Intrathecal pain pump (intrathecal drug delivery) for chronic pain and spasticity

Overview

An intrathecal pain pump is a small device placed under the skin of the abdomen. It sends medicine through a thin tube (catheter) directly into the fluid around the spinal cord. Because the medicine goes right where it works, a small fraction of the oral dose may be needed. This may mean fewer side effects than with pills for some people. A pain pump may be an option for long-lasting pain, including cancer pain and other pain, and for stiff, tight muscles (spasticity). It is usually considered after simpler care, injections and other procedures have been tried. A trial comes first, and results vary.

GSMC is led by Dr. Dharam Mann, who completed fellowships in pain management, cardiac anesthesia and critical care at Massachusetts General Hospital/Harvard.

Watch: how Intrathecal Drug Delivery works

Video: “TDD Animation Medtronic Targeted Drug Delivery” from MedtronicChronicPain on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

An intrathecal drug delivery system has two parts:

• The pump: a round, battery-powered device about the size of a hockey puck, placed under the skin of the abdomen. It holds the medicine and releases it at a set rate.
• The catheter: a thin, soft tube that runs under the skin from the pump to the intrathecal space around the spinal cord.

The pump can be programmed with a small device held over the skin, so the dose can be adjusted without surgery. Some systems also let you give a small extra dose within safe limits your physician sets.

Medicines that may be used include certain pain medicines and, for spasticity, baclofen.

Who it's for

A pain pump may help some people with:

• Cancer pain that is not controlled well with pills or patches, or causes too many side effects
• Chronic non-cancer pain that has not responded to conservative care, injections and other interventional treatments, such as spinal cord stimulation
• Spasticity (tight, stiff muscles), for example from multiple sclerosis, spinal cord injury, brain injury or cerebral palsy
• People who have side effects from oral medicines that limit their dose

What the procedure involves, step by step

Step 1: Evaluation. We review your history, medicines and imaging. Many insurance plans also ask for a psychological evaluation for non-cancer pain.

Step 2: The trial. 1. A test dose of medicine is given into the spinal fluid, either as a single injection or through a temporary catheter. This is done in a monitored setting. 2. We watch how your pain or spasticity responds and check for side effects. This may take a few hours to several days.

Step 3: The decision. You and your physician review the results. If the trial did not help enough, the pump is not placed.

Step 4: The implant. 1. The pump and catheter are placed in a procedure under anesthesia. 2. The catheter is placed in the intrathecal space through a small incision in the back, then passed under the skin to the abdomen. 3. The pump is placed in a pocket under the skin of the abdomen and connected. 4. The incisions are closed. Some people go home the same day; others stay overnight.

Step 5: Ongoing care.

• The pump is refilled with a needle through the skin in the office, usually about every 3 months, depending on the medicine and dose.
• The dose can be adjusted by programming at your visits.
• The pump battery typically lasts about 7 years. Then the pump is replaced in a shorter procedure. The catheter can often stay in place long term.

Recovery and what to expect

• Soreness at the incisions is common for a week or two.
• You will usually limit bending, twisting and heavy lifting for several weeks while you heal.
• It may take several visits to find the right dose.
• Never miss a refill appointment. Running out of medicine, especially baclofen, can cause serious withdrawal symptoms. Carry your pump ID card.
• Some people are able to lower or stop some oral medicines, and some are not. Results vary.

Candidacy: who may or may not be a good fit

May be a good fit: people with chronic pain, cancer pain or spasticity that has not responded well enough to conservative care, injections and other interventional treatments, who have a successful trial and can keep regular refill visits.

May not be a good fit: people with an active infection, a bleeding problem, certain spine problems that block the catheter path, an allergy to the medicine, a body size too small for the pump, untreated mental health conditions or active substance use that need care first, or anyone unable to keep refill appointments.

Risks in brief

Risks include infection, bleeding, a spinal fluid leak or headache, catheter problems (kinking, moving or blockage), pump problems and the need for another procedure. Medicine side effects can include drowsiness, nausea, constipation, itching, swelling and, rarely, slowed breathing. Withdrawal or overdose can happen if the pump malfunctions, a refill is missed or a refill is done incorrectly. Rarely, a small mass can form at the catheter tip. We will review your specific risks.

Alternatives

Other options may include oral or patch medicines, physical therapy, injections, radiofrequency ablation, spinal cord stimulation, dorsal root ganglion stimulation and, for spasticity, oral medicines, therapy and botulinum toxin injections.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

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• Failed back and neck surgery
• Neuropathic (nerve) pain
• Back pain
• Post-Laminectomy Syndrome

Related treatments and resources

• Spinal cord stimulation
• Patient education library