Drug-enhanced spinal stimulation for pain: a new strategy

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Neuropathic pain management is challenging, with limited drug efficacy.
• Spinal cord stimulation (SCS) is an option, but 30-50% of patients experience trial failure or reduced long-term benefits.
• GABA-B receptor agonists, like baclofen, show promise in potentiating SCS effects based on animal studies.

Purpose of the Study:

• To evaluate the efficacy of intrathecal baclofen (ITB) as an adjuvant therapy in patients with neuropathic pain inadequately managed by SCS.
• To assess the safety and long-term outcomes of combining ITB with SCS.

Main Methods:

• 48 patients with neuropathic pain and insufficient SCS response received ITB in bolus doses.
• Some patients were implanted with SCS and ITB systems; others received baclofen pumps alone.
• Adenosine was explored as an alternative but faced technical challenges.

Main Results:

• Over 50% of patients experienced sustained, very good effects from SCS + baclofen therapy at long-term follow-ups (average 32 and 67 months).
• The required daily baclofen dose approximately doubled over the observation period.
• Intrathecal baclofen showed few mild side-effects, unlike peroral baclofen which caused significant adverse events.

Conclusions:

• Intrathecal baclofen is a viable adjuvant therapy for neuropathic pain patients with inadequate SCS response.
• A trial of ITB in combination with SCS may be warranted for this patient group.
• Peroral baclofen combined with SCS is associated with adverse effects and is not recommended.