Long-term baclofen therapy may involve an implantable pump device. What should be considered before initiating therapy?

• A. Implantable baclofen pump device
• B. Not relevant
• C. Avoid imaging studies
• D. Begin with high-dose oral therapy

Answer: (A)

Before starting long-term baclofen therapy that may use an implantable pump, evaluate whether an implanted device is appropriate for the patient. This approach is invasive and requires surgical placement of a pump and catheter to deliver baclofen directly into the intrathecal space, along with ongoing management, refills, and potential device-related risks. A key step is determining candidacy, often through a trial infusion to see if intrathecal delivery provides meaningful relief with acceptable tolerability. If the trial is favorable, the next step is implanting the pump; if not, alternative strategies are pursued. This planning also includes discussing possible complications (infection, catheter problems, pump malfunction) and ensuring the patient can commit to regular follow-up and device care. Imaging and other preoperative assessments are typically part of planning, not something to avoid, and starting with high-dose oral therapy is not the primary route when the plan is to use an implantable pump.