Spinal Drug Pump (Intrathecal Pump)

A spinal drug pump, or intrathecal pump, can help provide chronic pain patients round-the-clock pain relief. Spinal pumps are programmable devices that deliver a measured and safe drug dose to meet the patient’s daily needs for pain management.

Unlike oral pain medication that takes time to take effect, an intrathecal drug pump bypasses the gastrointestinal system and delivers medication into the cerebrospinal fluid. The brain and spinal cord float in the cerebrospinal fluid. Patients may benefit 4 ways:

  • less pain medication is needed
  • pain relief is sustained and better controlled
  • side effects are reduced (i.e. constipation, nausea)
  • increased quality of life

The success of pain management using a spinal pump depends on (1) careful patient selection and (2) a successful trial.

Careful patient selection is important to a successful outcome and may include a psychological evaluation, as a spinal pump is not suitable treatment for all chronic pain patients. Some considerations include:

  • nonoperative treatments have failed
  • surgery is not an option
  • surgery is not expected to improve pain
  • spine surgery failed (i.e. failed back syndrome)
  • the patient is addiction free (i.e. drugs)

About Intrathecal Pumps

Although there are different companies who manufacture pumps, the concept is similar. The system includes a programmable battery-powered pump, intraspinal catheter, and remote programming device. Most pumps resemble a hockey puck (or smaller) and have an access port that attaches to the catheter. Catheters are flexible and deliver medication from the pump to the spine.

As mentioned, there are different types of spinal pumps. Your doctor will help you determine which system is best for you based on your condition.

Trial Period

Before an intrathecal pump system is implanted, your response to therapy is assessed. This involves an injection of morphine or other opioid into the spinal canal and evaluating for pain relief.

Depending on your response, including any side effects, we would decide whether the trial is a success. We look for a pain reduction of 50% or more. Keep in mind that pain reduction is an individual response and you may experience a higher level of pain relief.

Possible Risks and Complications

Implantation of a spinal pump, like other surgical and medical procedures, may present risks. Complications include risk of infection, bleeding, headache, allergic reaction, spinal fluid leakage, paralysis, and device malfunction.

Intrathecal Pump Implantation

The surgical procedure is performed under general anesthesia using fluoroscopic guidance (real time x-ray) and may take 1 to 2 hours. The pump is implanted either on the left or right side of your abdomen beneath the skin. The catheter is attached to the pump and fed to the appropriate place in the spinal canal.

From your assessment and trial results, the pump reservoir is filled with a drug and programmed. You periodically (i.e. monthly) return to our office to:

  • Refill the pump
  • Adjust your dose (as needed)
  • Pain management follow-up, therapy goals

Procedure Aftercare

Before you are released home, we provide you with written home care instructions. In general, you should avoid lifting, bending, stretching, and twisting. Walking is encouraged to help relieve post-procedure pain and build strength.

Conclusion

We will telephone you 24 to 48 hours after your procedure to follow-up. We recommend you keep a daily journal of your pain level and other symptoms following your procedure, whether you are undergoing a spinal pump trial or had the device permanently implanted. The pain diary will help you provide your doctor with detailed information about your treatment progress when you come back for your follow-up office visit.

To Learn More

If you are interested in a spinal drug pump (intrathecal pump) to manage your pain, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, New York and Staten Island, New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.