Can Intrathecal Baclofen Infusion Cause Back Pain or Spinal Issues?
Yes, intrathecal baclofen infusion can cause back pain and spinal complications, though these are relatively uncommon when proper technique and monitoring protocols are followed.
Documented Back-Related Complications
Catheter-Related Mechanical Issues
- Catheter placement itself can cause localized back pain at the insertion site, particularly during the initial post-implantation period 1, 2.
- Isolated case reports document lumbar and cervical radicular symptoms associated with intrathecal catheter injection after inadvertent dural puncture, though these resolved in the early postnatal period in obstetric populations 3.
- Catheter migration, kinking, or dislodgement can cause localized discomfort and may require surgical revision 1, 4.
Infection Risk
- Deep infection represents a small but serious risk with any intrathecal catheter system 3.
- Central neuraxial infection is concerning because the dura is breached and the catheter sits within cerebrospinal fluid adjacent to nerve roots and meninges 3.
- Case reports have documented meningitis in patients with intrathecal catheters 3.
Serious Neurological Complications (Rare)
- While no cases of cauda equina syndrome have been reported specifically with intrathecal baclofen pumps in the available evidence, this complication has occurred with other intrathecal catheter systems, particularly micro-catheters smaller than 24-G 3.
- Spinal or epidural hematoma is a theoretical risk in patients with coagulopathy, though large retrospective reviews have not identified cases in properly selected patients 3.
- Direct spinal cord trauma from catheter placement is possible but extremely rare with proper technique 3.
Critical Safety Considerations
Pump Malfunction and Withdrawal
- Abrupt cessation of intrathecal baclofen creates life-threatening withdrawal risk including seizures, psychic symptoms, hyperthermia, and potentially death 5, 6.
- Withdrawal symptoms are more dangerous than overdose and most commonly occur from delivery system problems 6.
- Patients must understand the urgency of timely refills and catastrophic consequences of missed appointments 5.
Overdose Complications
- Drug overdose can cause excessive hypotonia, central depression, and respiratory compromise 2, 4.
- Two documented overdoses in early pump models took several days to resolve 4.
- Overdose primarily arises from test doses or human error during refill and programming 6.
Contraindications That Increase Back Complication Risk
Intrathecal baclofen therapy is explicitly contraindicated in patients with 3, 7:
- Active infections (local or systemic)
- Coagulopathy or anticoagulant therapy
- Anatomical abnormality of the spine
Arachnoiditis is a relative contraindication due to introduction of foreign material into an already inflamed and adherent subarachnoid space 7.
Common Pitfalls to Avoid
Inadequate Patient Selection
- Failure to obtain mandatory psychological evaluation documenting favorable candidacy increases risk of non-compliance with refill schedules 5, 7.
- Skipping the required trial with temporary catheter demonstrating ≥50% symptom reduction before permanent implantation 7.
Technical Errors
- Improper catheter placement technique increases risk of direct neural trauma 3.
- Inadequate sterile technique during implantation or refills raises infection risk 3.
Monitoring Failures
- Insufficient follow-up to detect catheter migration or pump malfunction before withdrawal symptoms develop 4.
- Failure to educate patients about withdrawal symptoms and refill urgency 5.
Clinical Bottom Line
Back pain from intrathecal baclofen systems is typically localized, mechanical, and related to the catheter/pump hardware rather than the medication itself 1, 2. The most serious spinal complications—infection, hematoma, and neurological injury—are rare when proper patient selection, sterile technique, and monitoring protocols are followed 3, 1. The greater danger lies in pump/catheter malfunction leading to baclofen withdrawal, which can be fatal 5, 6. Any new or worsening back pain in a patient with an intrathecal baclofen pump warrants immediate evaluation for catheter complications, infection, or delivery system failure 1, 4.