Spasticity is defined by an increase in muscle tone resulting in resistance to movement. It may develop secondary to spinal cord injury, brain injury, stroke, multiple sclerosis, or a peripheral nerve injury.

Several long-lasting conditions may result from spasticity. These include orthopedic deformities, impairment of activities of daily living, impairment of mobility, skin breakdown, pain, sleep disturbance and depression secondary to lack of functional independence. There are no differences between age, sex, or race in the occurrence of spasticity.

Patients who suffer from spasticity should have full evaluations by their primary and specialty physicians. Neurologists, plastic surgeons, orthopedic surgeons, pain specialists, and neurosurgeons can play an important role in managing spasticity and its sequelae. Physical, occupational, speech, and recreational therapists can assist with patient training and education as well as therapeutic interventions

The goals of spasticity management should be to improve function with activities of daily living and overall functional independence, to prevent pressure sores and orthopedic deformity, and to reduce pain. A stepwise approach from conservative to aggressive measures often is used, sometimes combining therapies from various levels. These include preventative measures, therapeutic interventions and physical modalities, positioning/orthotics, oral medications, injectable medications, and surgical interventions.

Prevention consists of alleviation or treatment of precipitating factors (ie: pressure areas, infections, deep venous thrombosis, constipation, bladder distention, and fatigue) as well as an aggressive physical therapy regimen that includes stretching and range of motion exercises. Orthotics may help hold a limb in a functional position, reduce pain, and prevent deformity.

Common oral medications used to treat spasticity include Baclofen, Dantrolene, Tizanidine, and Clonidine. Injectable medications that can be used are Phenol and Botulinum Toxin. These medications can be injected into specific muscles or muscle groups to relieve the spasticity.

Lastly, delivery of Baclofen to the spinal fluid by way of a continuous implantable pump has shown great promise in reducing muscle tone as well as the pain secondary to spasticity. These pumps can be implanted in the appropriately chosen patient on an outpatient basis.

If you do suffer from chronic spasticity, consultation from your primary care physician as well as specialists including neurologists and pain specialists is appropriate. Here at University Hospitals Pain Medicine, we specialize in medication management and implatable drug delivery systems for the treatment of spasticity.