Intrathecal Pumps

Intrathecal pumps (IT pumps) can be helpful in alleviating discomfort for patients with a variety of conditions that result in chronic pain. Most often, intrathecal pumps are implanted in patients with cancer pain, muscle spasms, neuropathic pain, and severe back pain. It is a safe and effective technique in which an automated medication pump is inserted near the base of the spine where it can deliver a combination of drugs directly into the spinal fluid. By delivering the pain medication directly to the pain receptors, smaller doses are required to achieve pain relief. Intrathecal pumps are a great choice for patients who have had little relief from physical therapy, surgery, injections, and if oral medications are not effective or have undesirable side-effects.


Utah Intrathecal Pump Implant

An intrathecal trial is preformed when an IT pump is being considered for placement. To do this, the doctor will inject medication into the spinal fluid to see if relief is achieved. If the patient does well with an IT trial, an appointment will be made for the actual procedure to take place. The operation can take place at a hospital, but is also commonly done in an outpatient setting. General anesthesia is usually not required, but may be preferred by the surgeon or patient. First, the physician will sterilize the entry location and locally anesthetize where the dissection will be started. Once the surgeon has reached the layer of muscle next to the spine, the doctor will use fluoroscopic guidance to place a needle and a catheter into the intrathecal space inside of the patient's spine. Once the catheter is in the correct location, the needle will be removed and the catheter anchored in place. The catheter will then be tunneled to a predetermined site. The pump and catheter will be connected and both will be placed under the skin of the lower abdomen or buttocks and wounds are closed surgically. After the pump has been correctly implanted, the physician can refill the pump (usually every 4-6 weeks) by simply injecting medicine into the pump's reservoir, where it will automatically deliver the proper medications to the spinal fluid either continuously or as programmed by the doctor. The procedure normally takes between 1 and 2 hours followed by anywhere from a couple of hours to an overnight stay before the patient is discharged. A full recovery should take less than two weeks.

 

Risks and Benefits

Because any number of medications can be placed inside an intrathecal pump, it can be beneficial to patients suffering from a variety of problems. It can be helpful in relieving nociceptive, neuropathic, spasmodic, and visceral pain. Nociceptive pain (pain from tissue irritation) may be relieved with local anesthetics, and opioids such morphine. Neuropathic pain (peripheral or central nervous system pain), which includes failed back surgery syndrome, phantom limb pain, cancer pain, shingles, carpal tunnel syndrome, and others, may be helped by local anesthetics. Spasmodic pain (pain from muscle spasms) is most often helped by administering anti-spastic muscle-relaxing medication, such as Baclofen. Visceral pain (pain from the autonomic nervous system), such as abdominal and pelvic pain, may be relieved with local anesthetics, opioids, prialt, clonidine, or any combination of the aforementioned medications. Many different pain conditions often overlap in a single patient, custom blends of medication are often mixed for a patients specific problems in an attempt to produce maximum relief. Although intrathecal pumps are considered effective and safe, there are risks involved from both the procedure and the medications used. Common side-effects include respiratory depression, sleepiness, constipation, facial flushing, weakness, itching, nausea and vomiting. More serious but less common complications can include catheter malfunction, infection, meningitis, infection, bleeding, and hematoma.

 

Outcomes

Intrathecal pumps have proven to be safe, clinically effective, and well tolerated in patients seeking pain relief. In fact, Intrathecal Baclofen therapy has been shown to be so safe and effective that it has become the standard treatment for severe spasticity. It is often recommended by patients and their families. Patients with painful cancer have benefited greatly from intrathecal opioids and reported an improved quality of life. Terminal cancer patients have found continuous intrathecal narcotic infusion to be a very effective method for controlling pain and appreciate the ability to be treated in an outpatient setting.