Intrathecal Baclofen Therapy (ITB)
This pump is surgically implanted under the skin, usually near the waistline, and connected to a catheter that delivers the medication. By administering baclofen directly to the spinal cord, ITB can be much more effective and require lower doses compared to oral medication, reducing side effects and making the medication more tolerable.
ITB is often used for patients with conditions like multiple sclerosis, spinal cord injuries, cerebral palsy, stroke, and traumatic brain injuries when other treatments have not been effective. The therapy helps improve muscle movement, reduce spasms, and enhance overall quality of life.
What to Expect
1. The Trial Phase: Before committing to intrathecal baclofen (ITB) therapy, you get to test it out first. This is called the “trial phase,” and it’s ideal for testing whether this therapy works for you. During the trial, a lumbar puncture is used to inject a tiny amount of baclofen in the cerebrospinal fluid around your spinal cord.
The trial phase lasts several hours. During this time, we will check on you periodically to determine the effectiveness of the medication. The goal of the trial is to see if the therapy reduces your spasticity and improves your pain. It’s like taking it for a test drive—you get to decide if it’s right for you.
2. The Implant Procedure: If the trial is successful and you find ITB effective, we can move forward to the next step.
Implanting an ITB pump is an outpatient surgical procedure done at the surgery center or hospital. A small pump is placed under the skin of your abdomen, near your waistline. This pump is connected to a thin, flexible tube called a catheter. The catheter is carefully routed under the skin to your back, where its tip is positioned in the fluid-filled space around your spinal cord (called the intrathecal space).
The procedure is done under either deep sedation or general anesthesia. After surgery, you will be discharged home with post-procedure instructions and a follow up appointment with us. Initially, the pump is filled with saline so you will need to continue to take your oral medication until we replace the saline with baclofen in our office.
3. Programming the ITB pump: After the pump is implanted, the dose of baclofen is customized just for you. We will schedule a series of appointments to adjust the dose to get the most effective muscle relaxation while minimizing any side effects.
4. Adjusting and Living with ITB: Over time, we can adjust the pump settings if needed. Periodically, the pump will need to be refilled with baclofen, which is easily done in the office. The time between refills depends on the dose of baclofen being used.
Once we find the right dose of baclofen, patients find it improves their ability to move and allow them to live more comfortably without having to deal with spasticity.
Instructions Before the Procedure
1. If you take blood thinners, we will provide detailed instructions on when to stop and restart them.
2. Please let us know if there are any changes to your health, such as a new pregnancy, or if you start antibiotics before your procedure.
3. Since this procedure is done with anesthesia in a surgery center or hospital, plan for a friend or family member to drive you home afterward. They are welcome to wait in the waiting area during your procedure, or you can call them when you are ready to leave.
4. We’ll provide additional instructions based on the surgery center or hospital where your procedure is scheduled.
Instructions After the Procedure
Rest and Activity:
- Plan to take it easy following the procedure until you follow up with us.
- Avoid heavy lifting or strenuous physical activities.
- We will let you know when to gradually return to your normal daily activities.
- Avoid operating heavy or potentially dangerous equipment on the day of your procedure.
- Plan to avoid driving until you follow up with us.
Alcohol: If you received sedation, please skip alcohol for the rest of the day.
Dressings: We will provide instructions on when you may remove any dressings. Do not remove them on your own.
Blood Thinners: You can restart your blood thinners the day after your procedure unless we have advised you otherwise.
Comfort at the Procedure Site: It’s normal to feel some mild discomfort. Applying ice can help ease the soreness—just remember to wrap the ice in a cloth and avoid placing it directly on your skin. Refrain from using heat on the incision sites.
Additional Instructions: Follow up appointments and any other specific instructions will be provided the day of the procedure.
Is ITB therapy covered by my insurance plan?
Yes, Medicare and the Medicare Advantage plans cover ITB therapy, as do most commercial insurance plans. Prior authorization is required by most plans.
Can any other medications be used in an ITB pump?
It is important to make sure the medication being used is suitable for intrathecal use (use directly in the fluid around the spinal cord).