The Morphine Intrathecal Pain Pump for Chronic Pain

Chronic pain is a major problem for Americans. International studies have shown that chronic pain affects around 10% of the general population, and in the U.S., 25% of people have some type of recurring or chronic pain. In addition, 2/3rds of people have experienced chronic pain for more than 10 years. A promising treatment for chronic pain is the morphine intrathecal pain pump.

What is intrathecal analgesia?

Also called spinal analgesia, intrathecal analgesia involves infusing medication into the intrathecal space. Morphine remains the gold standard due to its ease of use, duration of action, ad effectiveness. The type of therapy recommended for individuals with a life expectancy of more than 6 months. The procedure involves implanting a small battery-operated pump under the skin, which delivers tiny amounts of medication through a catheter into the intrathecal space. The pump is refilled every 1-3 months, which is more effective than oral medications.

What is an intrathecal morphine pain pump trial?

Before the programmable pump is implanted, the patient must first undergo a trial. The trial phase determines whether or not the implantable device will work. During the trial, the doctor places an indwelling catheter in the intrathecal space, and this infuses slowly a dose of morphine. The pump is worn outside the body. Typically, the doctor considers the long-term pump with the patient has at least a 50% improvement in pain scores and function.

How is the pain pump procedure performed?

The placement of an implantable intrathecal morphine pump consists of the catheter is done under light sedation (twilight anesthesia). After you change into a gown, the nurse places an IV catheter in your arm to administer sedation. The doctor cleans the skin and makes a small incision over the skin. The device is placed under the subcutaneous tissue. A catheter is threaded from the pump and placed in the intrathecal space. Position of the catheter is done using fluoroscopy (real-time x-ray). The incisions are closed using sutures or steri-strips.

Does intrathecal analgesia with morphine work?

Clinical studies show that intrathecal morphine is the best analgesia for patients with refractory long-term pain. One study showed that intrathecal morphine had an 80% success rate for improvement in quality of life scores, as well as pain reduction.

What are the benefits of intrathecal drug delivery via a programmable pump?

Oral medications must be absorbed systemically, crossing over the blood-brain barrier. With the intrathecal pain medicine, the intrathecal medicine interrupts pain pathways at their source in cerebrospinal fluid. The patient only needs a fraction of the drug compared to the oral dose. By bypassing the gastrointestinal tract, intrathecal medicine does not have pesky side effects like nausea, vomiting, and constipation.

When does the Colorado pain management specialist use the intrathecal pain pump?

Clinical evidence shows that intrathecal morphine pain management using an FDA-approved infusion device works. The measure is used for those who:

  • Have a life expectancy of greater than 6 months.
  • Have a positive response during the morphine intrathecal trial.
  • Had unsatisfactory response to other pain control methods, such as oral medicines and physical therapy.
  • Have pain not psychological in nature.
  • Are not an opioid abuser.

Who is a candidate for the implantable morphine pain pump?

Intrathecal pain medication is contradicted for some people. Those who cannot have this include:

  • Anyone with an active infection.
  • Those with allergy or hypersensitivity to morphine.
  • People who have a TENS unit or other implanted device.

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.

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

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

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.