Sir,
Baclofen is a centrally acting skeletal muscle relaxant due to its selective agonism on GABAB receptor. It is useful for alleviation of signs and symptoms of skeletal muscle spasticity, particularly in patient suffering from multiple sclerosis, spinal, and cerebral disorders. In psychiatry, it is used as an anti-craving agent as it tackles dopamine surge in ventral tegmentum areas.[1] Baclofen has multiple side effect such as drowsiness, sedation, dizziness, fatigue, respiratory depression, and coma. It is not mentioned in the literature that baclofen can also cause severe back pain which is a paradoxical phenomenon where baclofen is prescribed to relieve back spasm.[2]
A 30-year-old married man a farmer who was diagnosed to have alcohol dependence syndrome for the last 10 years presently abstinent for the past 3 months. He was prescribed baclofen 60 mg 2 months ago as an anti-craving agent. In the first 1 month of abstinent, the patient never complained of anybody ache. After 1 week of starting baclofen, patient started complaining severe back pain which was could be due to alcohol-induced neuropathy or myelopathy. However, all the investigations including renal functional test, liver function test, and serum electrolytes were found to be within normal limits. Neurological assessment was found to be within the normal limit. The onset of back pain was temporally related to use of baclofen. Hence, we gradually tapered and stopped the baclofen. Following 2 weeks of stopping baclofen, the patient got relieved of back pain without any other intervention.
Baclofen is quite a safe and useful drug for multiple neuropsychiatric disorders. Where baclofen relaxes the stiff muscles and relieves the pain, baclofen producing muscular pain is a surprisingly rare phenomenon. Patients who are involved in strenuous exercise needs their lower body muscle to be contracted at the time of hard word. The patient described above was a farmer who used to work in the fields for prolonged period. The baclofen-induced relaxed lower body muscle may not support the weight of the upper body during work which could be the cause of severe back pain however, this is just an assumption. Research is much warranted in the patients who complain of back pain following baclofen use.
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REFERENCES
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