An intrathecal pain pump is a small medical device that delivers pain medications directly to the spinal cord. The pain pump consists of two parts: 1) the pump (reservoir) that holds pain medication, and 2) the medication tubing (catheter) that carries pain medication to the spinal cord nerves. Pain signals are nullified by targeted pain medication before reaching the brain.
Deliver a continuous amount of a drug at a consistent flow rate.
Completely mechanical and works using a gas chamber, doesn't require a battery or electricity to operate.
Are programmed so that the amount and timing of drug delivery can be adjusted to your needs and can be adjusted as your schedule changes.
Some newer pumps can allow patients to self-administer a controlled dose for breakthrough pain.
Uses a battery that will need to replaced when charge runs out.
You can discuss which type of pump best suits your needs with your physician.
Because medication is targeted to areas of pain signaling - as opposed to oral medications that are distributed throughout the entire body - pain pumps can alleviate pain with less than 1% of the amount of oral medication.
Chronic pain (pain that has been present for years)
Failed back surgery syndrome (persistent pain after back surgery)
Complex regional pain syndrome
Causalgia (burning pain related to peripheral neuropathy)
Spinal cord injury
Morphine is the most common drug for severe chronic pain in intrathecal pain pumps.
Hydromorphone is commonly used as an alternative for morphine.
Baclofen is an FDA-approved drug used for treatment of muscle spasms, neuropathic pain, and severe spasticity.
Ziconotide is commonly used for severe chronic pain for patients who cannot tolerate intrathecal morphine.
If none of these work for any reason, you discuss other options for medication with your physician.
Interventional Pain Doctors
Look for doctors who are fellowship-trained in pain management and minimally invasive procedures. These doctors are usually highly skilled in the diagnosis and treatment of pain because they have training exclusively within the field of pain management.
Intrathecal pain pumps are considered effective for those trying to treat chronic pain, with 86% of patients in a study willing to implant the pain pump again for the same results. Source
Pain pumps are consideredmore effectivethan oral medication as they work directly in the CSF or cerebrospinal fluid, which surrounds your brain and spinal cord and means that drugs are absorbed quicker and more directly. You also need far less medication for this reason: pain pumps use about 1/300 the amount of drugs (in regard to baclofen or morphine) than oral medications.
If you have any of the medical conditions above and you're interested in learning more, the first step is to discuss pain pumps with your interventional pain doctor.
An interventional pain doctor specializes in non-surgical, minimally invasive procedures to reduce pain.
Before a permanent pain pump is inserted, a trial run is performed.
The purpose of the trial is to evaluate the degree of pain relief and side effects of having a pain pump without having to actually implant the full device.
There aretwotrial methods, both of which work well and are determined by you and your pain doctor.
In this method, a needle filled with pain medication (usually morphine or baclofen) is injected into the space surrounding the spinal cord (the same location where the implanted pain pump delivers medication). Over the day, your degree of pain relief and comfort is assessed by you and your doctor.
Continuous Infusion Method
In this method, an easily removabletemporarysystemthat closely resembles an actual pain pump is inserted. Over the next day, your degree of pain relief and comfort is assessed by you and your doctor.
Assess if the trial led to pain relief that helped you throughout the trial.
Discuss if the trial led to any unwanted side effects.
Decideif you're ready to go ahead with pump implantation.
If the trial run is successful, a minimally-invasive procedure is performed to place a more permanent pain pump.
First, a small tube (catheter) is placed into the fluid surrounding the spinal cord. During this portion of the procedure, the doctor uses real-time fluoroscopy to guide the catheter into the appropriate location.
Next, through a small incision near the waistline, the reservoir/pump (similar in size to a pacemaker) is placed just beneath the skin.
Most patients leave the day of or the morning after their procedure.
Full recovery usually takes 6-8 weeks. You may experience some initial discomfort and limits on movements; however, this usually resolves quickly.
After a few weeks, you should be able to start getting back to many of the activities you enjoy, such as going for a walk, riding your bike, or going to a movie.
During refill appointments, your physician will assess your symptoms, check that your drug delivery system is working properly, and confirm you are receiving appropriate therapy.
The pump will be emptied with a small needle that is inserted under local sedation (numbing medication). The pump will then be refilled with medication.
Refill appointments usually take 10 to 15 minutes. How often your pump needs to be refilled depends on your individual dosing schedule and the size of your drug pump.
"It's been a truly life-changing experience."
Jessica shares her experience after 1 year of having an intrathecal pain pump.