What are Intrathecal Pump Implants?

Intrathecal pump implants explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Intrathecal PumpAn intrathecal pump implant is a procedure that was approved in the early 1990s to treat severe, debilitating pain. In this procedure, a pump is surgically implanted in the abdomen to deliver pain meditation directly into the spine. This form of pain management improves quality of life for patients suffering from severe chronic pain that cannot be managed by oral medication. This procedure is similar to an epidural injection, although an intrathecal pump allows the medication to be delivered closer to the spinal cord than an epidural injection.

This procedure often has fewer side effects than other pain medications due to the direct administration of medication to the spinal cord. Because the effects of intrathecal pump implants remain localized to the area surrounding the spinal cord, they can be used in patients that are unable to use oral medications for pain relief. The use of an intrathecal pump allows for dramatically lower doses of medications (up to 300× less than oral medications) and the medication does not circulate in the blood.

Medications delivered via an intrathecal pump implant are determined by the doctor. The pump is programmed to release a pre-determined dose of medication at specific intervals throughout the day. Because every patient is different, if the dose is too high or low for a particular patient, the doctor can reprogram the device to ensure a proper pain management regimen for each patient.

How is an Intrathecal Pump Implant Procedure Performed?

Procedure PreperationAn intrathecal pump implant is a surgical procedure performed by a physician, typically as an outpatient procedure. Prior to beginning the procedure, the patient’s skin is cleansed at the site for the procedure. To ensure proper placement of the needle or catheter into the spine, fluoroscopic or ultrasonic guidance is used. Once the catheter has been inserted into the spine, an incision is made in the abdomen so that the pump can be inserted beneath the skin.

After the catheter and pump are in place, the abdominal incision is closed by suture or staples and covered with a dressing until it has healed. The pump can be refilled during a visit to the physician. This is typically done every few weeks with an injection directly into the pump through the patient’s skin.

Several studies have been conducted to assess the safety and efficacy of intrathecal pump implants. A 2002 study published in Journal of Clinical Oncology sampled 202 cancer patients reporting pain of at least 7.5 out of 10. Patients receiving intrathecal pumps were significantly more likely to report a greater than 20% reduction in pain. These patients also reported significantly less side effects associated with oral medications.

Conditions Related To Intrathecal Pump Implants

Intrathecal Pump Implant DiagramAccording to the World Health Organization (WHO), 10-20% of patients that have terminal cancer have pain that cannot be effectively managed by oral medications alone. These patients often have difficulties with oral medications due to the complicating side effects of cancer and its treatment, so oral delivery of medications is not always feasible.

Sufferers of severe chronic pain, such as some forms of back pain, can also be treated by the delivery of medication via an intrathecal pump. Much of the research devoted to intrathecal pump implants was at first focused on failed back syndrome. Recently, more attention has been given to other diseases associated with severe chronic pain such as postherpetic neuralgia, peripheral neuropathy, and regional pain syndrome. This procedure has also been used successfully for patients suffering from phantom limb pain, multiple sclerosis (MS), and other conditions resulting in chronic pain.

The consensus from these studies is that intrathecal pump implants are safe and effective options for pain management. As with any procedure, complications may occur. Potential side effects include bleeding, infection, facial flushing, constipation, nausea, vomiting, and sleepiness.

Conclusion

Intrathecal pump implants are often a method of last resort for patients suffering from chronic pain. When oral medications are insufficient or result in unacceptable adverse side effects, intrathecal pumps provide an alternative option for pain management. The ability to adjust the dosage and timing of medication allows the physician to adjust the device for each patient’s needs. Intrathecal pump implants are safe and effective for a wide range of diseases and injuries that result in severe chronic pain.

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References

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