Symposium Proceedings| Volume 122, P106-109, September 2021

Characterizing Baclofen Withdrawal: A National Survey of Physician Experience



      We studied physicians’ opinions and experiences concerning clinical concerns, perceived severity, occurrence, and management of baclofen withdrawal due to abrupt discontinuation.


      A nationwide 26-question electronic survey was distributed via e-mail to physicians (N = 952) representing varying specialties who manage spasticity with baclofen. A total of 110 physicians provided responses to the survey (response rate = 11.6%). Results were evaluated using descriptive statistics.


      Withdrawal from both oral and intrathecal (IT) baclofen was recognized as a significant concern and was observed by most respondents. However, approximately 75% and 35% of respondents or their clinic sites lack established management protocols for managing anticipated interruption of oral or IT baclofen, respectively.


      These findings highlight the need for further research on and the development of guidelines for the prevention and treatment of baclofen withdrawal. The results of this survey, along with a systematic literature review and multidisciplinary stakeholder input, may be helpful in establishing guidelines for the treatment and prevention of baclofen withdrawal.


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        • Green L.
        • Nelson V.
        Death after acute withdrawal of intrathecal baclofen: case report and literature review.
        Arch Phys Med Rehabil. 1999; 80: 1600-1604
        • Ross J.C.
        • Cook A.M.
        • Stewart G.L.
        • Fahy B.G.
        Acute intrathecal baclofen withdrawal: a brief review of treatment options.
        Neurocrit Care. 2011; 14: 103-108
        • Therapeutics S.
        Lioresal intrathecal.
        in: AG NPS Baclofen Injection. Intrathecal Baclofen, Minneapolis, MN2016: 1-14
        • McKesson
        Baclofen Tablet Package Insert.
        2013: 1-8
        • Dastgir A.
        • Ranalli N.J.
        • MacGregor T.L.
        • Aldana P.R.
        Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity.
        J Neurosurg Pediatr. 2015; 16: 335-339
        • Gooch J.L.
        • Oberg W.A.
        • Grams B.
        • Ward L.A.
        • Walker M.L.
        Complications of intrathecal baclofen pumps in children.
        Pediatr Neurosurg. 2003; 39: 1-6
        • Motta F.
        • Buonaguro V.
        • Stignani C.
        The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases.
        J Neurosurg. 2007; 107: 32-35
        • Albright A.L.
        • Gilmartin R.
        • Swift D.
        • Krach L.E.
        • Ivanhoe C.B.
        • McLaughlin J.F.
        Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin.
        J Neurosurg. 2003; 98: 291-295
        • Borowski A.
        • Littleton A.G.
        • Borkhuu B.
        • et al.
        Complications of intrathecal baclofen pump therapy in pediatric patients.
        J Pediatr Orthop. 2010; 30: 76-81
        • Borowski A.
        • Shah S.A.
        • Littleton A.G.
        • Dabney K.W.
        • Miller F.
        Baclofen pump implantation and spinal fusion in children: techniques and complications.
        Spine. 2008; 33: 1995-2000
        • Dvorak E.M.
        • McGuire J.R.
        • Nelson M.E.
        Incidence and identification of intrathecal baclofen catheter malfunction.
        PM&R. 2010; 2: 751-756
        • Mandac B.R.
        • Hurvitz E.A.
        • Nelson V.
        Hyperthermia associated with baclofen withdrawal and increased spasticity.
        Arch Phys Med Rehabil. 1993; 74: 96-97
        • Schmitz N.S.
        • Krach L.E.
        • Coles L.D.
        • et al.
        A randomized dose escalation study of intravenous baclofen in healthy volunteers: clinical tolerance and pharmacokinetics.
        PM&R. 2017; 9: 743-750
        • Coffey R.J.
        • Ridgely P.M.
        Abrupt intrathecal baclofen withdrawal: management of potentially life-threatening sequelae.
        Neuromodulation. 2001; 4: 142-146
        • Agarwal S.K.
        • Kriel R.L.
        • Cloyd J.C.
        • et al.
        A pilot study assessing pharmacokinetics and tolerability of oral and intravenous baclofen in healthy adult volunteers.
        J Child Neurol. 2015; 30: 37-41
        • Cunningham C.T.
        • Quan H.
        • Hemmelgarn B.
        • et al.
        Exploring physician specialist response rates to web-based surveys.
        BMC Med Res Methodol. 2015; 15: 32

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