An intrathecal pump, or drug delivery, refers to the method of providing medication for chronic pain directly to the spinal cord. The word “intrathecal” means something introduced into space under the arachnoid membrane which surrounds the brain or spinal cord.
The pump consists of a circular round metal piece about three inches in diameter and one inch thick. The catheter is a small plastic tube connected to the pump and placed in the intrathecal space in the spine. A space called the reservoir holds the medication inside the pump.
Through its direct approach, the goal of the pump is to more effectively reduce pain symptoms and reduce the use of oral medications and their related side effects. In fact, by delivering medication directly into the cerebrospinal fluid (CSF) through the pump, it allows for about 1/300th of the amount than when that medication is taken orally.
What Conditions Does an Intrathecal Pump Treat?
An intrathecal pump can help to alleviate pain due to the following conditions:
- Arachnoiditis (pain of the meninges (protective layers) of the spinal nerves)
- Cancer pain
- Causalgia (pain caused by a peripheral nerve injury)
- Complex Regional Pain Syndrome (CRPS)
- Chronic pancreatitis (pain caused by inflammation or blockage of the pancreatic duct)
- Failed Back Surgery Syndrome (FBSS)
- Phantom limb pain
- Post-shingles pain
- Nerve root injury pain
Benefits of the Intrathecal Pump
The benefits of the intrathecal pump include:
- Effective pain relief (50 percent or greater)
- Improved function (i.e., walking, sleeping, daily tasks)
- Reduced reliance on oral medications
- Reduced side effects from oral medications
- Outpatient procedure with limited recovery time
- Proven to be safe and effective
- A pump trail determines effectiveness
- Does not result in permanent changes to the spinal cord or nerves
- Is reversible
An Answer to Opioid Risks and Addiction
An intrathecal pump as an alternative to oral medications includes the use of opioids for treatment of chronic pain. When opioids are indicated, the main benefit of the pump is that the dosage delivered is extremely small when compared to the oral version. Oral medication must pass through the barrier of the cerebrospinal fluid (CSF) membrane. With the pump, the medication directly enters the CSF. Consequently, pain relief with the pump requires a minuscule amount (about only one to five percent) of the oral dose amount. Therefore, opioid dependence and addiction is very rare in those who receive the medication through the intrathecal method.
Side Effects of Intrathecal Pump
Although the side effects for the intrathecal drug pump are minimal, they do exist. All surgery entails the risk of bleeding and infection. The catheter can become dislodged or blocked, and while rare, mechanical failure of the pump is a possibility. Cerebrospinal fluid (CSF) can leak around the pump and may require a drain.
Side effects from the drugs used may include anxiety, depression, edema, constipation, dizziness, muscle spasms, twitching and urinary retention.
How is the Intrathecal Pump Implanted?
Prior to permanent implantation of the device, an intrathecal pump trial is conducted to determine effectiveness. On the day of the procedure, which takes from one to three hours, anesthesia is administered. An incision on the lower belly is made to form a pocket in the abdomen to house the pump. A second incision is made on the back to implant the catheter. After the pump and catheter are positioned and connected, the incisions are closed.
The type of medication used in the pump is determined by the source and type of the pain, and other factors are taken into account by the pain management physician. The pump may be programmed by the physician and set to automatically provide a certain amount of medication. The pump will need to be refilled with medication, most likely every one to three months.
To explore the intrathecal pump for pain and to receive a customized evaluation and treatment plan from our pain management specialist, contact Nova Spine & Pain Centers to schedule an appointment.