Intrathecal Pump Implant
Chronic pain can severely disrupt your ability to engage in life as you wish. As a pain management specialist, Dr. Trujillo values variety for patients in the White Mountains area of Arizona. In our experience, a combination of appropriate pain management, healthy lifestyle habits, and physical therapy can help reinstate a better quality of life while also minimizing the need for invasive surgery. One modality that may be suitable for the management of chronic pain is an intrathecal pain pump.
What Is An Intrathecal Pain Pump?
A pain pump is a type of targeted drug therapy in which medication is delivered into the intrathecal space. This is the space that surrounds the spinal cord with cerebrospinal fluid as a protective barrier. A pain pump is a round metal device that resembles a hockey puck. It is surgically implanted beneath the skin in the abdominal area. The center of the device serves as a reservoir for medication. A tube spans from the device to the intrathecal space around the spine.
When the pump is implanted, it is programmed to automatically deliver pain medication in slow-release fashion. This method of delivery bypasses the digestive tract, which maximizes the efficacy of pain medication and also minimizes side effects such as constipation and nausea. The use of a pump also significantly decreases medication dosing compared to oral ingestion.
The pain pump can be removed at any time if the patient desires.
Candidates For Intrathecal Pain Pumps
Before deciding to implant a pain pump, Dr. Trujillo performs one or more trials to ensure that this method of pain management is appropriate. A trial is conducted after a comprehensive consultation, medical history review, and physical examination. A trial may involve:
- A single injection of pain medication administered through a lumbar puncture.
- Multiple injections over a series of days. Administration may be through a lumbar puncture or catheter.
- A continuous trial using an external pump. This trial increases the dosage of medication every few hours until pain relief is achieved.
The trial enables us to gather pertinent information about the drug type, dosage, and catheter location that would be best for the individual patient.
You may be a good candidate for an intrathecal pain pump if:
- You depend on pain medication for comfort and mobility
- You have no medical conditions that would interfere with the efficiency of the pump
- You have no allergies to the drugs commonly prescribed in pain pump therapy
- Your pain has not improved much with conservative therapies
- Trial screening achieved good results
How Does An Intrathecal Pain Pump Work?
An intrathecal pain pump is an internal device that administers small doses of pain medication directly into the space around the spine. The consistent delivery of medication prevents the brain from perceiving pain signals. The pump can be programmed to administer varying dosages of pain medication at different times of day depending on individual needs.
How To Prepare For Implantation
Presurgical tests may be scheduled before the implantation procedure. These may include chest x-ray, blood tests, an electrocardiogram, or other screenings to assess general health.
The patient should not eat or drink anything after midnight the night before the procedure. Contact our office if you have any questions about medications or other aspects of preparing for your pump installation.
Intrathecal Pain Pump Procedure
The pain pump implantation procedure is performed under general anesthesia, which is administered once the patient is on the operative table. With the patient lying on their side, the surgical team prepares the skin on the stomach and the back, where the device and catheter will be inserted.
An incision is made in the central area of the back and the catheter is inserted and guided into the intrathecal space near the spinal cord. An extension catheter is then passed from the spinal area around the torso to the stomach area where the pump will be inserted.
Next, an incision is made in the side of the lower abdominal area. A pocket is created between the muscle layer and the skin. The extension catheter is attached to the pump, and the device is positioned into the pocket that was created. Sutures secure the pump to the thick layer of fascia that lies over the abdominal muscles.
All incisions are closed with sutures and dressings are placed on the skin.
Recovery After Pain Pump Procedure
Initial recovery involves coming off of anesthesia. During this time, all vital signs are monitored and pain is managed by the medical staff, if necessary. Many patients go home the same day with instructions for post-operative care. Instructions will outline how to manage comfort, when various activities such as walking can be resumed, how to care for incisions, and when to call the doctor.
How Will I Feel After Getting A Pain Pump?
Initially after getting a pain pump, patients may experience discomfort related to the procedure itself. This may be addressed with narcotic medication for two to four weeks, after which patients will transition to other, non-addictive drugs. As recovery from the pump implantation procedure progresses, patients notice results such as:
- Reduced need for oral pain medication
- Less upset stomach, constipation, fatigue, and other side effects of oral medication
- Improved physical comfort and mobility
- Reduction in muscle spasms and rigidity
Side Effects Of A Pain Pump
Side effects for an intrathecal pain pump are relatively uncommon, but they may occur. The catheter may become blocked or may shift out of place. Cerebrospinal fluid may leak, causing headache or discharge from incisions. This side effect typically resolves on its own but, on some occasions, requires drainage.
The drugs administered through the pain pump may cause edema (swelling), nausea or vomiting, constipation, urinary retention, anxiety, dizziness, muscle spasms, or respiratory depression. The pre-treatment trial is conducted to reduce the risks of side effects by evaluating the effects of pain medication prior to use.