Intrathecal baclofen for dystonia of complex regional pain syndrome
| Autor: | E. M. Delhaas, Alexander G. Munts, Irene M. Teepe-Twiss, N T van Dasselaar, K.S. de Boer, Johan Marinus, J.J. van Hilten, J. H. C. Voormolen, M.A. van Rijn |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Baclofen Neurological disorder Placebo Central nervous system disease chemistry.chemical_compound Quality of life medicine Humans Single-Blind Method Adverse effect Injections Spinal Dystonia Dose-Response Relationship Drug Muscle Relaxants Central business.industry medicine.disease Treatment Outcome Anesthesiology and Pain Medicine Complex regional pain syndrome Neurology chemistry Anesthesia Female Neurology (clinical) business Complex Regional Pain Syndromes |
| Zdroj: | Pain. 143:41-47 |
| ISSN: | 0304-3959 |
| DOI: | 10.1016/j.pain.2009.01.014 |
| Popis: | Dystonia in complex regional pain syndrome (CRPS) responds poorly to treatment. Intrathecal baclofen (ITB) may improve this type of dystonia, but information on its efficacy and safety is limited. A single- blind, placebo-run-in, dose-escalation study was carried out in 42 CRPS patients to evaluate whether dys- tonia responds to ITB. Thirty-six of the 38 patients, who met the responder criteria received a pump for continuous ITB administration, and were followed up for 12 months to assess long-term efficacy and safety (open-label study). Primary outcome measures were global dystonia severity (both studies) and dystonia-related functional limitations (open-label study). The dose-escalation study showed a dose- effect of baclofen on dystonia severity in 31 patients in doses up to 450 lg/day. One patient did not respond to treatment in the dose-escalation study and three patients dropped out. Thirty-six patients entered the open-label study. Intention-to-treat analysis revealed a substantial improvement in patient and assessor-rated dystonia scores, pain, disability and quality-of-life (Qol) at 12 months. The response in the dose-escalation study did not predict the response to ITB in the open-label study. Eighty-nine adverse events occurred in 26 patients and were related to baclofen (n = 19), pump/catheter system defects (n = 52), or could not be specified (n = 18). The pump was explanted in six patients during the follow- up phase. Dystonia, pain, disability and Qol all improved on ITB and remained efficacious over a period of one year. However, ITB is associated with a high complication rate in this patient group, and methods to improve patient selection and catheter-pump integrity are warranted. |
| Databáze: | OpenAIRE |
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