FAQs on Intrathecal Pain Pump Implant in Philadelphia

An intrathecal pump (ITP) implant is a device used for the treatment of chronic pain. These pumps automated equipment that are programmed to deliver medication through a small catheter into the spinal cord.

What types of pain is treated with an intrathecal pump?

Intrathecal pain pumps are effective for treating severe back pain, cancer pain, neuropathic pain, sympathetic nerve pain, and muscle spasticity. The ITP delivers pain medication directly to pain receptors of the spinal cord, and this allows bypass of the gastrointestinal system, which means less side effects.

What is the purpose of the intrathecal pain pump?

The purpose of the intrathecal pain pump is to interrupt pain signals that travel through the spinal cord. The medication enters the intrathecal space, which surrounds the spinal cord.

Why is ITP implants superior to oral medication?

Because the medication is delivered directly to the spinal cord, it does not pass through the stomach. This allows less medication to be used for the same effect. Also, GI symptoms like nausea and vomiting are not associated with the intrathecal pain route.

What is an ITP trial?

Before the intrathecal pump is implanted, the doctor will perform an ITP trial. This involves only implantation of a small catheter directly into the back. If the trial is successful, then the doctor can surgically implant the pump.

How is the intrathecal pump implant procedure performed?

Placement of the ITP can be done at the outpatient center or in the hospital. The procedure usually is done with a local anesthetic, but general anesthesia can be used if necessary. After the skin is cleansed with an antiseptic solution, the doctor uses a local anesthetic to numb the area. After this, small incisions are made to place the catheter in position. The pump and catheter are both tunneled under the skin, and the incisions are closed with sutures.

What medications are delivered via the intrathecal pump?

The ITP delivers pain medication, muscle relaxants, and/or local anesthetics. Pain relievers include morphine, hydromorphone, demerol, fentanyl, and codeine. Local anesthetics include bupivicaine and lidocaine. The doctor will refill the medication reservoir in the pump every 4-6 weeks. The pain specialist injects the medication through the skin and into the pump.

What types of pain does the ITP treat?

The ITP is used to treat many painful conditions. These include:

  • Nociceptive pain – This occurs due to tissue irritation, and this pain responds to opioids.
  • Neuropathic, peripheral, and central nervous system pain – These types of pain all are receptive to local anesthetics. Neuropathic pain syndromes include complex regional pain syndrome, phantom limb pain, post-herpetic neuralgia, peripheral neuropathy, carpal tunnel syndrome, cancer pain, and failed back surgery syndrome.
  • Spasmodic pain – Muscle relaxants are used to treat spasmodic pain, which occurs due to impairment of the spinal cord or brain. This pain is seen with stroke, cerebral palsy, multiple sclerosis, spinal cord injury, and brain injury.

What risks are associated with the intrathecal pump implant procedure?

This procedure is safe and effective, but there are some rare risks associated with the ITP procedure. These include bleeding, hematoma, infection, meningitis, and catheter malfunction.

Are there side effects to the medication?

All medication have side effects. Common side effects associated with the medications dispersed through the pump include:

  • Nausea and vomiting
  • Weakness
  • Sleepiness
  • Constipation
  • Itching
  • Respiratory depression
  • Facial flushing
  • Sleepiness

How effective is the intrathecal pain pump?

In a large clinical study, researchers found that the ITP implant was well-tolerated, effective, and improved functionality. In addition, patients had improved muscle tone, less spasms, and pain intensity reduction. A large study involving the Medtronic SynchroMed System found the efficacy rate of this pump to be around 86%.

Resources

Corrado P, Alperson B, & Wright M (2008). Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients. Neuromodulation, 11(2): 98-102.

Ethans, K. (2007). Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy. Acta Neurochir Supplement, 97(Pt 1):155-62 PMID: 17691371

Guillaume D, Van Havenbergh A, Vloeberghs M, Vidal J, Roeste G (2005). A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity. Arch Phys Med Rehabil, 86(11):2165-71

Knight KH, Brand FM, Mchaorab AS, & Venezian G (2007). Implantable intrathecal pumps for chronic pain: Highlights and updates. Croat Med Journ, 48(1): 22-34.