{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T09:04:37Z","timestamp":1768640677067,"version":"3.49.0"},"reference-count":10,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intrathecal baclofen (ITB) is a proven, effective treatment for refractory spasticity and chronic pain, with applications ranging from spinal cord injury to amyotrophic lateralsclerosis (ALS). Despite its effectiveness, the withdrawal syndrome of intrathecal baclofen can be life\u2010threatening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>This case describes the treatment of a patient with chronic spasticity related to ALS with an ITB pump infection requiring explant and a prolonged period of antibiotics before reimplantation. A 62\u2010year\u2010old man with ALS\u2010related spasticity maintained on high\u2010dose ITB for 20\u2009years presented to the emergency department with one week of fever, confusion, and localized erythema to the R\u2010side of his abdomen. Laboratories indicated a mild leukocytosis 12.9\u2009K\/uL and imaging showed a 2.9\u2010cm fluid collection with fat stranding surrounding the ITB pump. The pack was explanted, and the patient started on intravenous antibiotics. Due to the high baclofen dosage, our pain service recommended PO (per os) baclofen 30\u2009mg every 6\u2009h via gastrostomy and PO diazepam 10\u2009mg every 6\u2009h via gastrostomy. These doses were titrated carefully to avoid oversedation while preventing withdrawal symptoms. On Day 23 postexplant, the patient had the baclofen pump reimplanted and baclofen titrated over three days to his previous dose of ITB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case demonstrates a successful approach to avoiding severe baclofen withdrawal using PO baclofen combined with PO diazepam. The high dose of maintenance ITB (1188.8 mcg\/day), the inability to reinsert the patient's intrathecal pump, and the high risk of intubation in a patient with severe neuromuscular dysfunction all made this a challenging case.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.13229","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T15:44:53Z","timestamp":1681919093000},"page":"847-850","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of high\u2010dose intrathecal baclofen pump explant: A case report"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1903-2788","authenticated-orcid":false,"given":"Campbell","family":"Belisle\u00a0Haley","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of California, Irvine Medical Center  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mrinal","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology University of California, Irvine Medical Center  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Newton","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology University of California, Irvine Medical Center  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent","family":"Yeung","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology University of California, Irvine Medical Center  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakhi","family":"Dayal","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology University of California, Irvine Medical Center  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010211\u201033079\u20101_24"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/rapm.2002.29244"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885\u20103924(96)00152\u20102"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20900"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurol.2020.08.009"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/20503121211022197"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011776.pub2"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181c6b257"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ner.12467"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028\u2010010\u20109422\u20106"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.13229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T02:57:45Z","timestamp":1697770665000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.13229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,19]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/papr.13229"],"URL":"https:\/\/doi.org\/10.1111\/papr.13229","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,19]]},"assertion":[{"value":"2023-01-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}