Effect of intrathecal baclofen on evoked pain perception: An evoked potentials and quantitative thermal testing study

Authors

  • H. Kumru,

    Corresponding author
    1. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
    • Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
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  • M. Kofler,

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Department of Neurology, Hochzirl Hospital, Zirl, Austria
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  • M.C. Flores,

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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  • E. Portell,

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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  • V. Robles,

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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  • N. Leon,

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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  • J. Vidal

    1. Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
    2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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  • Funding sources

    This work was supported in part by grants from the Foundation La Marató TV3 (110930) and the Instituto de Salud Carlos III PI10/00442.

  • Conflicts of interest

    None declared.

Correspondence

Hatice Kumru

E-mail: hkumru@guttmann.com

Abstract

Background and Objectives

Somatic antinociceptive effects of baclofen have been demonstrated in animal models. We hypothesized that if enhanced thermal or pain sensitivity is produced by loss of gamma-aminobutyric acid (GABA)-ergic tone in the central nervous system, spinal administration of GABA agonists might be predicted to be effective in thermal and/or pain perception changes and pain-related evoked potentials in candidates for intrathecal baclofen (ITB) treatment.

Methods

Eleven patients with severe spinal cord injury (SCI) who suffered from severe spasticity were evaluated during a 50-μg ITB bolus test. Warm and heat pain thresholds, evoked heat pain perception, and contact heat-evoked potentials (CHEPs) were determined above SCI level from the right and left sides. Nine age- and gender-matched healthy volunteers undergoing repeat testing without any placebo injection served as control group.

Result

In patients, heat pain perception threshold increased, and evoked pain perception and amplitude of CHEPs decreased significantly after ITB bolus application in comparison with baseline (p < 0.005), with no change in warm perception threshold. In controls, no significant changes were observed in repeat testing over time.

Conclusion

Our findings indicate that ITB modulates heat pain perception threshold, evoked heat pain perception and heat pain-related evoked potentials without inducing warm perception threshold changes in SCI patients. This phenomenon should be taken into account in the clinical evaluation and management of pain in patients receiving baclofen.

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