For some pain conditions, it’s important to go directly to the source. An intrathecal pump is one way to effectively deliver pain-relieving medication directly to your spinal cord before it sends pain signals to the brain. Here’s what you can expect with this treatment approach.
What is an intrathecal pump?
Intrathecal pumps are an automated piece of equipment programmed to deliver medication into your spinal fluid through a small catheter.
The purpose of this pump is to interrupt pain signals that travel through the spinal cord. Medication is delivered into the intrathecal space, the space that surrounds the spinal cord between the cord itself and the vertebrae that protect it. This intrathecal pump delivers pain medication directly to the area, decreasing the amount of pain medication necessary to provide relief.
This pain treatment technique is generally both safe and effective. However, since it deals directly with the spinal cord, intrathecal pumps are an option only when oral pain medications and other methods of pain control have been exhausted or proven ineffective.
What conditions can an intrathecal pump help with?
Intrathecal pumps can help treat a variety of serious pain conditions. Pumps can help treat three main types of pain:
- Neuropathic pain
- Spasmodic pain
- Nociceptive pain
Neuropathic pain, also referred to as peripheral or central nervous system pain, tends to be receptive to treatments with local anesthetics (rather than opioids) that are delivered by an intrathecal pump.
Examples of neuropathic pain syndromes include:
- CRPS (complex regional pain syndrome or reflex sympathetic dystrophy)
- Cancer pain
- Phantom limb pain
- Post herpetic neuralgia (shingles)
- Carpal tunnel syndrome
- Failed back surgery syndrome
- Peripheral neuropathy (from diabetes mellitus or vitamin deficiencies)
This type of pain is effectively treated with anti-spastic muscle-relaxing medications like baclofen, but it may also benefit from intrathecal pump administration.
Spasticity is an abnormal increase in muscle tone and tightening of the muscles. It may stem from impairments in the brain or spinal cord and can occur with several conditions.
- Brain injury
- Spinal cord injury
- Cerebral palsy
- Multiple sclerosis
Nociceptive pain, or pain from tissue irritation, is usually localized and constant. It may also benefit from this form of pain management.
What to expect with an intrathecal pump
Before your doctor places an intrathecal pump, they’ll perform a trial with medication. They’ll administer medication in the spinal fluid. If pain relief is adequate, you may get a permanent intrathecal pump to manage your pain.
Placement of the pump can be performed in an outpatient setting or in the hospital. The implantation of the device is done with local anesthesia and sedation (general anesthesia is usually not required).
After a sterile scrub, your doctor will use local anesthesia to numb the needle entry location. Once the area is numb, they’ll place a larger needle and catheter into the intrathecal space using X-ray guidance.
When the catheter is in the proper location, the pump is connected and placed under the skin on the lower part of your abdomen. The catheter and pump tunnel under your skin and, after, your doctor will close the area.
The pump delivers pain medication directly into the intrathecal space around your spinal cord. Your doctor refills the medication reservoir in the pump periodically (every four to six weeks). They inject the medication through your skin directly into the pump.
The entire procedure typically takes one to two hours in an outpatient or inpatient basis.
Intrathecal pump implants are generally effective and safe for pain management. Most of the side effects are less associated with the pump and are more related to any medications in use.
Some of the common side effects due to pain medications may include:
- Nausea and vomiting
- Facial flushing
- Respiratory depression
More serious complications that can ensue include:
- Infection or meningitis
- Catheter malfunction
Intrathecal pumps may be an appropriate treatment for many patients who suffer from chronic, difficult-to-control pain. However, as with any medication or invasive procedure, there are risks and potential side effects that may occur. All patients receiving a pump implant should talk to their doctor about any personal risk factors.
In the days following your procedure, take some time to listen to your body and allow it to rest and recover. Your doctor will provide you with detailed recovery instructions, but in general, take at least a week with lower activity levels before gradually returning to normal activities. It can take six to eight weeks to fully feel the effects of the intrathecal pump.
If you experience pain, fever, or swelling at the surgical site, give your doctor a call, as this could be a sign of infection.
Could an intrathecal pump help me?
A 2009 study of patients with spasmodic pain found that not only was a pump well-tolerated with few side effects, but it also offered measurable improvement in pain levels, functioning, and overall quality of life.
Intrathecal baclofen therapy is considered safe and so effective that it has evolved into the standard treatment for severe spasticity. Spasm frequency appears to be the single most common variable positively affected by therapy.
For cancer, intrathecal pumps have been proven effective for cancer pain in both surviving and terminal patients. In addition to controlling pain for terminal cancer patients, one of the main benefits of intrathecal pumps enables treatment in an outpatient setting that many terminal patients and their families prefer.
Pain can be a debilitating condition physically, as well as emotionally. Intrathecal pumps can dramatically help those with painful conditions that are unrelieved by other therapies.
Arizona Pain offers a variety of pain management treatments for hard-to-treat chronic pain, or consultations with specialists for more advanced procedures. Get in touch today to discuss your options.
- Intrathecal Baclofen Therapy and Multiple Sclerosis: Outcomes and Patient Satisfaction John R. Vender, M.D.; Mary Hughes, M.D.; Betsy D. Hughes, B.S.; Sydney Hester, M.D.; Stephen Holsenback, B.S.; Brenda Rosson, R.N. Neurosurg Focus. 2006;21(2) 2006 American Association of Neurological Surgeons
- Complications of Intrathecal Drug Delivery Systems Saadat Kamran MD, Ballard D. Wright MD Department of Neurology, Anesthesiology University of Kentucky and The Pain Treatment Center Lexington, KY
- Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy. Ethans K. Acta Neurochir Suppl. 2007;97(Pt 1):155-62 PMID: 17691371
- 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
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- 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 over 10 years. Rawlins PK. J Neurosci Nurs. 2004 Dec;36(6):322-7.