“Thriasio” General Hospital IMAST 2006 Athens Greece THE MANAGEMENT OF COMPLEX PAIN SYNDROMES DUE SPINAL CORD INJURY: THE COMBINATION OF INTRATHECAL DRUGS “Thriasio” General Hospital Athens Greece KISKIRA O1, GRIVAS TB2, KOLOTOURA1, KOINHS A2, POULIOU A1, ANASTASSIOU E1 1 Department of Anesthesiology and Pain Clinic 2 Department of Orthopaedics and Traumatology “Thriasio” General Hospital, Magoula, Attica, Greece

“Thriasio” General Hospital IMAST 2006 Athens Greece Introduction The use of neuraxial techniques for providing functional analgesia is usually the next step beyond the administration of oral and transcutaneous agents. Intrathecal baclofen morphine clonidine administration via an implantable pump has evolved into an alternative treatment for complex pain syndromes. The aim of the study was to determine the efficacy and safety of intrathecal baclofen, clonidine plus morphine therapy for severe spasticity related pain delivered by a constant flow implantable pump. “Thriasio” General Hospital Athens Greece

“Thriasio” General Hospital IMAST 2006 Athens Greece Methods A long term observational follow-up study evaluating 11 patients having spinal cord related spasticity with intractable pain who received intrathecal baclofen, morpine plus clonidine via a constant flow pump. “Thriasio” General Hospital Athens Greece

“Thriasio” General Hospital IMAST 2006 Athens Greece Methods The mean follow-up period was 43 months. The initial Ashworth score was 3.6, while the initial VAS score 8.4. The average daily dosages were: baclofen 275 mcg, morphine 2.5 mg, clonidine 12 mcg. At each follow up visit, clinical efficacy of constant drug administration on spasticity was evaluated by applying Ashworth score. Pain was assessed with VAS score. All adverse events and complications were recorded. “Thriasio” General Hospital Athens Greece

“Thriasio” General Hospital IMAST 2006 Athens Greece Results All patients responded satisfactorily to therapy. Ashworth score declined from 3.6 to 1.7 VAS score reduced from 8.4 to 3.7. Complications were rare. Technical incidents related to the catheter occurred in 1 patient (9%). One (1) patient (9%) developed abdominal wall haematoma. No infections were reported. The vast majority of cases demonstrated a moderable reduction in spasticity and exhibited a considerable improvement in their psychosocial status. “Thriasio” General Hospital Athens Greece

“Thriasio” General Hospital IMAST 2006 Athens Greece Conclusions Combinations of baclofen, morphine and clonidine intrathecal infusion are more effective than each drug alone for spasticity related pain syndromes. They should therefore be considered in the management of these patients. Possible adverse side effects resulting from this therapy can be alleviated by adjustments in the dosage. “Thriasio” General Hospital Athens Greece