Intrathecal Pain Pump Insertion
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Intrathecal Pain Pump Insertion

(Pain Pump Insertion)

En Español (Spanish Version)

Definition

Intrathecal pain pump insertion involves surgically placing a small pump in your body through which pain medication can be delivered to the area around your spinal cord to help manage pain. Examples of pain medication includemorphine, fentynl, hydromorphone, sufentanil, clonidine, baclofen, or ketamine. This invasive pain management technique is generally only used if noninvasive pain management has failed. There are intolerable side effects to the therapies used.

Parts of the Body Involved

  • Skin
  • Abdomen
  • Back
  • Spinal cord

Reasons for Procedure

Intrathecal pain pump insertion can be used to manage chronic pain caused by:

Compression Fracture

Compression fracture lumbar

© 2008 Nucleus Medical Art, Inc.

Risk Factors for Complications During the Procedure

  • Psychological problems (personality disorder, mood disorder, psychosis, dementia, anxiety, addiction/abuse history)
  • Infection
  • Allergy or intolerance to the pain medication to be used or materials being used
  • Bleeding disorders, concurrent anticoagualation therapy

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Blood tests
  • Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
  • Chest x-ray

In the days leading up to your procedure:

  • Do not eat anything after midnight the night before your surgery, unless directed otherwise by your doctor.
  • Take and/or avoid certain medications, if directed to do so by your doctor.
  • Arrange to have someone drive you to and from the procedure, and for help at home after your procedure.

Anesthesia

Local, spinal, or general anesthesia may be used.

Description of the Procedure

Before performing the surgery to permanently implant an intrathecal pain pump, you will undergo a trial to see if the pump will actually decrease your pain. This trial will be performed by injecting pain medications into the area around your spine one or more times.

Cervical Injection

Cervical epidural injection

© 2008 Nucleus Medical Art, Inc.

Alternatively, a catheter may be placed in the area around your spine and connected to an external pump. The proper placement of the catheter and ideal dose of medication for you will also be found in the trial period.

Once the trial stage is complete, you will be scheduled for surgery to insert the pump. An intravenous (IV) line will be placed in your arm, and an anesthesiologist will administer the type of anesthesia you and your doctors have agreed upon.

Your doctor will begin the insertion procedure by making a small incision in your back. A small tube (called a spinal catheter) will be placed above your spinal cord and secured with sutures. Your doctor will use an x-ray machine to help guide the catheter from your spine, around your torso, and into the abdomen. From here, the pump will be positioned into a pocket created under the skin of your abdomen.

Once the device is in place, you will be awakened so the pump can be tested. Then the incisions in your back and abdomen will be closed with sutures or staples, and covered with bandages.

After Procedure

You will be taken to a recovery area, where your blood pressure, heart rate, and breathing will be monitored.

How Long Will It Take?

The procedure takes about 3-4 hours.

Will It Hurt?

You will be under anesthesia for the procedure, so you should not feel pain. You will experience some pain after the surgery, but it will be managed with medications.

Possible Complications

  • Bleeding
  • Infection
  • Spinal headaches
  • Catheter becomes blocked and stops working
  • Fluid accumulation around the pump
  • Side effects from the pain medication
  • Cerebrospinal fluid leak
  • Pump-related complications
  • Nerve root injury
  • Meningitis

Side effects

Average Hospital Stay

In most cases, you will be observed for about an hour and then allowed to go home.

Postoperative Care

After returning home, you should do the following:

  • Avoid bending, twisting, stretching, lifting objects over five pounds, raising your arms above your head, sleeping on your stomach, climbing a lot of stairs, or sitting for long periods of time for 6-8 weeks.
  • Avoid driving for 2-4 weeks after surgery.
  • Do not do housework or yard work, or resume sexual activity until you have had your follow-up appointment with your doctor and have been cleared to do these activities.
  • Gradually return to your normal activities.
  • Walk short distances at first, and after 2 weeks, gradually increase to 1-2 miles daily.
  • Follow instructions regarding caring for your incisions.

Outcome

Most people have a significant reduction in pain and are better able to function in daily life after having an intrathecal pain pump insertion. You will need to carry an Implanted Device identification card, since the pump will set off metal detectors (eg, at airport security gates). The battery in your pump will need to be replaced every 5-7 years. You will need to go for regular visits to your doctor to have the pump reservoir refilled with medication at regular intervals.

Call Your Doctor If Any of the Following Occurs

  • Redness, swelling, pain, or discharge around an incision site
  • Fever
  • A headache that persists after 48 hours
  • Sudden back pain
  • Sudden onset of leg weakness and spasm
  • Loss of bladder and/or bowel function
  • Beeping sounds from your pump

RESOURCES:

American Chronic Pain Association
http://www.theacpa.org

American Pain Foundation
http://www.painfoundation.org

CANADIAN RESOURCES:

Canadian Pain Coalition
http://www.canadianpaincoalition.ca

Canadian Pain Society
http://www.canadianpainsociety.ca

References:

Implantable technologies: spinal cord stimulation and implantable drug delivery systems. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/MyTreatment/news_implantabletherapy.asp#implantable. Accessed April 20, 2007.

Intrathecal drug pump. Mayfield Spine Surgery Center website. Available at: http://www.mayfieldclinic.com/PE-PUMP.htm. Accessed April 20, 2007.

Jain, KK, Intrathecal administration of drugs. In: Gilman S, editor. MedLink Neurology. San Diego: MedLink Corporation. Available at www.medlink.com. Accessed May 31, 2008.



Last reviewed May 2008 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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