Intrathecal Pain Pump

Featured Expert:

Eellan Sivanesan, M.D.

An intrathecal pump, also known as a pain pump, is a surgically implanted device that delivers medication directly to the fluid surrounding the spinal cord. Medicine delivered in this way can interrupt irregular signals traveling through the nerves and spinal column to the brain. An intrathecal pump may also be called an implanted intrathecal drug delivery system, or IDDS.

Eellan Sivanesan, M.D., director of the neuromodulation - pain medicine division and assistant professor of anesthesiology and critical care medicine, provides information on how intrathecal pumps work and what patients may expect if their doctors recommend this method of pain or spasticity control.

A pain pump is a small device, implanted with surgery, that allows direct delivery of medicine to the spinal cord and nerves. It consists of several parts, including a pump and reservoir placed in the abdomen (belly) and a catheter placed in the intrathecal space of the spinal cord.

The intrathecal space (sometimes called the subarachnoid space) is the area between the spinal cord and the thin, strong membranes that surround and protect it. The intrathecal space holds the cerebrospinal fluid that bathes the spinal cord. Infusing medication directly into this area helps it reach the spinal cord and nerves, where it can control pain or the abnormal muscle contractions that lead to spasticity.

Because the intrathecal pump delivers medication directly to this area, powerful relief can be achieved with a much lower dose (less than 1%) than what’s found in pills or injections, which become diluted as they flow throughout the body in the digestive system or bloodstream. Using a pump may also reduce medication side effects common with long-term pill use.

In two studies looking at patients with cancer-related pain and pain from AIDS, researchers found that intrathecal pumps afforded greater pain control and more manageable side effects than traditional oral pills.

The parts of the intrathecal pump are placed in your body through a surgical procedure. There are several parts:

An intrathecal pump may be used with opioid pain medications, anesthetics (numbing medications) or baclofen (a drug used to treat muscle contractions and ease spasticity). Other drugs commonly used include pain medicines like clonidine and ziconotide.

Yes: If you no longer need or want the pump, or if there is a mechanical problem, it can be taken out.

A pain pump may be recommended to address:

As part of the Blaustein Pain Treatment Center, Eellan Sivanesan, M.D., specializes in the treatment of both spasticity and cancer-related pain with intrathecal pump surgery.

A pump may be appropriate for a person experiencing severe, long-term pain or spasticity that has not been relieved through other approaches such as pills, physical therapy or relaxation techniques.

A pain specialist will help you decide if it is a good option by asking questions about your pain, what makes it better or worse, what you have tried in the past and the impact of the pain on your life and well-being.

In general, an intrathecal pump is most likely to be recommended for people who:

Because individuals’ response to medication varies, the intrathecal pump may not work for everyone. To help you and your doctor decide, you may undergo a trial of medication infused into the intrathecal area to see if it provides relief. Trials are rarely performed for chronic pain, but are more common for pumps to treat spasticity. In most cases, pumps for cancer pain are placed without a trial phase.

There are different ways to perform the trial:

The trial may also help the doctor find the best place to implant the catheter and the medication that works best to relieve your symptoms.

The procedure is performed by an interventional pain specialist and takes three or four hours.

For four to six weeks after surgery:

Having a pain and/or spasticity pump is generally safe. Side effects and complications are rare, but can include:

Having a pain pump in place and working should ease your pain and help you get back to some of your regular activities. Here are answers to common questions:

Every one to three months, you will return to your pain doctor to have the pump refilled with medication. Sometimes these refills can be performed at home through a skilled nursing service under the guidance of a physician. The provider will remove any remaining medicine from the pump’s reservoir with a needle and then inject new medicine into the reservoir.

If your pain level increases, your physician may be able to adjust the dosing after evaluating that the pump is working appropriately. If your pain or spasticity keeps getting worse, call your doctor, who can reprogram the pump at his or her office. You may be prescribed medicine in pill form to have available for times when the pain and/or spasticity gets worse.

Yes. You will be given a card identifying you as having an implanted device in your body. Keep this with you at all times.

The battery of the pump is designed to last five to seven years. When the battery begins to wear down, your doctor will get a signal when you are getting it refilled. There will be time to replace the pain pump before it stops working.

If you have an MRI test done, notify the doctor ordering the test and the technologist performing the MRI that you have a pain pump implanted. While the imaging is taking place, the pain pump will stop working and may alert you with an alarm. It will start working again after the test is over; however, a device representative or physician will need to double check that the pump is working appropriately after the MRI.

Call your doctor if the pump is beeping or if you experience any of the following: