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Muscle spasms are one of the most common symptoms of multiple sclerosis (MS). Muscle spasms are sudden, involuntary muscle movements that may feel like tightness, stiffness, cramping, or pain. They are a common part of an MS symptom known as spasticity. For many people with MS, muscle spasms can make it hard to walk, sleep, or perform daily tasks.
Baclofen is a medication commonly prescribed by healthcare providers to help manage muscle spasms and other symptoms of spasticity. Some MyMSTeam members find that baclofen makes a big difference. One member shared, “Baclofen is helping me so far.” But for others, it may not work so well. Another member asked, “Does anyone get relief from baclofen? I’m not seeing much of a difference using it.”
In this article, we’ll discuss how baclofen works for MS muscle spasms, what its possible side effects are, and who might benefit from this treatment.
Baclofen is a medication that can help relieve muscle tension and muscle spasms in people with MS. It can also be used for people with other spinal cord injuries or diseases. Baclofen belongs to a group of medications called skeletal muscle relaxants. It works by calming the nerves in the spinal cord, which helps reduce how often and how strongly muscles spasm.
Doctors often recommend baclofen as the first treatment for people with painful spasticity that affects their ability to move around or do daily activities.
Baclofen works by reducing chemical signals in overactive nerves that cause muscle stiffness and muscle spasms. You can think of baclofen as acting like a dimmer switch for your nerve activity. In MS, the nerves that control your muscles may send too many “on” signals, causing muscles to tighten and spasm. Baclofen helps turn those signals down so your muscles can relax.
Researchers don’t fully understand how baclofen works. It seems to activate a special receptor in the brain and spinal cord called the GABA-B receptor (short for gamma-aminobutyric acid-B). When this receptor is turned on, it helps to slow down nerve activity. Baclofen attaches to the GABA-B receptor and mimics this calming effect, helping muscles relax.
You can take baclofen by mouth (orally) or as an injection into the spine (intrathecally).
If your healthcare provider recommends baclofen, you’ll probably start with oral baclofen. Several clinical trials have found that oral baclofen can help reduce how often and how frequently muscles spasm, making daily tasks easier.
You can take baclofen tablets or liquid baclofen (available as the brand names Fleqsuvy or Ozobax DS). The liquid form of baclofen can be easier to take if MS makes it difficult for you to swallow pills.
Your doctor will usually start you on a low dose, then slowly increase it until your symptoms improve or you reach the highest dose you can handle. The maximum daily dose of baclofen is 80 milligrams.
Because each baclofen dose only lasts a few hours, you’ll need to take it several times a day. Your healthcare team can help you figure out the best time to take it. Some people take baclofen at night so that muscle spasms don’t keep them from getting sleep. Other people use baclofen during the day to stay more active.
If oral baclofen doesn’t help enough or if it causes too many side effects, your healthcare team might suggest intrathecal baclofen — an injection directly into the fluid around your spinal cord. This is done using a baclofen pump. This small device is surgically placed under the skin to deliver baclofen to your spinal canal.
When you take baclofen by mouth, only a small amount reaches your brain and spinal cord because of the blood-brain barrier — the protective barrier that keeps unwanted substances out of the central nervous system (CNS). That’s why some people have to take high doses of baclofen to see an effect. These high doses of baclofen can lead to more side effects.
Intrathecal baclofen can work better than oral baclofen for some people because it’s given directly into the CNS. Because intrathecal baclofen bypasses the blood-brain barrier, a smaller dose (about 100 times lower than oral baclofen) can still be effective.
A 2016 study found that people who used long-term intrathecal baclofen had fewer and less intense muscle spasms than those taking oral baclofen.
Intrathecal baclofen isn’t right for everyone. One MyMSTeam member asked, “Does anyone have a baclofen pump? Is it really better than oral baclofen?”
Before getting surgery for a baclofen pump, you’ll need to try a test dose to see how your body responds. For this test, your doctor will inject a relatively large dose of baclofen into your cerebrospinal fluid (CSF) — the fluid that surrounds your spinal cord. Your healthcare team will monitor you closely after the injection to see how well it works and whether you have any side effects.
As one MyMSTeam member shared, “I’m having a baclofen test to see if I’m a candidate for a baclofen pump because my spasticity is so bad.”
After your test dose, you and your doctor can decide whether to move forward with surgery to implant the baclofen pump.
Side effects are relatively common for people taking baclofen. About 45 percent of people taking baclofen experience these common side effects:
In some cases, baclofen can cause more serious side effects, such as hallucinations (seeing or hearing things that aren’t real) or seizures.
Some people find these side effects too hard to manage. One MyMSTeam member shared, “Baclofen made me super nauseated. I had to use anti-nausea meds with it. It also made me sleep too much. I had to discontinue use because of these side effects.”
This MyMSTeam member isn’t alone. A 2023 study from Sweden found that almost half of people stopped taking baclofen within 150 days of starting. After two years, up to 90 percent of the people in the study had stopped taking baclofen.
Don’t stop baclofen suddenly without seeking medical advice from your healthcare provider first. Stopping baclofen too quickly can cause serious withdrawal symptoms. Your healthcare provider can help you safely lower your dose over time.
If baclofen helps your muscle spasms but causes too many side effects, your healthcare provider may be able to help you manage the side effects. As one MyMSTeam member shared, “Baclofen wipes me out (even more fatigue), but it works well on the muscle spasms.”
If baclofen causes fatigue, you could talk to your healthcare team about changes to your treatment plan that can help with this. If you feel nauseous, try taking baclofen with food. If you feel dizzy, stand up slowly to reduce the risk of feeling lightheaded.
If side effects continue to bother you, your healthcare provider might suggest switching to intrathecal baclofen, which may cause fewer side effects like drowsiness and headaches. Just know that using a baclofen pump comes with its own risks, such as infection or pump malfunction.
Although baclofen is often the first choice for MS muscle spasms, it’s not right for everyone. You shouldn’t take baclofen if you’ve had an allergic reaction to baclofen in the past. You should also avoid baclofen if you are pregnant or wish to become pregnant — baclofen may harm an unborn baby.
People with kidney disease or mental health conditions like schizophrenia should have a careful conversation about the potential benefits and risks of taking baclofen.
Before you start taking baclofen, make sure to tell your healthcare provider about all the medications you take, to avoid harmful drug interactions. This includes prescription drugs, over-the-counter drugs, vitamins, and supplements.
MyMSTeam is the social network for people living with MS and their loved ones. On MyMSTeam, people come together to share their experiences and offer support to others.
Do you take baclofen for MS muscle spasms? How does baclofen work for you? MyMSTeam offers a place to share your experiences or ask for advice. Join today and share your thoughts in the comments below, or start a conversation by posting on your Activities page.
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