(FDA approved in bold)

• Spasticity and pain related to disorders such as multiple sclerosis or spinal cord diseases
  
• Trigeminal neuralgia
  
• Tourette syndrome
  
• Tardive dyskinesias
  
• Chorea in Huntington’s disease
  
• Acquired peduncular nystagmus
  
• Migraine prophylaxis
  
• Neuropathic pain
  
• Alcohol dependence

• Baclofen is an analog of GABA_B, an inhibitory neurotransmitter. However, the exact mechanism of action is unknown but presumably is related to hyperpolarization of afferent terminals inhibiting monosynaptic and polysynaptic reflexes at the spinal level. Has CNS depressant properties

• Pain – hours-weeks

• Slowly titrate to most effective dose as tolerated. Many patients will need gradual titration to maintain response and limit sedation

• Make sure to increase to highest tolerated dose – as high as 200 mg/day. If ineffective, slowly taper and consider alternative treatments for pain. In general, baclofen is more effective for spasticity related to MS or spinal cord disease than other causes of spasticity

• For focal spasticity, i.e., post-stroke spasticity, botulinum toxin is often more effective and is better tolerated
  
• Use other centrally acting muscle relaxants with caution due to potential synergistic CNS depressant effect
  
• Baclofen is usually used in combination with neuroleptics for the treatment of tardive dyskinesias or chorea
  
• Trigeminal neuralgia often responds to anticonvulsants. Pimozide is another option. For truly refractory patients, surgical interventions may be required

• None required