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12/19/2017
1
PAIN, SPASTICITY
and PUMPS
PHIL FILBRANDT,MD AND ANGIE SOLECKI,RN
PUMPS�What
�Why
�When
�Where
�Who
�How
WHAT is an IntrathecalPump?
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Two different intrathecalpumps
� Medtronic � Flowonix
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WHY Pumps?
� For pain – FBSS
� Medications:
Morphine
Hydromorphone
Fentanyl
Prialt
Bupivicaine
Clonidine
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Other options
� Constant dosing vs flexible dosing
� Patient self bolus
Pumps for Spasticity
CVA
SCI
TBI
MS
CP
Anoxic Encephalopathy
Familial Spastic Paraparesis
Consequences of Spasticity
� Comfort, sleep
� ROM
� Hygiene, skin
� Pain
� Mobility, contractures
� QOL
� Caregiver burden
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Treatment of Spasticity
� Positioning
� ROM
� PT
� OT
� Modalities: heat, cooling, etc.
� Eliminate irritants: skin, b/b, meds-?SSRIs,
sprained ankle
Treatment - continued
Medication: Baclofen
Dantrium
Zanaflex
Valium
Tendon release surgery: wrist, ankle
Nerve block: musculocutaneous, median, tibial
obturator
Botulinum toxin: Xeomin, Botox
Intrathecal baclofen pump
More pump topics
� Test dose
� Battery life
� Refills
� Problems
MRI – ok!
Catheter disconnect/displacement
Programming – withdrawal and overdose
Skin
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Pump refill
� Angie Solecki,RN
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