“It (Baclofen Pump) is a life-changer”

By Umer NangianaOnly those who have experienced chronic pain can truly appreciate the value of relief. And the hand that provides this respite is nothing less than a messiah for them. Here, we are talking about bodily pain; more specifically, the agony that people with movement disorders undergo.Spasticity, caused by the functional problems of brain, is one such disorder. It leaves its victims wheelchair-bound, and they often howl in pain. Thanks to advancements in medical science, there are now procedures available, which enable spasticity patients to get rid of both the wheelchair and the pain.These procedures, though, have to be administered by trained hands which, unfortunately, are few and far between. Dr R. Ramnarayan from India, a specialist in functional neuro surgery, is one of them. Eager to put his knowledge to use, he does not mind travelling to areas outside his country where people might need him.He was in Qatar recently and Community sat him down to talk about spasticity and what solutions he has up his sleeve.“Spasticity is the stiffness of muscles and it affects legs more. Most of the people suffer from it also have an associated problem called flexor spasms where their muscles start growing upwards and it is miserably painful,” says Dr Ramnarayan.“It is so severe that patients sometimes howl and scream with pain. It lasts a short while but for as long it does, the patient goes through hell,” explains the doctor before going on to cite another condition called multiple sclerosis which, he says doctors in Qatar have told him, has rendered many people wheelchair-bound.“The other thing is that people here drive very fast and there are accidents so spinal cord injury is very common — that is what I have understood from conversations with colleagues here,” the doctor says.Trained in functional neurosurgery from UK, Dr Ramnarayan is a specialist in surgery for movement disorders, chronic pain epilepsy, spasticity, bowel or bladder dysfunction, patients in coma state and other such conditions.For almost a decade, he has been treating patients with these problems through modern medical techniques, both inside and outside India. He treats patients of spasticity and similar conditions with something called ‘Intrathecal Baclofen Pump.’ It has achieved miraculous results. It changes the patient’s life completely, he says.“Baclofen is a muscle relaxing drug given to spasticity patients for pain and stiffness relief. But the problem is that the drug in the form of a tablet does not effectively work on more than 90 percent of the patients,” the doctor informs before going on to explain why.Normally, it has to get absorbed after reaching a patient’s stomach before reaching the spinal cord to activate a system for muscle relaxation. But most of the times, Baclofen never gets absorbed. In 90 out of 100 people, it would just go in and go out.It is here that Intrathecal Baclofen Pump shows its prowess: by putting the drug directly into the spinal cord.“We put the drug into this pump which is placed, through a surgery, under the skin besides the stomach of the patient. The pump is connected to the spinal cord through a tube and thus directly delivers the drug to it,” says the doctor, elaborating with his hand how it is done.“It can be refilled periodically and is so good that it tells you the next date of refill. You can adjust the required dose by wireless techniques without touching the patient,” he says.After the surgery, he would sit with the patient and adjust the dose. The walking part is then managed by the physiotherapist.Most of the spasticity patients are already going to the physiotherapist, but they are facing a complex dual problem; stiffness of muscles and weakness.The idea of physiotherapy is to improve weakness but spasticity comes in the way. The physiotherapist will work for one or two hours and reduce spasticity but then he would not be able to reach the weakness part of it.Initially, 15-20 minutes after the physiotherapy, the spasticity would be reduced but it would come again. That is because spasticity is not in the muscles; it is in the brain and the spinal cord. The weakness is in the muscles.“Spasticity kind of stonewalls the physiotherapist to reach the weakness part. What I am doing is removing this stonewall (through the pump technique) for the physiotherapist to work on the weakness part and make the patient walk,” explains Ramnarayan.“It (the pump) is a life-changer. Just imagine…enabling a wheelchair-bound person to walk. It gives him a new life,” says the neurosurgeon.The pump is made of metal and can be refilled from outside with the help of a very small syringe by a trained doctor. One refill lasts for months. Dr Ramnarayan is travelling to Muscat, Oman to administer refill on one of his patients, who was last given one a year ago.Also, the amount of Baclofen put into the spinal cord through the pump needs to be only up to 50 micro grams compared to up to 30 milligrams minimum in the tablet form. This reduces any side effects to almost none.For the first two months or so after the surgery, Dr Ramnarayan coordinates with the physiotherapist to adjust the precise amount of dosage required by the patient to enable him to walk.Besides Baclofen, the pump can also be filled with morphine to be used on cancer patients to reduce the pain they suffer during the terminal stages. In India, this method has been very effective, says Dr Ramnarayan, adding that in Qatar, he has heard that the use of morphine is not admissible due to legal constraints.It can also be used to treat patients with ‘failed back surgery syndrome.’ Dr Ramnarayan comes to Qatar for two to three days every month to see some of his patients. However, he is planning to make his treatment for spasticity available locally, considering a large number of people suffer from the problem here.The doctor says he has learnt from senior doctors here that patients are sent abroad for surgeries but when they come back, they face problems as there is no-one here to take care of them.“These patients need continuous supervision. It is not like they are operated upon and then they can forget about the disease. The pump, for instance, needs to be refilled and it takes hardly five minutes. You cannot go abroad for a five-minute treatment,” says Dr Ramnarayan.He plans to develop these things here. Some good medical centres have shown interest in his proposal. As part of his plan, Dr Ramnarayan will train people here so that five years down the lane, this country does not need people like him to come here and do it for them.To start with, he needs support, which is not just financial or infrastructural support but trained manpower. Dr Ramnarayan proposes to bring his own team in the beginning which would assist him in everything from pre- to post-operation analyses as training people here will take time. He is however, hopeful that he can do it here.In the second part of the interview to be published this week, Dr Ramnarayan will speak on Parkinson’s and its treatment