1. Use of Intrathecal Baclofen in Combination Therapy for Pain Management Kim Spinelli MSN, RN-BC, CNS Pain Management Clinical Nurse Specialist Memorial Hospital-University of Colorado Health Colorado Springs, CO

2. Efficacy of Intrathecal Drug Delivery Pain Therapy Reduction in pain Discontinued or greatly reduced consumption of oral analgesics Enhanced performance of daily activities and increased activity

3. Addition of Baclofen to Current IT Therapy for Pain Management Added to current therapy as an adjunct Patients typically already on a combination of opioid and bupivacaine Starting dose of Baclofen 50-75 mcg/day

4. Paul 63 y/o Hx DDD & post laminectomy syndrome (L4-5, S1 fusion) Intrathecal pump with hydromorphone and bupivacaine controlling pain, but; Muscle spasms in bilateral lower extremities, especially in his calves Unable to tolerate PO muscle relaxants Added Baclofen 75 mcg/day in the pump Was up to 100 mcg/day, now at 40 mcg/day (past 3 years)

5. May 65 y/o Hx Multiple Sclerosis, spinal stenosis and DDD On PO Baclofen- ineffective for lower extremity spasticity Increasing cognitive decline with oral pain meds for low back pain IT Pump implanted- Hydromorphone (80 mcg/day), bupivacaine (5 mg/day), and baclofen (70 mcg/day) Currently on 350 mcg/day with ongoing titration Hydromorphone dose is 1.7 mg/day currently

6. Elaine 51 y/o Hx breast CA with post mastectomy syndrome and radiation fibrosis. Intractable chest wall pain Unable to tolerate any opioid medication IT pump with hydromorphone, bupivacaine, droperidol Pain well controlled, but having muscle tightness and spasms Added Baclofen at 50 mcg/day Currently at 170 mcg/day and titrating

7. Thanks!