, and Sadiq, SA. Journal of Neurology. 2012; 259(5): 982-984.
Spasticity and pain are common features of spinal cord
disease that may be adequately treated with oral medications
in many patients. However, for optimal results it is
necessary to use intrathecal baclofen (ITB) or intrathecal
morphine (ITM) delivered via a surgically implanted programmable
pump in some patients [1–4]. Most patients
who need ITB/ITM therapy respond well but in some
clinical situations there are problematic issues, including:
(1) Occasionally titration of ITB dose is difficult when
relief of spasticity is associated with an unacceptable
degree of muscle weakness; (2) Rarely patients on continuous
long-term ITB therapy develop drug tolerance and
cease to respond to escalating doses of ITB ; (3) Some
patients with pain are intolerant to or rarely, inadequately
responsive to intrathecal (IT) narcotics.