Doctor and patient discuss the patient's condition

Programming Adjustments

Severe Spasticity

Your doctor will program your baclofen pump to deliver the right amount of medication at the right time. Tell your doctor whether treatment is working well for you, or if a change would better help you reach your goals.

Adjusting Your Dose

When you first start treatment, the pump is programmed to deliver a constant dose of medication throughout the day. In the first weeks or months, your doctor will adjust the dose gradually until the level is right for you.

Later, if your spasticity increases or there’s a new treatment goal, your doctor can adjust the dose. Let your doctor know if you are not satisfied with the results you’re getting with treatment and what you would like to improve.

Changes are made gradually, and results are monitored.

Flex Dosing

Once your optimal dose is reached at the beginning of treatment, your pump can be programmed to vary the amount of medication at different times of the day or week. For example, the pump can be set to deliver less medication in the daytime, when you may rely on your stiffness to walk, transfer, or put on clothing, then deliver more medication at night to reduce spasticity to help you sleep more comfortably. “Flex dosing” gives you more or less baclofen when you need it. There can be up to 13 changes every day.

Programming can also vary from day to day to match your scheduled activities. For example, you might need less or more baclofen on the day you have physical therapy.

Work with your doctor to adjust the timing of your dosing schedule so that it right for you.

        How flex dosing helps people who have ITB Therapy

The Medtronic baclofen pump is part of the Synchromed® Infusion System, which delivers the drug called Lioresal® Intrathecal (baclofen injection) for ITB TherapySM, a treatment for severe spasticity. Please read the following important safety information about ITB Therapy.


Please follow your doctor's instruction closely because a sudden stop of intrathecal baclofen therapy can result in serious baclofen withdrawal symptoms such as high fever, changed mental status, muscle stiffness, and in rare cases may result in loss of function of many vital organs and death. It is very important that your doctor be called right away if you experience any of the above symptoms.

It is important for you to keep your scheduled refill visits so you don't run out of medication (baclofen) and to know the early symptoms of baclofen withdrawal. Some patients are at more risk than others for baclofen withdrawal; speak with your doctor about this.

People who suffer from severe spasticity resulting from cerebral palsy, multiple sclerosis, stroke, brain injury, or spinal cord injury may be candidates for ITB Therapy. If you have spasticity due to spinal cord injury or multiple sclerosis, you may be considered for ITB Therapy if oral baclofen has not controlled your spasticity or has resulted in serious side effects that you cannot accept. If you suffered a brain injury due to trauma you must wait until one year after the injury to be considered for ITB Therapy. A trial of ITB Therapy will help to show if ITB Therapy can help you. You should not receive ITB Therapy if you have an infection, are allergic to baclofen, or your body size is too small for the implantable pump.

The implanted pump and catheter (tube that delivers the drug from the pump to the fluid around the spinal cord) are placed under the skin during a surgery. Some complications that you may experience with the surgery include infection, meningitis (infection of the lining of the brain and central nervous system), spinal fluid leak, paralysis, headache, swelling, bleeding, and bruising.

The most common and/or serious drug-related side effects of ITB Therapy include loose muscles, sleepiness, upset stomach, vomiting, headaches, and dizziness. Failure of the pump placed under your skin may cause symptoms due to overdose (receiving too much) or underdose (receiving too little) of intrathecal baclofen. The signs and symptoms of overdose include drowsiness, lightheadedness, dizziness, respiratory depression (difficulty breathing), hypothermia (lower than normal body temperature), seizures, loss of consciousness, and coma. Once the infusion system (the pump and the catheter) is implanted, possible complications include unintended movement of the catheter or pump within the body or breakdown of the skin over the pump. The catheter could leak, tear, kink, or become disconnected from the pump, resulting in underdose or no baclofen infusion. Symptoms of underdose include an increase or return in spasticity, itching, low blood pressure, lightheadedness, and tingling sensation. These symptoms are often early signs of baclofen withdrawal. The pump could stop because the battery has run out or because of a problem with one or more of its inner parts. The pump will sound an alarm when the pump needs to be filled with baclofen, replaced, or if there is a problem with the pump. You or your caregiver should always inform any healthcare personnel that you have an implanted infusion system before any medical or diagnostic procedure such as MRI or diathermy.

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.