Spinal Pump (Intrathecal Pump)

Therapeutic Drug Delivery to Relieve Chronic Pain

A spinal drug pump, or intrathecal pump, can help provide chronic pain patients round-the-clock pain relief. Spinal pumps are programmable implanted devices that deliver a measured and safe drug dose to meet the patient's daily needs for pain management.

Video: Spinal Pump

Click below to view a video from our library about Spinal Pump.

Unlike oral pain medication that takes time to take effect, an intrathecal drug pump bypasses the gastrointestinal system and delivers medication into the cerebrospinal fluid. The brain and spinal cord float in the cerebrospinal fluid. Patients may benefit in 4 ways:

• far less oral pain medication is needed
• pain relief is sustained and better controlled
• side effects are reduced (i.e. constipation, nausea)
• quality of life is improved

The success of pain management using a spinal pump depends on (1) careful patient selection and (2) a successful trial.

Careful patient selection is important to a successful outcome and may include a psychological evaluation, as a spinal pump is not suitable treatment for all chronic pain patients. Some considerations include:

• nonoperative treatments have failed
• further spine surgery is not an option
• surgery is not expected to improve pain
• spine surgery failed (i.e. failed back syndrome)
• the patient is no longer a candidate for oral opiates

About Intrathecal Pumps

Although there are different companies who manufacture pumps, the concept is similar. The system includes a programmable battery-powered pump, intraspinal catheter, and remote programming device. Most pumps resemble a hockey puck (or smaller) and have an access port for refills from the outside. A small bore and flexible catheter delivers medications from the pump's reservoir to the spinal fluid.

Trial Period

Before an intrathecal pump system is implanted, your response to therapy is assessed. This may involve an intraspinal (into the spinal canal) injection of an opiate solution, epidural injection, or continuous drug infusion via a catheter.

Depending on your response, including any side effects, most doctors consider the trial a success if pain is reduced by 50% or more. Keep in mind that pain reduction is an individual response and you may experience a higher level of pain relief.

Possible Risks and Complications

Implantation of a spinal pump, like other surgical and medical procedures, may present risks. The rare, but possible complications of implantation surgery include risk of infection, bleeding, headache, allergic reaction, spinal fluid leakage, paralysis, and device malfunction. Long term complications of spinal catheter and opiate delivery include catheter tip inflammatory mass formation (granuloma) and suppression of certain hormone production (e.g. testosterone).

Prior to considering this option, we want you to learn as much as possible about this technology. If you wish to speak with patients using this device, our existing patients commonly volunteer to share their experiences with others.

Intrathecal Pump Implantation

The surgical procedure is performed under conscious sedation or twilight anesthesia, using fluoroscopic guidance (real time x-ray) and may take 2 hours. The pump is implanted either on the left or right side of your upper abdomen beneath the skin. The spinal catheter is tunneled from the back and around the side under the skin to attach to the pump.

From your assessment and trial results, the pump reservoir is filled with a drug and programmed. You will periodically return to our office to:

• refill the pump (every 2-3 months)
• adjust your dose (as needed)
• pain management follow-up, therapy goals

Procedure Aftercare

Before you are released home, our medical team provides you with written home care instructions. In general, you should avoid lifting, bending, stretching, and twisting. Walking is encouraged to help relieve post-procedure pain and build strength. An abdominal binder worn over the pump site helps to control swelling.