Intrathecal Pain Pumps

There are several reasons why a person might experience chronic pain. These could include trauma, underlying health conditions, pain after surgery, cancer, and more. So if there is no one specific location that is causing a person to experience debilitating and life-changing pain, how is it supposed to be treated? Thankfully this is what makes a pain pump, or intrathecal pain pump, so helpful as they have been proven helpful in treating chronic and often difficult-to-treat pain. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas understand how difficult life can be when experiencing pain for days and weeks on end, and can help to determine if an intrathecal pain pump could benefit you. 

What is an Intrathecal Pain Pump? 

An intrathecal pain pump, also known as a pain pump, is a surgically  implanted device that delivers medication directly to the fluid surrounding the spinal cord, which is also known as the intrathecal space or subarachnoid space. This space is the area between the spinal cord and the membranes that surround and protect it, and holds the cerebrospinal fluid that bathes the spinal cord.

The pump consists of several parts, including a pump and reservoir placed in the abdomen and a catheter placed in the intrathecal space of the spinal cord. Injecting medication directly into this space helps to reach all of the nerves that connect to the spinal cord and prevent any pain sensations from being sent to the brain, as well as any abnormal muscle behavior that can lead to contractions or spasms. 

An amazing benefit of injecting medication directly into the intrathecal space is that much less medication is needed since it’s being directly injected, versus administered orally. Using a pump may also reduce the long-term need for pain medication and associated issues with use. 

What Conditions Does an Intrathecal Pain Pump Treat?

A pain pump is a helpful tool for treating several chronic pain conditions that haven’t responded to more conservative treatment methods. The most common include: 

• Chronic low back and neck pain from fractures, disc issues, spinal stenosis or spondylosis
• Lower extremity pain
• Abdominal pain
• Pelvic pain
• Post-surgical pain
• Complex regional pain syndrome (CRPS)
• Post-herpetic neuralgia
• Cancer pain (from cancer or cancer treatment)
• Peripheral nerve injury pain
• Neuropathic pain
• Spasticity (muscle stiffening), either due to stroke, multiple sclerosis, cerebral palsy or brain/spinal cord injury

An intrathecal pain pump has also proven extremely helpful for treating the symptoms of severe chronic pain conditions where conservative methods have failed to provide much needed relief. 

Who Can Benefit from an Intrathecal Pain Pump?

An intrathecal pain pump is a great option for patients who are suffering from severe and chronic pain or muscle stiffening and haven’t been able to find relief from other conservative methods including medications, physical therapy or relaxation methods. 

Overall, an intrathecal pain pump might be recommended for people who: 

• Have tried other pain control methods but haven’t been able to experience needed pain relief
• Need medication around the clock to mitigate symptoms
• Don’t have an underlying health condition that shortens their lifespan (six months or sooner)
• Don’t have any illnesses or disorders that could complicate pain treatment

The best way to determine if an intrathecal pain pump is a viable treatment option for your chronic pain is to partner with a pain management specialist who can accurately diagnose your symptoms and decide if the pump is the best option for you. 

What Does an Intrathecal Pain Pump Procedure Involve? 

The pain pump itself is made up of a thin, flexible tube called a catheter that is inserted into the intrathecal space. An extension catheter attaches to the main catheter and goes around the torso. This attaches to a pump that is implanted under the skin in the abdomen. Your pain management specialist will program the pump to auto-deliver a specific amount of medication at specific times. Inside the pump is a reservoir that holds the medication until it is ready to be administered. The reservoir can be refilled with a needle. A personal therapy manager (PTM) device helps to provide an extra dose if needed, depending on the level of pain at that time. 

The procedure itself is performed as an out-patient procedure (meaning the patient can return home the same day) in two stages: a trial stage and a permanent stage. During the trial procedure, local anesthesia is given to the patient so the catheter and the temporary pump surgery is more comfortable. If the patient experiences pain relief, the surgery is deemed successful and a permanent pump will be implanted. 

The permanent pump is implanted while the patient is under general anesthesia because the temporary implant is removed and the permanent one is implanted. A catheter is also placed in the intrathecal space, and is connected to the pump that is programmed to dispense medicine. 

Depending on the level of pain and underlying condition, the provider could recommend (and dispense) morphine, opioid-based medication and/or local anesthetics. The pumps are programmable for patient and provider preference, and can be refilled once a month with an office visit. 

Patients can experience mild pain after the surgery due to the incision, but symptoms can most often be remedied with pain medications. While the pump should last several years, the catheter might require repositioning due to movement from strenuous activity or damage. 

The main benefit of an intrathecal pain pump is that it offers consistent medication and subsequent pain relief that is delivered directly to the area of pain. This not only lowers a person’s dependency on oral medication, but also lowers the amount of medication needed since it’s being directly applied to the nerves that are causing pain. Also, if the pump is no longer needed, it can simply be removed. 

If your chronic pain conditions have not been remedied by conservative methods, an intrathecal pain pump might benefit you. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas can help determine if this is your best course of option by asking about your level of pain, when your pain symptoms are most often felt, and what methods you’ve previously tried and have failed. Please schedule an appointment today so that we may recommend the best treatment to both reduce your level of pain and improve your quality of life, now and in the future.

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Most medications for pain management are taken by mouth or injection. There are some disadvantages to this: the medication has to travel through the entire bloodstream before it begins to have an effect on the nerves, brain, and other parts of the body to relieve pain. For some patients, this causes side effects including drowsiness, confusion, nausea, constipation, and respiratory depression. Over time, the body may become used to the medication, requiring higher doses to manage pain.

An intrathecal pain pump is considered after oral pain medications and other methods of pain control have been exhausted or proven ineffective.

Intrathecal pain pumps can be used to treat nociceptive and neuropathic pain conditions. Examples of conditions that can be treated with an intrathecal pain pump are: complex regional pain syndrome or reflex sympathetic dystrophy, cancer pain, phantom limb pain, post herpetic neuralgia (shingles), carpal tunnel syndrome, failed back surgical syndrome, and peripheral neuropathy from diabetes mellitus or vitamin deficiencies.

Procedure Overview: Trial

The best part of this treatment option is that a patient can trial it before they decide to have the pump surgically implanted. An intrathecal medication trial can be performed in the office. This procedure is no different than having a lumbar epidural done except, instead of an injection of steroids into the epidural space, an injection of pain medication is done into the spinal fluid (intrathecal space). Following the procedure, the patient will then be assessed for pain relief and function. If adequate pain relief and improved function is noted with the trial, you and your physician will then determine if a permanent pain pump should be surgically implanted.

Permanent Implant

A permanent intrathecal pain pump is a surgical procedure that usually lasts one to three hours and will take place at a hospital or surgical center.

You will be comfortably sedated and monitored by an anesthesiologist during the surgery. The physician will make an incision in the skin of your abdomen or flank region to place the pump. Then, a second incision will be made in your back to allow the catheter to be placed near the spinal cord. Then, the other end of the catheter will be threaded under your skin and connected to the pump in your abdomen or flank, making the entire system internal and fully implanted. There are no components on the outside of the body. Once the system has been tested and checked, the incisions are closed and the surgery is completed.