Living with chronic pain
Ongoing pain can decrease your quality of life. The limitations imposed by living with chronic pain may mean that activities such as work and hobbies, even little things that once brought satisfaction, pleasure, and self-esteem, may only be memories. Regaining quality of life is one of the goals of physicians who attempt to treat chronic pain. Pain signals travel from the site of injury, through the spinal cord, to the brain where the signal is interpreted as "pain." Then the brain sends a signal back through the spinal cord to the site of injury. When that signal is blocked or scrambled, the pain message is not received.
When to consider Intrathecal Pain Therapy
Oral opiate medications work for some people by altering the message sent to and from the brain. For others, doses enough to relieve pain may result in side effects including confusion, grogginess, over-sedation, etc. When attempts to increase quality of life with oral pain medications is unsatisfactory, your physician may recommend intrathecal pain therapy. This may be effective for pain that is caused by certain conditions, including failed back syndrome, arachnoiditis, osteoporosis, and cancer.
What is Intrathecal Pain Therapy?
Intrathecal pain therapy works by delivering small doses of analgesic directly into the cerebrospinal fluid to the pain receptors in the spinal cord, blocking the message to the brain. Because the doses are small and applied directly at the site of pain receptors, the entire body is not flooded with medications, and therefore negative side effects such as grogginess, confusion, and over sedation are usually avoided. A surgically implanted pump delivers medication in small, regular doses to maintain pain control. The medication goes under the skin through a catheter to the intrathecal space around the spinal cord where it most effectively blocks pain signals. Exact medication dosages and frequency of delivery are determined by the physician.
How will I know if it will work for me?
Once you and your doctor have decided that this is an option for long-term treatment, a trial of intrathecal pain medicine will be arranged. An injection of pain medicine will be injected with x-ray into the cerebrospinal fluid (CSF). While in the surgery center over the next several hours you will report your pain levels to determine how the medication dosage is working to relieve your pain. A successful trial will reduce your pain by at least 50%.
After a successful trial, you and your doctor will discuss the best position for the placement of the pump. The pump implantation is a surgical procedure. There will be two incisions, one in the buttock or abdomen and one in the back. The pump will be placed underneath the skin at one side of the buttock or abdomen, and the catheter will be inserted into the spinal canal through a smaller incision in the back. The other end of the catheter will be tunneled under the skin around to the pump at your side.
There will be some discomfort at the incision sites. Your doctor may prescribe something to help relieve post surgery pain and an antibiotic to prevent infection. Infection is rare, but you do need to be aware of the signs of infection. You will want to limit your activity for 6 to 8 weeks in order to prevent the catheter from moving before healing is complete. After the incision has healed, the pump site will require no special care. You will wear an abdominal binder for six weeks after surgery to promote proper healing of catheter placement and implanted pump. Oral medications will be reduced and stopped as the amount of medication released by the pump is increased. It will take several weeks to reach the optimal dosage.
Maintaining Your Pump
You will schedule regular appointments with your doctor for pump refills. At each visit your pump will be checked to be sure it is working properly.