34 – Pain Relief from Spasticity

Albert has stiffness and pain in his shoulder, elbow, and hand from spasticity, but the pain that he has in his lower back is the pain that causes him to stop whatever he’s doing to lie down with a heating pad underneath him. 

Spasticity is an everyday occurrence that can cause Albert to be in pain for hours at a time because it tightens the muscles around his joints and his lower back, and without rehab the pain is uncontrollable. Spasticity is an abnormal muscle tightness due to prolonged muscle contraction. It is a symptom associated with damage to the brain, spinal cord, or motor nerves, and is seen in individuals with various neurological conditions.  Albert’s spasticity is a product of his ischemic stroke. 

There are different ways spasticity attacks his body.  Albert has an abducted shoulder with internal rotation, a flexed elbow, and a bent wrist. He has increased muscle tone in his left shoulder and his shoulder never relaxes fully and is always somewhat contracted without some type of rehab. The levels of pain that spasticity causes him can range from feeling uncomfortable, to painful but manageable, to having debilitating pain.  I’ve seen Albert go through all of these stages of spasticity. 

Albert doctors first prescribed him Baclofen for the spasticity that he had in his elbow, wrist, and hand. He had the option to receive Baclofen from the pump, which some in the medical profession said had an advantage over oral drugs because it would allow smaller doses of the medicine to be pumped into his body throughout the day, which would effectively control the spasticity. Albert’s doctor looked at his needs and decided that he should take the baclofen orally, and I agreed.  His doctor would monitor his pain and make changes to his prescription as needed.

Along with the baclofen, Albert was given exercises to do for his shoulder, arm, and fingers. Then he was fitted for an arm brace to extend his arm and fingers which would provide him temporary relief from the spasticity.  We noticed immediately that when Albert used the arm brace daily, there was an improvement in his ability to straighten his arm and fingers. When he completed his exercises and used the brace for several hours throughout the day, his arm and fingers were sometimes straighter and more relaxed.  

The prescription, arm brace, and exercises all made a noticeable difference in Albert’s pain level and tolerance of the pain from spasticity.  Spasticity hasn’t gone away, but how Albert deals with the pain has changed and when he’s in control of how he manages the pain, his day is more productive and peaceful.  

^{Some of the information that I used in this week’s blog is from johnhopkinsmedicine.com}