When persistent and intractable chronic pain is affecting your life, and numerous other interventional and medication therapies have failed, exploring a minimally invasive surgical treatment option such as an intrathecal pump implant, also known as Targeted Drug Delivery, may offer promising and long-lasting pain relief.
What Is an Intrathecal Pump Implant?
An Intrathecal Pump Implant is a specialized medical device that delivers medication directly into the cerebrospinal fluid (CSF) surrounding your spinal cord. This method, called targeted drug delivery, allows for significantly smaller doses of medication while still providing powerful pain relief. Since it bypasses the digestive system, it reduces the side effects commonly associated with oral medications.
By delivering medication directly to the source of pain—your spinal cord and central nervous system—an intrathecal pump can offer better pain control with fewer side effects.
What Conditions Can Be Treated with Intrathecal Pump Implant?
This innovative therapy is often recommended for patients who:
- Suffer from chronic pain conditions like failed back surgery syndrome, complex regional pain syndrome (CRPS), chronic pancreatitis or abdominal pain, arachnoiditis, or severe osteoarthritis.
- Experience cancer-related pain that doesn’t respond to traditional treatments.
- Have spasticity or muscle stiffness due to neurological conditions like multiple sclerosis or spinal cord injuries.
- Are unable to tolerate the side effects of high-dose oral pain medications.
How Does the Procedure Work?
1
Evaluation and Trial Phase
Before the pump is implanted, we conduct a thorough evaluation to determine if you are a suitable candidate.
After being determined to be an eligible candidate for this therapy, an intrathecal trial is conducted by depositing a dose of the planned medication into the intrathecal space with a very small spinal needle, similar to the ones used in other interventional pain procedures.
You are then monitored to determine the amount of pain relief obtained with the single-shot injection. If an appropriate and satisfactory amount of pain relief is obtained, the trial is considered a success and further workup is conducted to move to the permanent implant phase.
2
Implantation Surgery
Once the trial phase is successful, we proceed with a minimally invasive surgical procedure. Here’s what happens:
- A small catheter is placed into the intrathecal space near the spinal cord.
- The pump, a small battery-powered device, is implanted under your skin, typically in the abdomen or in the lower flank of your back.
- The catheter is then connected to the pump, allowing for continuous medication delivery.
3
Post-Surgery Care
After the procedure, we provide detailed recovery instructions and offer adjustments to ensure the pump is delivering optimal pain relief.
Advantages of Targeted Drug Delivery
Improved Quality of Life
Helps restore mobility, improve sleep, and enhance daily functioning. It also reduces your dependency on oral opioids.
Reduced Medication Side Effects
Lower doses reduce risks of nausea, drowsiness, and dependency. Up to 1/300th of the oral dose may be needed.
Customizable Therapy
The pump can be programmed to fit your specific needs by being able to customize the type, dose, and concentration of the medications. In some cases, combinations of certain medications may be used.
Precision Pain Management
Delivers medication directly to the intrathecal space and spinal cord, which provides superior pain relief.
What Medications Are Used?
An intrathecal pump can deliver various medications, including:
1
Opioids
- Purpose: Used for managing severe, intractable pain that can’t be controlled by oral or transdermal medications.
- Common Drugs: morphine, hydromorphone, fentanyl.
- Benefits: Direct delivery to the spinal cord reduces systemic exposure and side effects like nausea and constipation.
- Applications: Often used for cancer-related pain, failed back surgery syndrome, or severe osteoarthritis.
2
Baclofen (Lioresal® )
- Purpose: A muscle relaxant used to treat spasticity (tight or stiff muscles), especially in neurological conditions.
- Benefits: Reduces muscle stiffness and spasms, improving mobility and flexibility.
- Applications: Used for conditions like multiple sclerosis, cerebral palsy, and spinal cord injuries.
3
Local Anesthetics
- Purpose: Blocks pain signals transmitted through the nerves, providing relief from acute or chronic pain.
- Common Drugs: Bupivacaine, ropivacaine.
- Benefits: Focused nerve pain relief with minimal impact on other body functions.
- Applications: Effective for neuropathic pain syndromes like complex regional pain syndrome (CRPS) or post-surgical nerve pain.
4
Clonidine
- Purpose: An alpha-2 adrenergic agonist that enhances the pain-relieving effects of other medications.
- Benefits: Lowers the required opioid dose, reducing the risk of opioid-related side effects.
- Applications: Often used in combination for refractory pain.
5
Ziconotide (Prialt® )
- Purpose: A non-opioid analgesic derived from cone snail venom, used for severe chronic pain.
- Benefits: Provides effective pain relief without the risk of opioid dependency or tolerance.
- Applications: Best for patients who cannot tolerate or do not respond to opioids.
Safety and Maintenance
The device requires periodic refills and adjustments, which are done during outpatient visits. At Vertex Pain Physicians, our compassionate team ensures your pump is functioning correctly and is providing the medication levels needed for continuous pain relief.
Risks and Considerations
As with any surgical procedure, there are some risks:
- Catheter complications (e.g., dislodgement or blockage)
- Medication side effects or overdose if not properly monitored
- Pump malfunction (rare)
- Infection at the implant site
However, these risks are low, especially when managed by an experienced pain specialist.
Is It Right for You?
A pain pump may be appropriate if:
- You have chronic pain that hasn’t improved with medications, therapy, or surgeries.
- You experience side effects from high doses of oral pain medications.
- You are seeking long-term, controlled pain relief.
Not everyone is a candidate. Certain medical conditions as well as psychological factors may affect eligibility.
Schedule Your Consultation Today
Contact us or visit our clinic to learn more about how we can help you find relief through this advanced treatment. Let us partner with you on your journey to a pain-free life!
Frequently Asked Questions
How does this therapy compare to spinal cord stimulation?
Intrathecal pumps deliver medication directly to the spinal fluid, whereas spinal cord stimulators use electrical impulses to block pain signals. Both therapies are effective, but the choice depends on your condition and medical history.
How often does the pump need to be refilled or replaced?
The pump requires refills every one to six months, depending on medication and dosage. The device itself may need replacement every 7 to 10 years due to battery life.
Can I undergo MRI scans with an intrathecal pump?
Intrathecal pumps are MRI-conditional. Patients with intrathecal pumps are able to undergo MRI studies without issue. However, it’s important to inform your healthcare provider and imaging technician about your implant before undergoing any MRI procedures to program the device for safety and functionality reasons.
Can I travel with an intrathecal pump?
Yes, you can travel with an intrathecal pump. Inform airport security or customs officers about your device to avoid potential issues. Carry documentation from your physician detailing the device and medications.
Are there any activity restrictions with an intrathecal pump?
After implantation, avoid heavy lifting, twisting, or strenuous exercise for a few weeks. Long-term, most patients can return to normal activities, but extreme sports may be discouraged.
Will I feel the pump after it’s implanted?
The pump is implanted under the skin and may create a slight bulge. Most patients become accustomed to it and do not find it uncomfortable.
How soon can I resume normal activities after implantation?
Recovery times vary, but many patients can resume light activities within a few days to weeks. Your healthcare provider will give specific recommendations based on your situation.
Medical Disclaimer: The information provided on this page is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any medical concerns.
