FAQs on Intrathecal Pumps in Colorado

 

Pain is one of the most common reasons people visit their doctors. When pain is persistent, and causes a physical disability, it is considered to be chronic pain. According to some international studies, around 20% of the general population are afflicted with chronic pain. In the U.S., 25% of people have recurring, chronic pain, and around 2/3rds of these people have had the pain for more than five years. An intrathecal pain pump is used when the patient has persistent pain despite conventional treatment measures.

What is intrathecal analgesia?

The term “intrathecal” refers to inside the epidural space, and the word “analgesia” means pain relief efforts. Spinal analgesia began in the late 19th century, and is an effective means of pain relief today. Morphine and cocaine were used in the early 1900s for pain relief. In 1973, doctors started using o9pioid drugs in spinal analgesia. In 1981, the first implantable intrathecal pain delivery device was used.

Who needs intrathecal pain medicine?

Patients needing intrathecal drug deliver are divided into two categories: patients suffering from terminal illnesses, such as cancer, and people with non-malignant chronic pain. Patients who need this measure are those who have failed on many conservative therapies, who have no active addiction issues, and who have passed psychological testing.

What is an intrathecal pump?

The intrathecal pump is a small device that is surgically implanted under the skin. This device has a tiny battery-powered pump that is programmable and refillable. The nurse refills the pump every 1-3 months using a syringe and needle. The pump is connected to an intrathecal catheter that delivers tiny concentrated amounts of pain medicine to the spinal fluid.

How is the intrathecal pump implanted?

Before the permanent device is implanted, the pain management specialist will have you take an epidural trial. This means the catheter tip is placed in the epidural space, but the pump is worn outside the body. The Colorado pain management doctor checks to see if you have at least 50% improvement in pain scores during the trial before the pump is surgically placed in the body.

When you have surgery, a small incision is made over the skin of the lower abdomen, and the pump is placed just under the subcutaneous tissue. The catheter is connected to the pump, and the incision is closed using sutures. To assure correct positioning of the catheter, the surgeon uses real-time x-ray.

What can I expect after the procedure?

The intrathecal pump implantation procedure is done under general anesthesia, so you will have no memory of the event. The incision sites of the lower abdomen and spinal region will be tender, and you may have some mild discomfort. A remote device is used to deliver the medication, which you carry with you. When you awake from surgery, you will be dizzy, drowsy, and may have nausea. After you become alert, the nurse will give you something to eat/drink, and have you sit up. We recommend that you rest for 2-3 days, and gradually return to activities of daily living.

What medications are used in the intrathecal pump?

For pain relief, the doctor may fill the pump with local anesthetics, adrenergic agonists, opioids, and other agents. The first line treatment for severe pain is morphine and hydromorphone. Other drugs used include Fentanyl and methadone.

Does the intrathecal pain pump work?

According to a recent study involving methadone in the pain pump, the intrathecal delivery system offered an 80% efficacy rate. A double-blind randomize clinical study involving 24 patients found that patients had improved quality of life when bupivacaine was added to their opioid agent in the intrathecal pump.

Resources

Knight KH, Brand FM, Mchaourab AS, & Veneziano G (2007). Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates. Croat Med J, 48(1), 22-34. Croat Med J, 48(1), 22-34.