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Intrathecal Baclofen Pump — FRCA Final MCQ

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ModeratePain MedicineIntrathecal Baclofen PumpFRCA Final

A 62-year-old man (ASA III) with chronic pain following a spinal cord injury at T6 has severe spasticity. He is scheduled for insertion of an intrathecal baclofen pump. What is the main advantage of intrathecal over oral baclofen?

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Correct answer: A — Delivers drug directly to the CSF at much lower systemic doses, reducing sedation and other systemic side effects

Intrathecal baclofen delivers the drug directly to the GABA-B receptors in the dorsal horn of the spinal cord, achieving effective CSF concentrations at approximately 1% of the equivalent oral dose. This dramatically reduces systemic side effects (sedation, cognitive impairment, weakness) while providing superior spasticity control. Oral baclofen has poor CNS penetration and requires high doses that cause significant sedation. The pump requires surgical implantation and regular refilling (every 1-3 months). Abrupt withdrawal of intrathecal baclofen can cause life-threatening autonomic instability and seizures.

Reference: Faculty of Pain Medicine – 2021 – Intrathecal drug delivery guidelines; NICE – 2014 – Spasticity in adults