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Pain Pump

Spinal Pain Pump

Medicines taken orally get diffused throughout the entire body, which means that a great deal of pain medication must be ingested in order to get the appropriate quantities to the place it is needed most: the spinal cord. Now we have the ability to get that medicine to exactly where it’s needed. By surgically implanting a pump under the skin of a person’s abdomen and running a catheter to the pain’s precise location in the spine, we can pump medication directly into the spinal fluid, allowing for a much more potent effect on the spinal cord. This drastically cuts down the dose of medication that is needed, and the medication often provides even better pain relief with fewer side effects.

What is an Intrathecal Pump Implant (“Spinal Pain Pump”)?
An Intrathecal Pump is a specialized device, which delivers concentrated amounts of medication(s) into spinal fluid area via a small catheter (tubing).

Am I a candidate for Intrathecal Pump Implant (“Spinal Pain Pump”)?
Currently at Spine Institute Northwest, Intrathecal Pump is offered to patients with chronic and severe pain, who have not adequately responded to other treatment modalities including oral opioids. Some of the examples are failed back syndrome, cancer pain, RSD. These patients usually failed oral and IV medications or had severe side effects from the these treatments (sedation, constipation, nausea)

What is the purpose of the Spinal Pain Pump?
This device delivers concentrated amounts of medication into the spinal fluid area, allowing the patient to decrease or eliminate oral medications, and experience better pain relief and spasticity control with fewer side effects. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and/or other symptoms.

How long does the procedure take?
It is done in two stages. In the first stage, a single injection or temporary catheter is inserted to assess effectiveness and screen for unwanted side effects. If this trial is successful in relieving symptoms, then the permanent device is placed under the skin. The patients have to meet certain other screening criteria before implanting the pump.

Will the procedure hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “Flu shot”), so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

Will I be “put out” for this procedure?
The placement of the tubing is done under local anesthesia with patients mildly sedated. The amount of sedation given generally depends upon the patient tolerance. For the pump placement, patients are given spinal injection or general anesthesia depending on the patient general health.

How is the procedure performed?
It is done with the patient lying on his/her stomach. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needle for inserting the tubing.

Where is the tubing inserted? Where is the pump placed?
Tubing is inserted in the midline at the lower back. The pump is then placed on the side of the back.

What should I expect after the procedure?
You may have incisional acute postoperative pain after the procedure. The pump is adjusted electronically to deliver adequate amount of medication to control your chronic pain.

What should I do after the procedure?
This procedure normally a couple of hours, and patients are discharged the same day after pump adjustment.

How long will the pumps last?
The medication contained within the pump will last about 1 to 6 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 office or at your home, and takes only a few minutes. The batteries in the pump may last 5 to 7 years depending upon the usage. The batteries can not be replaced or recharged, and so the pump is replaced at that time.

Will the Intrathecal Pump Implant (“Spinal Morphine Pump”) help me?
It is very difficult to predict if the procedure will indeed help you or not. For that reason a trial is carried out to determine if a permanent device (pump) will be effective to relieve your pain or not.

What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Please discuss your concerns with your physician.

Who should not have this procedure?
If you are on a blood thinning medication (e.g. Coumadin®) or you have an active infection, you should not have the procedure. Patients also have to meet certain other screening criteria before implanting the pump.

Where can I get additional information?
More detailed information is available from the manufacturer of this device. Additional information is also available at the Medtronic’sTM Website.