What is it? Intrathecal Drug Delivery, or “Pain Pump,” is a method of giving medication directly to your spinal cord. A pain pump may be a treatment option if all other traditional methods have failed to relieve your long-term symptoms. Because the medication is delivered directly to the spinal cord, your symptoms can be controlled with a much smaller dose than is needed with oral medication. The goal of a drug pump is to better control your symptoms and to reduce oral medications.
Who is a Candidate? Intrathecal pump candidates include people for whom conservative treatments have failed. The choice of treatment depends on the type of pain, how severe it is, and how you respond to your pain treatment. If your doctor thinks you are a good candidate for an intrathecal pump, you can complete a trial screening test so that you can experience the therapy to see if you are a good candidate.
How is it done? There are two parts to the procedure: 1) placement of the catheter in the intrathecal space surrounding the spinal cord, and 2) placement of the pump/reservoir in the abdomen. The operation generally takes 3 to 4 hours.
What Can I expect after the procedure? You will wake up in the postoperative recovery area. Your blood pressure, heart rate, and respirations will be monitored, and your pain will be addressed. Most patients are discharged home the same day. You will be given written instructions to follow when you go home. Results will vary depending on the underlying condition being treated and its severity.
Possible complications? Side effects for intrathecal drug pumps are minimal, although they do exist. As with all surgeries, complications may include infection and bleeding. The catheter could move or become blocked, or the pump could stop working (rare). Accumulation of fluid (cerebrospinal fluid leak) can occur around the pump causing a clear watery discharge from your incisions or a headache. These usually disappear on their own, but may require a drain. Reasons for removal of the device include infection, failure to relieve pain, and patient misuse.
Side effects from the drugs may include respiratory depression, twitching, muscle spasm, urinary retention, constipation, nausea, vomiting, dizziness, anxiety, depression, and edema.
Depending on how much medication the pump delivers, the battery will eventually need to be replaced.
Will I have limitations after the procedure? You will need to avoid specific activities for 6 to 8 weeks to prevent movement of the catheter. No bending, twisting, stretching, raising your arms above your head or lifting objects over 5 pounds. Avoid sleeping on your stomach. No climbing stairs or sitting for long periods of time. You will not be able to drive for 2 to 4 weeks after surgery or until discussed with your surgeon. Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer. Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.
What happens next after my Intrathecal Drug Delivery Implant? You must schedule medication refills on a regular basis with the surgeon or pain management specialist. At your refill appointment, the effectiveness of your treatment will be assessed and your pump will be adjusted accordingly. The goal is to find the optimal amount of pain or spasticity control while having minimal side effects. You should tell your doctor if you experience unusual symptoms, drug overdose, or feel that your dosage is ineffective. You may need to take supplemental oral medicine if you have periods of stronger pain.
Just like a cardiac pacemaker, other devices such as cellular phones, pagers, microwaves, security doors, and anti-theft sensors will not affect your pump. Be sure to carry your Implanted Device Identification card when flying, since the device is detected at airport security gates.
If you hear the pump making beeping sounds, call the doctor’s office immediately. This may indicate that the pump needs refilling, battery needs to be replaced, or other maintenance. Be sure to always carry your Emergency Information and Procedure cards with you at all times.
Depending on how much medication the pump delivers, the battery will eventually need to be replaced every five to ten years. It is important to keep all scheduled follow appointments.