Intrathecal Pump Refill Management for Chronic Pain

Critical Safety Considerations

• Abrupt cessation of intrathecal baclofen infusion can lead to catastrophic intrathecal baclofen withdrawal syndrome, which usually evolves over 1-3 days but may become fulminant if not recognized and treated promptly, and the best management strategy is resuming the intrathecal infusion as soon as possible, making timely refills urgent procedures 1, 2
• High-dose benzodiazepine intravenous infusion or oral baclofen may be lifesaving before intrathecal baclofen therapy can be resumed, though acute withdrawal may still occur with high-dose oral baclofen 1
• Intrathecal pump refills are considered urgent pain patient procedures due to the risk of withdrawal syndromes 2
• Patients at high risk of intrathecal drug withdrawal should be identified and educated pre-emptively about the importance of timely refills 1, 2
• Pain physicians should consider higher drug concentrations during periods when reducing refill visit frequency is beneficial, though this must be weighed against granuloma formation risk with long-term high-concentration infusions 1, 2

Refill Schedule and Monitoring

• Never allow intrathecal baclofen pumps to run empty, as this creates life-threatening withdrawal risk 1, 2

Continuation of Intrathecal Baclofen Therapy

Clinical Evidence Supporting Continuation

• The patient has an implanted intrathecal pump that continuously infuses baclofen (900 mcg/mL) for lower extremity spasticity, with regular refills approximately every 1.5 months, indicating an established treatment regimen 3
• Clinical practice guidelines recommend intrathecal baclofen for chronic patients with spasticity resulting in pain, poor skin hygiene, or decreased function - all concerns relevant to this patient's presentation 3