Intrathecal Therapy for Chronic Pain

Chronic pain is a major problem in the United States. A new, effective means of pain control is the Medtronic Targeted Drug Delivery System, which involves managing chronic intractable cancer pain, neuropathic pain, and musculoskeletal pain. Intrathecal therapy for chronic pain involves use of medications that bypass the gastrointestinal tract.

How does intrathecal pain medication work?

Oral medications must be absorbed systemically, crossing the blood-brain barrier to reach pain signals. Intrathecal pain medicine interrupts pain pathways at their source in the cerebrospinal fluid and spinal cord. The small programmable pump is surgically implanted under the skin, and a catheter is inserted into the space around the spinal cord. The pain medicine leaves the pump and goes into the cerebrospinal fluid.

What are the benefits of intrathecal drug delivery?

With intrathecal pain medication, the patient experiences pain relief using a fraction of medication compared to the oral dose. This helps to decrease uncomfortable side effects, such as nausea, vomiting, dizziness, drowsiness, and constipation. These side effects are more pronounced with oral medication, as it passes through the GI tract.

What is chronic nonmalignant pain?

Chronic nonmalignant pain is a complex issue involving cognitive, neurophysiologic, behavioral, social, cultural, and economic factors. It is typically defined as pain of at least 6 months’ duration, and it can include pain from a long-standing health condition, prolonged healing from a traumatic injury, or be related to an unknown cause.

What treatment measures will be tried first before an intrathecal pain pump is implanted?

Before you have the minimally invasive procedure for implanting a pain pump, the specialist will try several other treatment options. These include:

  • Nonprescription anti-inflammatory drugs (ibuprofen and naproxen)
  • Prescription strength pain relievers
  • Oral muscle relaxants
  • Oral antidepressants
  • Nerve blocks
  • Electrical stimulation
  • Physical therapy

When is an intrathecal pain pump used?

Clinical evidence supports the use of intrathecal pump for chronic nonmalignant pain when delivered using an FDA-approved implantable infusion device. All of the following apply:

  • Life expectancy is greater than 3 months.
  • Unsatisfactory response to other methods of pain control, such as oral opioids or physical therapy.
  • Positive response to the drug during an intrathecal trial.
  • The pain is not mainly psychological in nature.
  • Patient is not an opioid abuser or has a history of narcotic addiction.

Intrathecal therapy involves the continuous infusion of a drug directly into the cerebrospinal fluid. After you are positioned on the procedure table, and given a sedative. The abdomen is cleaned using an antiseptic solution. The surgeon makes a small incision and inserts the pump into the abdominal soft tissue. The pump holds the medication, and it is programmable. A catheter is threaded under the skin and placed into the cerebrospinal fluid. After the pump is inserted, the incision is closed using sutures.

Who cannot have an implantable pain pump?

The intrathecal pain medication system is contraindicated in the following people:

  • Those with known hypersensitivity or allergy to the drug being used.
  • Anyone with an active infection.
  • People who have a body size insufficient to support the bulk of the device.
  • Anyone with another implanted device (TENS unit or other).

Colorado Clinic offers expert pain management treatment at seven locations in Northern Colorado. Most insurance is accepted, and the providers offer both medication management and interventional procedures. Call today!

Resources

Grider JS, Harned ME, Etscheidt MA. Patient selection and outcomes using a low-dose intrathecal opioid trialing method for chronic nonmalignant pain, Pain Physician 2011; 14:343-351.

Hamza M, Doleys D, Wells M, et al. Prospective study of 3-year follow-up of lowdose intrathecal opioids in the management of chronic nonmalignant pain. Pain Med. 2012;13:1304-1313.

Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database of Systematic Reviews. 2010, Issue 1

Ruan X. Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician. 2007;10:357-366.

Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20:4040-4049.