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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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