FAQs on Intrathecal Pain Pumps in Atlanta

Intrathecal pain pumps provide relief to those experiencing pain associated with neuropathy, muscle spasticity, chronic back problem, and cancer. Safe and effective, these devices directly administer medication to your spinal cord and are a great option when other treatments, including surgery, fail to assure pain relief.

Continuing to evolve since the 1990s, the therapy aims at better pain control with smaller doses of medications and without inconvenient oral drugs known to cause potential side effects. Atlanta pain management doctors offer intrathecal pain pumps for various indications such as failed back surgery, cancer pain, postherpetic neuralgia and more.

What is an intrathecal pain pump?

An intrathecal pain pump is a round metal device with a catheter, a small tube. As small as a hockey puck, the pain pump derives its name from its place of implant – the intrathecal space, a fluid area adjoining the spinal cord. The pump is programmed to deliver small amounts of medication (pain relief medication, such as morphine or baclofen) automatically through its catheter over an extended period. Due to its proximal position, the medication is inserted directly into the spinal cord, nerves, and cerebrospinal fluid.

The pump, through its medication delivery, disrupts pain signals carried by the spinal cord. Weak signals fail to get the attention of the brain and patients feel relief.

What are the advantages of intrathecal pain pump?

Intrathecal pain pumps are found to successfully treat pain when both conservative and surgical methods fail to provide relief. Direct medication delivery to the spinal cord not only saves patients from the inconvenient daily dosages, but also significantly reduces the amount of drug. A pump administers only 1/300th of oral medication we supposed to take daily.

Now patients can control pain symptoms with minimum medication. Direct medication delivery assures more efficient pain control and lesser associated side effects on other body parts.

The pump is an automated device that can be programmed according to patients’ needs, including steady release of constant amount of medication or different amounts during various times in a day. It can be refilled with medication using an injection or removed when required.

Who is a candidate for intrathecal pain pump? What conditions are treated with intrathecal pain pump?

One is recommended for intrathecal pain pump implant when

  • Conservative therapies fail to provide pain relief
  • Surgical intervention fail to benefit and pain persists
  • One continues to be reliant on pain medication for a long time

In addition to these conditions, a perfect candidate for intrathecal pain pumps must not have any psychological problems, sensitivity to drug in the device, medical conditions that prohibit the implant or responds negatively during a trial dose of medication.

An intrathecal pain pump is a great way to relieve chronic pain associated with

  • pain linked to cancer or tumors that constrict spinal nerves
  • failed back surgery
  • complex regional pain syndrome
  • spinal cord injury
  • nervous system disruption
  • causalgia or burning pain in nerves
  • reflex neurovascular dystrophy
  • peripheral nerve injury.
  • arachnoiditis or inflammation spinal nerves membrane
  • chronic pancreatitis
  • brain injury
  • muscle spasticity
  • cerebral palsy
  • multiple sclerosis caused by nerve cell damages
  • heart stroke

How is intrathecal pain pump implant procedure performed?

Neurosurgeons and doctors with adequate training specialization perform the intrathecal pain pump implant. A trial is carried out prior to permanent implantation. Injections of the medication that pumps carry are administered to check if it is going to relieve your pain.

  • The trial

The process includes any of the following trials depending on patient condition and amount of medication needed.

  • Single injection trial: Medication is injected to the lumbar area once and the patient is monitored for a while.
  • Multiple injection trial: Medication is injected to the lumbar area multiple times and pain relief is monitored.
  • Continuous trial: Doctors use a catheter tube instead of injections and medication is put into to it from an external pump. Gradual increase in dosages with a gap of two hours between each session helps to assess the impact and amount of medication needed for a patient.

 

  • Implant Procedure

If the trial results are found to be satisfactory, the patient is considered for a permanent intrathecal pain pump implant. Pre-surgical tests are done to identify if any adverse medical condition exists and the patient is asked to come prepared on a suitable day.

The procedure is a bit invasive, as it involves a small surgery under intravenous drugs. Once it is done, the process starts step by step.

  • Step 1: The posterior bony arch of the low back vertebra is reached through an incision. This is followed by the insertion of a catheter into the intrathecal space.
  • Step 2: An extension catheter is put under the skin that extends from the first catheter to the abdomen.
  • Step 3: An incision of about 4 to 6 inch is done for the pump placement on the side of patient’s abdomen. It is fixed just above the stomach muscle layers and beneath the skin. The tunneled extension is attached to the pump.
  • Step 4: The incisions are closed and the patient is kept under observation.

How much time does it take?

The entire intrathecal pain pump implant process needs around 3 to 4 hours.

Do I need rest after intrathecal pain pump implant surgery?

Patients are discharged within hours of the implant, mostly on the same day, unless they have respiratory, heart rate, and blood pressure abnormalities. Doctors may advise painkiller for 2 to 3 weeks after the procedure to deal with the post-operative trauma. It is suggested to increase intake of fibrous food and water to avoid constipation.

Avoid driving or taking nonsteroidal anti-inflammatory drugs, as they impede the bone healing. Consult with your doctor, if spinal headaches onset. Don’t sleep on your stomach, stretch, twist, bend, or climb many stairs for a few weeks, as it may lead to catheter displacement. Join your work only after the follow-up with your doctor. However, short-distance walking is good for the patient.

What are the side effects of intrathecal pain pump implant?

The procedure has minimal side effects when done properly. Surgical complications, including bleeding and infection, need to be preempted. If you experience spinal headaches after 48 hours following the surgery, contact your doctor. It may be due to cerebrospinal fluid leak traced to the incision. Rare adverse events include catheter displacement or blocking.

If you experience high temperature, sudden severe back or leg pain, skin irritation, edema, depression, or dizziness, you should seek an appointment with the doctor. Drug overdose may be the reason.

Remember, the device is not affected by proximity to electronic equipment.

When I need to refill intrathecal pain pump implant?

The intrathecal pain pump starts making beeps when it requires to be refilled with medication or battery. You may need battery changes in every 5 to 7 years. If it malfunctions, it can be replaced.

How well does intrathecal pain pump work?

  • Intrathecal pain pump procedure leads to reduction in chronic pain and improvement in life style. (Journal of Neurosurgery, 1996)
  • It helps reduce rigidity and muscle spasms in men and women suffering from spasticity. (Journal of Neurosurgery, 1993)
  • The therapy is highly successful in ensuring pain relief and increased cognitive and motor functional levels. (Archives of Physical Medicine and Rehabilitation, 2005)
  • The treatment method is highly beneficial for severe spasticity, cancer pain, recurrent muscle spasm, and lower extremity spasticity. (Acta Neurochirurgica Supplement, 2007)
  • Several studies suggested the therapy as “efficacious and safe” for painful cancer. (Surgical Neurology, 1999)

References

Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg 85:458-467, 1996.

Coffey RJ, Cahill D, Steers W. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicenter study. J Neurosurg 78:226-232, 1993.

A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity. Guillaume D, Van Havenbergh A, Vloeberghs M, Vidal J, Roeste G. Arch Phys Med Rehabil. 2005 Nov;86(11):2165-71

Continuous intrathecal opiate therapy with a portable drug pump in cancer pain. Motsch J, Bleser W, Ismaily AJ, Distler L. Anasth Intensivther Notfallmed. 1988 Oct;23(5):271-5.

Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy. Ethans K. Acta Neurochir Suppl. 2007;97(Pt 1):155-62 PMID: 17691371

Intrathecal morphine delivered via subcutaneous pump for intractable pain in pancreatic cancer. Gilmer-Hill HS, Boggan JE, Smith KA, Frey CF, Wagner FC Jr, Hein LJ. Surg Neurol. 1999 Jan;51(1):6-11.