What's a Pain Pump?

An intrathecal pump is a device used to alleviate chronic pain by delivering medication directly to the patient’s spinal cord. It consists of a small battery-powered pump that is surgically implanted under the subcutaneous tissue of the abdomen, which is connected to a catheter connected to the spinal cord. The pump stores the medication in the reservoir, and it is programmed to gradually release the medication over a period of time or at specific times throughout the day. When the reservoir becomes empty, a doctor or a nurse can refill it by inserting a needle into the fill port of the reservoir.

Intrathecal pain pumps tend to be a last-resort procedure, in cases in which traditional methods fail to relieve long-term pain. Intrathecal pumps deliver medicine directly to the cerebrospinal fluid (CSF). CSF is the fluid inside the intrathecal space within your spine that flows through the brain and spinal cord. As a result, intrathecal pumps are far more effective in terms of distributing medication than more common methods. Generally, patients using intrathecal pumps require 1/300 the amount of medication they would need if taken orally. Because the dosage is far smaller, the normal side effects when the medication is consumed orally, such as vomiting, constipation, and lethargy, are reduced.

There are many benefits of intrathecal drug delivery. As mentioned earlier, intrathecal pumps reduce the need for oral medication and the adverse side effects associated with it. In addition, the procedure is not permanent – the pump can be turned off or removed. Also, this form of treatment is very flexible. and doctors are easily able to view the prescription information that the pump is programmed to store, and the dosage of medication can be adjusted easily with the intensity of pain that the patient is undergoing.

Intrathecal pumps are oftentimes used to relieve patients who are struggling through chronic pain caused by failed back surgery, causalgia (peripheral nerve injury), arachnoiditis (spinal nerve inflammation), chronic pancreatitis, and cancer pain. Pumps may also be used to alleviate spasticity, which is muscle rigidity and spasms that inhibit motor control. Spasticity may be caused by cerebral palsy, multiple sclerosis, stroke, brain injury, or spinal cord injury.

To determine whether an intrathecal pump is the best choice, patients usually undergo a trial, through which doctors ascertain the most effective location for the catheter, as well as the optimum type and dosage of drug. Intrathecal medications include opioids, anesthetics, adrenergic agonists, and N-methyl-D-aspartate receptor agonists. There are three common screening tests. Single injection is an injection of an intrathecal medication, either morphine or baclofen, through lumbar puncture, or a spinal tap. Multiple injections is when you are given multiple shots throughout the course of a few days by lumbar puncture or catheter. For continuous trial, a catheter connected to an external pump is implanted into the patient, through which the medicine can be delivered. If doctors deem that the intrathecal pump is an effective option, the patient can undergo surgery.

The placement of an intrathecal pump consists of two parts: the placement of the catheter in the intrathecal space of your spine and the placement of the pump within the abdomen. The whole operation takes around three to four hours, through which the patient will be given anesthesia. After the patient is unconscious, a small incision will be made in the patient’s back, exposing the vertebra. The catheter is placed in the intrathecal space and secured with sutures. Next, an extension catheter is passed under the skin from the spine to the abdomen. Another skin incision, around 4 to 6 inches, is made near the abdomen, where the pump is placed. After the pump is connected to the extension catheter, it is sutured into position. Finally, the incisions made in the back and abdomen are closed with either sutures of staples. After the procedure, the patient will wake up in the postoperative recovery area, or the PACU. Most patients are discharged on the same day, with written instructions to follow at home.

People with intrathecal pumps must visit a surgeon or pain management specialist regularly for medicine refills. With each appointment, doctors will be able to gage the optimum dosage and adjust their treatment accordingly. Intrathecal pumps are much like cardiac pacemakers, and they are unaffected by cell phone signals, and anti-theft sensors. When traveling, people with intrathecal pumps should carry an Implanted Device Identification card, as the pump will be detected at airport security.

As with all medical treatments, the operation does not come without risks. Intrathecal drug pumps come with relatively very few side effects. They include bleeding, inflammation, infection, cerebral spinal leaks, and neurological injury. Pump failure and catheter blockage, although rare, are possible risks.

The intrathecal pump is still a relatively new technology, and as such, it has its share of supporters and detractors. It is a very effective treatment for patients with severe chronic pain who require large doses of opioids – for them, implanting a pain pump would allow them to greatly reduce their medication intake and alleviate side effects of the drugs they take. Intrathecal pumps have gained attention, both good and bad. One concern is that these pumps may be misused. In fee-based medical systems, doctors may have a financial incentive for placing intrathecal pumps when oral medication is a cheaper and better option. On the other hand, implementation of these expensive devices pose a financial burden on the medical system. Another concern is whether eliminating the side effects of a functional medication is worth undergoing a major, potentially life-threatening procedure.

With better recognition and data, intrathecal pumps may become a new, safe, and common alternative for patients suffering from chronic, non-malignant pain.

 

 

 

 

References:

  1. https://www.mayfieldclinic.com/PE-PUMP.htm
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/
  3. http://www.upmc.com/Services/neurosurgery/spine/treatment/pain-management/Pages/intrathecal-pump.aspx
  4. https://gardenstatepain.com/top-benefits-risks-of-getting-an-intrathecal-pump/
Mary Yoshikawa