Epidural/Intrathecal Pain Pump (Trials and Implants)

Epidural/Intrathecal Pain Pump (Trials and Implants)

Intrathecal pain pumps are devices battery-powered, programmable devices offered by Advanced Pain Consultants to help patients manage chronic pain that has failed to respond to more conservative therapies.

The pumps are implanted in the body and programmed to release predetermined dosages of pain medication into the patient’s intrathecal space (the area around the spinal cord) at regulated intervals. Delivering medication directly to the spinal cord provides powerful pain management and relief with relatively small doses by blocking pain impulses at the spinal level. These systems can even be programmed to release differing amounts of medication at various times of the day and night, depending on the patient’s lifestyle and personal needs.

An intrathecal pump system consists of a pump (which is about 3-inches wide) that is surgically implanted beneath the skin of the abdomen, and a small plastic tube called a catheter. A reservoir inside the pump holds the medication.

Who is a candidate?

Pain pump implants are safe and effective for a wide range of diseases and injuries that cause severe, chronic pain, including:

  • Failed back surgery syndrome (residual pain after surgery to the spine).
  • Cancer (pain due to tumors compressing the spinal nerves).
  • Severe osteoporosis or arthritis.
  • Scarring from previous radiation therapy.
  • Spinal cord injuries.
  • Complex regional pain syndrome (a nervous system disorder causing constant burning pain).
  • Arachnoiditis (inflammation and scarring of the protective layer of the spinal nerves).
  • Causalgia (a burning pain resulting from a peripheral nerve injury).
  • Chronic pancreatitis (a blockage or inflammation of the pancreatic duct).

Intrathecal drug pumps can also reduce spasticity (muscle rigidity and spasms which can inhibit proper movement of the arms and legs) associated with the following conditions:

  • Cerebral palsy (a nervous disorder that impairs control of body movement).
  • Multiple sclerosis (a disorder of the brain and spinal cord).
  • Stroke (damage to the brain after an interruption in blood supply).
  • Brain injury.

You may be a candidate for intrathecal drug delivery if you have chronic, severe pain that has not responded effectively to more conservative therapies (e.g., oral medication, physical therapy, chiropractic, massage, relaxation, acupuncture and spinal injections), and surgery (either a first surgical procedure or a second operation) is not an option.

Good candidates for this procedure do not have serious psychological or medical problems that would complicate treatment, are not addicted to pain medications or other drugs, and not allergic to any of the medications used in the pump.

Patients who are diabetic or taking blood thinning medications, or have an active infection or uncontrolled heart disease, may not be well-suited for this treatment or may need to postpone it until their overall medical condition has improved.

If Dr. Pasi believes you are a good candidate for a drug pump, she will ask you to complete a screening test, which may include a psychological evaluation as well as a trial dose of medication. If you achieve at least a 50 percent level of pain relief after undergoing a trial, you may be a candidate for a permanent intrathecal pump implantation. It is important to understand that this type of therapy does not cure any underlying disease processes or totally eliminate the pain, but it may be able to help you better manage painful symptoms.

The procedure

Doctors cannot always predict whether an intrathecal drug pump will help someone—even those who are “good” candidates. This is why a trial procedure is done first—before a permanent system is implanted. The trial or testing period allows Dr. Pasi to see if an intrathecal pain pump will be an effective treatment for a particular patient.

The trial period can be done in one of three ways. With most patients, Dr. Pasi asks them to come to the office to have a “temporary system” put in. This is a fairly quick procedure using local anesthesia. It involves the placement of a catheter (small plastic tubing) into the intrathecal space. The tubing is connected to an external pump, which will be used to deliver medication into the intrathecal space. The patient then has 2 to 3 days at home to “test” the system. Alternatively testing can be done by delivering a single injection or multiple injections of medication into the intrathecal space through a lumbar puncture.

Following testing, Dr. Pasi assesses the results. If the medication is not tolerated or doesn’t provide enough pain relief, the implantable device is not considered. But if the medication is effective and there are no unwanted side effects, that tells Dr. Pasi that a permanent device will likely be effective for that patient. She will then schedule a time to surgically implant a permanent pump and catheter.

Surgery to implant a permanent pain system is usually done at a hospital or surgery center while the patient is under general anesthesia. During the procedure, Dr. Pasi first removes the temporary catheter. She then inserts the permanent catheter through a small incision in the back and positions it in the intrathecal space, securing it in place with sutures. Once the catheter is in place, an extension catheter is passed under the skin from the spine, around the torso to the abdomen where the pump will be implanted. Next, the pump is inserted through an incision in the sides of the abdomen and placed into a pocket created between the skin and muscle layers. The pump is sutured to the thick fascia layer overlying the stomach muscles, and the extension catheter is attached to the pump. The incisions are then closed with sutures or staples and bandages are applied.

Before sending the patient to the recovery area, Dr. Pasi will fill the pump with medication and test it, to assure proper function. Most patients are discharged the same day, but some do spend the night in the hospital for monitoring. During the first several days following surgery, there may be some mild discomfort and swelling at the incision sites. After 2 to 3 days, patients can return to their normal activities.

The amount of medication dispensed by the pump will be programmed with an external unit. Periodic follow-up visits (every 1 to 3 months, on average) to Dr. Pasi will be necessary, to refill the pump (medication will be injected through the skin and into the pump’s reservoir) and reassess the patient’s treatment plan. During these visits, the pump may be adjusted electronically to make sure it is releasing the optimal amount of medication on a daily basis. The batteries in the pump may last 3 to 5 years, depending upon the usage. At this time, another surgery will need to be done to implant a new pump and battery.

Expected outcomes

If the trial was successful, in most cases the permanent implant will be too. The benefits will occur almost immediately after the catheter and pump are implanted. Potential benefits include a reduction in pain and/or muscle spasms, less reliance on and need for oral medications, improved sleep, and a significant improvement in quality of life. Since pain symptoms are able to be controlled at much smaller dosages with a pain pump compared to what’s typically necessary with oral analgesics, side effects (such as sleepiness, mental clouding, gastrointestinal upset, constipation, the potential for addiction, etc.) will be significantly reduced.

The extent of pain relief does vary from patient to patient, depending on the underlying condition being treated and its severity. For some patients, additional pain therapies such as physical therapy and supplemental oral medicine may be recommended if the patient still experiences significant pain after implantation of the pain pump.

At any time in the future, the pump may be removed if the patient opts to discontinue this therapy. While they may called a “permanent” type of treatment, intrathecal pump systems are fully reversible.

For more information

If you suffer from chronic, severe pain, and have tried more conservative treatments without success, an intrathecal pump may provide you with the pain relief you’ve been looking for. To find out if you are a candidate for an intrathecal pain pump, please call Advanced Pain Consultants at (919) 510-7901 to arrange an initial evaluation with Dr. Pasi.