Pediatric Rehabilitation Medicine Department, University of Colorado, Children's Hospital of Colorado, Aurora, CO, USA.
Pediatric Rehabilitation Medicine Department, Detroit Medical Center, Children's Hospital of Michigan, Detroit, MI, USA.
J Pediatr Rehabil Med. 2024;17(1):57-66. doi: 10.3233/PRM-220100.
The use of intrathecal medications for the management of spasticity and various pain syndromes in the adult population has been previously reported. However, no evidence-based guidelines currently exist in the pediatric population. This case series presents patients (n = 8) with pediatric-onset disability who underwent placement of intrathecal baclofen pumps initially for management of severe spasticity. Despite titration of dose and use of oral analgesia, their uncontrolled pain persisted. Each patient was transitioned to a combination of baclofen and analgesic intrathecal therapy. The outcome in pain improvement and quality of life, as reported by patients and/or caregivers, were retrospectively reviewed.
Retrospective review of the background and decision-making process regarding transition to combination intrathecal therapy identified patient selection characteristics. Each patient and/or their caregivers completed a survey regarding improvements in pain, spasticity, function, and quality of life following initiation of combination intrathecal medications.
Survey results revealed improvements in functional and pain assessments after initiation of combination baclofen and analgesic intrathecal medication. Patients and caregivers reported decreases in pain and oral spasticity medications.
Use of pumps with antispasmodic and analgesic medication for combination intrathecal medication delivery should be considered in the management of patients with childhood-onset disabilities who have both severe spasticity and pain.
先前已有报道称，鞘内药物在成人人群中用于治疗痉挛和各种疼痛综合征。然而，目前在儿科人群中尚无基于证据的指南。本病例系列报告了 8 名患有儿科发病残疾的患者，他们最初因严重痉挛而接受了鞘内巴氯芬泵的植入。尽管进行了剂量滴定和口服镇痛药物治疗，但他们的疼痛仍无法控制。每位患者均转为使用巴氯芬和镇痛鞘内治疗的联合治疗。通过患者和/或护理人员的反馈，回顾性评估了疼痛改善和生活质量的结果。
回顾性分析了转向联合鞘内治疗的背景和决策过程，确定了患者选择的特征。每位患者和/或其护理人员完成了一项关于开始联合鞘内药物后疼痛、痉挛、功能和生活质量改善的调查。
调查结果显示，开始联合使用巴氯芬和镇痛鞘内药物后，在功能和疼痛评估方面均有改善。患者和护理人员报告疼痛和口服痉挛药物的用量减少。
对于患有严重痉挛和疼痛的儿童发病残疾患者，应考虑使用带有抗痉挛和镇痛药物的泵进行联合鞘内药物输送治疗。
