<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1134-8046</journal-id>
<journal-title><![CDATA[Revista de la Sociedad Española del Dolor]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Soc. Esp. Dolor]]></abbrev-journal-title>
<issn>1134-8046</issn>
<publisher>
<publisher-name><![CDATA[Inspira Network Group, S.L ]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1134-80462024000100007</article-id>
<article-id pub-id-type="doi">10.20986/resed.2024.4076/2023</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Tolerance to intrathecal baclofen: clinical case report]]></article-title>
<article-title xml:lang="es"><![CDATA[Tolerancia a baclofeno intratecal. A propósito de un caso clínico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[de la Fuente-Escudero]]></surname>
<given-names><![CDATA[Claudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Benito-Penalva]]></surname>
<given-names><![CDATA[Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vidal-Samsó]]></surname>
<given-names><![CDATA[Joan]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Pérez]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Verde-Ortiz]]></surname>
<given-names><![CDATA[Ángel Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Fundación Alcorcón  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Neurorehabilitation Hospital Institut Guttmann  ]]></institution>
<addr-line><![CDATA[Badalona ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2024</year>
</pub-date>
<volume>31</volume>
<numero>1</numero>
<fpage>40</fpage>
<lpage>44</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1134-80462024000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1134-80462024000100007&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1134-80462024000100007&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: Widespread severe spasticity, resulting from a lesion or central nervous system disorder, which remains unresponsive to maximal oral drug doses or other techniques, may warrant consideration of surgical implantation of an intrathecal baclofen infusion system.  Materials and methods: This study entails a description of a clinical case along with a literature review.  Results: We present the case of a 46-year-old patient treated with an intrathecal baclofen pump for widespread severe spasticity secondary to an incomplete spinal cord injury, classified as C3 AIS C. Due to suspected tolerance development, a gradual tapering of intrathecal baclofen was initiated until complete withdrawal. Subsequently, the patient underwent a three-week morphine sulfate infusion before baclofen reintroduction. Follow-up at one and four months revealed sustained clinical improvement in spasticity with low doses of intrathecal baclofen.  Conclusion: The intrathecal baclofen pump ensures infusion of significantly lower baclofen quantities compared to oral ingestion. Catheter-related failure is the most common complication. However, in 5.9 % of prolonged treatment cases, a tolerance pattern has been documented, necessitating escalating intrathecal drug doses to sustain clinical efficacy. In such instances, a temporary cessation of baclofen, known as a &#8220;baclofen holiday&#8221;, may be considered.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: La espasticidad severa generalizada, resultado de una lesión o trastorno del sistema nervioso central, que permanece sin respuesta a dosis máximas de fármacos orales u otras técnicas, puede justificar la consideración de la implantación quirúrgica de un sistema de infusión intratecal de baclofeno.  Materiales y métodos: Este estudio conlleva la descripción de un caso clínico junto con una revisión bibliográfica.  Resultados: Presentamos el caso de un paciente de 46 años tratado con una bomba de baclofeno intratecal por espasticidad severa generalizada secundaria a una lesión medular incompleta, clasificada como C3 AIS C. Debido a la sospecha de desarrollo de tolerancia, se inició una disminución gradual del baclofeno intratecal hasta su retirada completa. Posteriormente, el paciente fue sometido a una infusión de sulfato de morfina durante tres semanas antes de la reintroducción del baclofeno. El seguimiento al mes y a los cuatro meses reveló una mejoría clínica sostenida de la espasticidad con dosis bajas de baclofeno intratecal.  Conclusiones: La bomba de baclofeno intratecal asegura la infusión de cantidades de baclofeno significativamente menores en comparación con la ingestión oral. El fallo relacionado con el catéter es la complicación más frecuente. Sin embargo, en el 5,9 % de los casos de tratamiento prolongado se ha documentado un patrón de tolerancia que hace necesario aumentar las dosis de fármaco intratecal para mantener la eficacia clínica. En tales casos, se puede considerar una interrupción temporal del baclofeno, conocida como &#8220;vacaciones de baclofeno&#8221;.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Intrathecal drug infusion]]></kwd>
<kwd lng="en"><![CDATA[baclofen]]></kwd>
<kwd lng="en"><![CDATA[spasticity]]></kwd>
<kwd lng="en"><![CDATA[spinal cord injury]]></kwd>
<kwd lng="en"><![CDATA[case report]]></kwd>
<kwd lng="es"><![CDATA[Infusión intratecal de fármacos]]></kwd>
<kwd lng="es"><![CDATA[baclofeno]]></kwd>
<kwd lng="es"><![CDATA[espasticidad]]></kwd>
<kwd lng="es"><![CDATA[lesión medular]]></kwd>
<kwd lng="es"><![CDATA[informe de un caso]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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