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In this case, treatment of severe spasticity and nociceptive pain was required while avoiding potentially lethal side effects of sudden baclofen withdrawal. We suggest an effective bridging and weaning protocol for oral drug titration to treat spasticity and pain as a blended syndrome in this challenging situation.<\/jats:p>","DOI":"10.1136\/bcr-2021-242686","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T12:47:48Z","timestamp":1632746868000},"page":"e242686","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Baclofen bridging, weaning protocol and pain management of a person with T6 paraplegia who required removal of intrathecal baclofen pump due to wound infection"],"prefix":"10.1136","volume":"14","author":[{"given":"Jessica","family":"Roth","sequence":"first","affiliation":[{"name":"London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayder","family":"Agha","sequence":"additional","affiliation":[{"name":"London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK"},{"name":"SCIC, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Davis","sequence":"additional","affiliation":[{"name":"London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK"},{"name":"SCIC, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"2025082712445353000_14.9.e242686.1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1396012"},{"key":"2025082712445353000_14.9.e242686.2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1941874416637404","article-title":"Oral baclofen withdrawal resulting in progressive weakness and sedation requiring intensive care admission","volume":"7","author":"Alvis","year":"2017","journal-title":"Neurohospitalist"},{"key":"2025082712445353000_14.9.e242686.3","unstructured":"National Institute for Health and Care Excellence (2020) . Perioperative care in adults (NICE guideline180). Available: https:\/\/www.nice.org.uk\/guidance\/ng180\/chapter\/Recommendations#managing-pain [Accessed 5 May 2021]."},{"key":"2025082712445353000_14.9.e242686.4","doi-asserted-by":"publisher","DOI":"10.1081\/CLT-120018277"},{"key":"2025082712445353000_14.9.e242686.5","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.73.6.705"},{"key":"2025082712445353000_14.9.e242686.6","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1111\/ner.12873","article-title":"A novel approach to avoid baclofen withdrawal when faced with infected baclofen pumps","volume":"22","author":"Hwang","year":"2019","journal-title":"Neuromodulation"},{"key":"2025082712445353000_14.9.e242686.7","unstructured":"National Institute for Health and Care Excellence . Surgical site infections: Prevention and treatment (NICE guideline 125), 2019. Available: https:\/\/www.nice.org.uk\/guidance\/ng125\/resources\/surgical-site-infections-prevention-and-treatment-pdf-66141660564421 [Accessed 2 Sep 2021]."},{"key":"2025082712445353000_14.9.e242686.8","unstructured":"Royal College of Physicians (2018) . Spasticity in adults: management using botulinum toxin. London: RCP, 2019. https:\/\/www.rcplondon.ac.uk\/guidelines-policy\/spasticity-adults-management-using-botulinum-toxin"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-242686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:45:00Z","timestamp":1756323900000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-242686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":8,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,27]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bcr-2021-242686"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-242686","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}