Intrathecal Pain Pumps For Chronic Pain – Are You A Candidate?

Table of Contents

What is an intrathecal pain pump?

An intrathecal pain pump is a small medical device that delivers pain medications directly to the spinal cord. The pain pump consists of two parts: 1) the pump (reservoir) that holds pain medication, and 2) the medication tubing (catheter) that carries pain medication to the spinal cord nerves. Pain signals are nullified by targeted pain medication before reaching the brain.

A pain pump consists of two components:

What types of intrathecal pain pumps exist?  

There are two main types of intrathecal pain pumps: 

Type 1

Fixed Rate Pain Pumps or mechanical pumps

Deliver a continuous amount of a drug at a consistent flow rate.

Completely mechanical and works using a gas chamber, doesn’t require a battery or electricity to operate.

Type 2

Variable Rate Pain Pumps or (battery-operated pumps)

Are programmed so that the amount and timing of drug delivery can be adjusted to your needs and can be adjusted as your schedule changes.

Some newer pumps can allow patients to self-administer a controlled dose for breakthrough pain.

Uses a battery that will need to replaced when charge runs out.

You can discuss which type of pump best suits your needs with your physician.

 PHYSICIAN INSIGHT

Because medication is targeted to areas of pain signaling – as opposed to oral medications that are distributed throughout the entire body – pain pumps can alleviate pain with less than 1% of the amount of oral medication.

Who are intrathecal pain pumps good for?

Pain pumps relieve pain best for patients with:

Chronic pain (pain that has been present for years)

Failed back surgery syndrome (persistent pain after back surgery)

Cancer-related pain

Complex regional pain syndrome

Chronic pancreatitis

Causalgia (burning pain related to peripheral neuropathy)

Arachnoiditis

Pain pumps can also help lessen spasticity (muscle rigidity and spasms) caused by:

Cerebral palsy

Multiple sclerosis

Stroke

Brain injury

Spinal cord injury

What drugs are typically used in a pain pump? 

The most common drugs used are:

Morphine
Morphine is the most common drug for severe chronic pain in intrathecal pain pumps.

Hydromorphone
Hydromorphone is commonly used as an alternative for morphine.

Baclofen
Baclofen is an FDA-approved drug used for treatment of muscle spasms, neuropathic pain, and severe spasticity.

Ziconotide
Ziconotide is commonly used for severe chronic pain for patients who cannot tolerate intrathecal morphine.

If none of these work for any reason, you discuss other options for medication with your physician.

What kind of physician implants the pain pump?

Interventional Pain Doctors 
Look for doctors who are fellowship-trained in pain management and minimally invasive procedures. These doctors are usually highly skilled in the diagnosis and treatment of pain because they have training exclusively within the field of pain management.

What is the success rate for pain pumps?

Intrathecal pain pumps are considered effective for those trying to treat chronic pain, with 86% of patients in a study willing to implant the pain pump again for the same results. Source

Pain Pumps vs Oral Meds:  Which is better?

Pain pumps are considered more effective than oral medication as they work directly in the CSF or cerebrospinal fluid, which surrounds your brain and spinal cord and means that drugs are absorbed quicker and more directly. You also need far less medication for this reason: pain pumps use about 1/300 the amount of drugs (in regard to baclofen or morphine) than oral medications. 

What is the process of getting a pain pump?

The 5 steps required to receive a pain pump are:

1

Evaluation by a medical doctor

If you have any of the medical conditions above and you’re interested in learning more, the first step is to discuss pain pumps with your interventional pain doctor.

An interventional pain doctor specializes in non-surgical, minimally invasive procedures to reduce pain.

2

Pain pump "trial"

Before a permanent pain pump is inserted, a trial run is performed.

The purpose of the trial is to evaluate the degree of pain relief and side effects of having a pain pump without having to actually implant the full device.

There are two trial methods, both of which work well and are determined by you and your pain doctor.

Injection Method

In this method, a needle filled with pain medication (usually morphine or baclofen) is injected into the space surrounding the spinal cord (the same location where the implanted pain pump delivers medication). Over the day, your degree of pain relief and comfort is assessed by you and your doctor.

Continuous Infusion Method

In this method, an easily removable temporary system that closely resembles an actual pain pump is inserted. Over the next day, your degree of pain relief and comfort is assessed by you and your doctor.

Illustration of the space surrounding the spinal cord nerves (intrathecal space). This is where a pain pump delivers medications such as morphine and baclofen.

After a trial, you will need to do 3 things with your doctor:

Assess if the trial led to pain relief that helped you throughout the trial.

Discuss if the trial led to any unwanted side effects.

Decide if you’re ready to go ahead with pump implantation.

3

Implantation

If the trial run is successful, a minimally-invasive procedure is performed to place a more permanent pain pump.

First, a small tube (catheter) is placed into the fluid surrounding the spinal cord. During this portion of the procedure, the doctor uses real-time fluoroscopy to guide the catheter into the appropriate location.

Next, through a small incision near the waistline, the reservoir/pump (similar in size to a pacemaker) is placed just beneath the skin.

Most patients leave the day of or the morning after their procedure.

spinal cord stimulator implantation procedure
The pump/reservoir is positioned just beneath the skin near the waistline. The pump is not visible to others but can be easily accessed by an interventional pain doctor

4

Recovery

Full recovery usually takes 6–8 weeks. You may experience some initial discomfort and limits on movements; however, this usually resolves quickly.

After a few weeks, you should be able to start getting back to many of the activities you enjoy, such as going for a walk, riding your bike, or going to a movie.

5

Refill

During refill appointments, your physician will assess your symptoms, check that your drug delivery system is working properly, and confirm you are receiving appropriate therapy.

The pump will be emptied with a small needle that is inserted under local sedation (numbing medication). The pump will then be refilled with medication.

Refill appointments usually take 10 to 15 minutes. How often your pump needs to be refilled depends on your individual dosing schedule and the size of your drug pump.

Patient Review

“It’s been a truly life-changing experience.”

Jessica shares her experience after 1 year of having an intrathecal pain pump. 

 

The information included in this document in no way substitutes for medical advice.

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