Intrathecal Pump Trial and Implantation
What is a spinal infusion pump implant?
A spinal infusion pump implant, commonly known as a morphine or intrathecal pump, is a specialized device, which delivers highly concentrated amounts of medication into the spinal fluid space (also called the intrathecal space) via a small catheter. Unlike medications that circulate throughout your body in your bloodstream, intrathecal drug delivery releases medication directly into the fluid surrounding your spinal cord thus continuously bathing the pain receptors on the spinal cord with pain medication. This allows the patient to eliminate or substantially decrease the need for oral medications for pain. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and other symptoms.
How is the intrathecal pump trial and/or implantation done?
This procedure occurs in an operating room of a hospital. You will have either general anesthesia or receive deep intravenous sedation that makes the procedure easy to tolerate. You may either lay on your side or stomach during the procedure. You will be monitored throughout surgery. The skin is cleaned with antiseptic solution and then the skin and deeper tissues are numbed with a local anesthetic. X-ray is used to guide the introducer needle for inserting the infusion catheter. The spinal infusion catheter is inserted in the midline at the lower back. Then a tunnel is made from the back to the lower abdomen with a special tunneling tool. A pocket under the skin is made in the lower abdomen into which the infusion pump will be placed. The pump is filled with morphine and the catheter is attached to the pump. Once this is done, the incisions are sewn shut and bandages applied. The actual procedure in the operating room takes from one to three hours.
What should I expect after the procedure?
If the procedure is successful, you may feel that your pain is much less. The pump is adjusted electronically to deliver adequate amount of medication. There will typically be some swelling over the pump site and tenderness or pain from the incisions. However, your incisional pain is controlled fairly well by the morphine infusion and may not require additional pain medication. Depending on your particular circumstances, you may go home several hours after the pump is inserted. Or you may be kept overnight for observation and pump adjustment. Someone will need to drive you home. Patients going home the night of the surgery should not be alone the first night. You are advised to take it easy for several days. Ice may be used for swelling around the pump and some patients are asked to wear a soft abdominal binder as a sort of pressure dressing over the pump. Antibiotic pills are given to decrease the risk of infection. The physician will check the wound in about three to five days in the office. If the wound is dry, the dressings will probably be removed at that time. The stitches will be removed in about two weeks or so.
How long will the spinal infusion pump last?
The medication contained within the pump will last about 1 to 3 months depending upon the concentration and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the doctor’s office or at your home and it takes only a few minutes. The batteries in the pump may last 3 to 5 years depending upon the usage. The batteries cannot be replaced or recharged. The entire pump must be replaced at that time.
How effective is the intrathecal pump?
It is sometimes difficult to predict if a spinal infusion pump will indeed help you or not. For that reason a trial of different doses of morphine injection into the spine is carried out to determine if a permanent pump would be effective to relieve your pain or not. Potential benefits include: reduction in pain, improved function and participation in activities of daily living, lower medication doses, fewer side effects, reversibility, and flexibility of dosing. Many people experience significant improvements in their pain symptoms and quality of life after receiving spinal infusion therapy. However, realistic expectations are essential to satisfaction with any pain treatment. Drug delivery therapy cannot eliminate the source of your pain or cure any underlying disease, but it may help you to better manage your severe chronic pain.
What are the risks and side effects?
Bruising, soreness, swelling and other tenderness are very common. Bleeding, infection, spinal fluid leak, headaches, tingling, short-term weakness or numbness caused by the catheter placement are much less common but do occur. The implanted pump and catheter are surgically placed under the skin. You should not undergo the implant procedure if you have an active infection at the time scheduled for implant. Depending on your medical history, there may be risks associated with general anesthesia or intravenous sedation. You should discuss the particulars with your surgeon as well as your anesthesiologist.
Once the infusion system is implanted, device complications may occur which may require surgery to resolve. Drug overdose or underdose can result because of these complications and have serious and even life-threatening adverse effects. Possible complications include the catheter or pump moving within the body or wearing through the skin. The catheter could leak, tear, kink, or become disconnected. The pump could stop because the battery has run out or because of failure of another part of the infusion system. Additionally, inflammatory masses have been reported at the tip of the catheter which may lead to complications, including paralysis.Please discuss the benefits and risks of this therapy with your doctor.
What if I am allergic or cannot tolerate morphine?
Morphine and ziconotide are the only FDA approved pain medications that are officially recommended for a spinal infusion pump. Patients with side effects from morphine may opt to try other pain medications including Fentanyl, Dilaudid and Sufentanil. Also, certain other medications can sometimes be added to the narcotic pain medication to increase its effectiveness or to decrease the overall amount of narcotic pain medication that is needed. There are risks associated with the use of any opioid pain medication.
Can I have an MRI if I have a spinal infusion pump?
MRIs, if truly necessary, can be performed with a spinal infusion catheter and infusion pump in place. Special protocols for pump patients can be given to the MRI technicians and radiologists. Most patients with a spinal infusion catheter and pump do not have MRIs.
Can I pass through airport security with a spinal infusion pump?
Maybe. Depending on the sensitivity of the specific screening device, many patients can pass through with ease, just like some patients with pacemakers. If not, all patients are provided with identification indicating that a medical device has been implanted.
Who should not have a spinal infusion pump?
Patients who have an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with the pain physician before receiving the procedure. There may be special instructions or lab testing or the procedure might need to be rescheduled. Patients also have to meet certain other screening criteria before implanting the pump.
Am I a candidate for a spinal infusion pump implant?
Spinal infusion pump implants are offered to patients with chronic and severe pain, who have not adequately responded to other, more conservative, treatments. Usually these patients’ pain cannot be easily controlled on oral pain medications or they find the side effects of oral medications intolerable. If your doctor thinks you are a good candidate for a drug pump, you can complete a screening test so that you can experience the therapy to see if you are a good candidate. Contact us for more information.
At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.