When should you consider Intrathecal Pain Pumps

Here at Southern Pain Clinic of Southeastern Louisiana, we employ a wide variety of pain-treatment methods, with the overarching goal of improving the quality of life for our patients while minimizing the need for costly and invasive surgeries. There are times, of course, when conservative pain therapy methods are not effective for a patient. In these instances, we introduce other options, including intrathecal pain pumps.

What is an Intrathecal Pain Pump?

An intrathecal pain pump delivers medicine directly into the cerebrospinal fluid, which flows through the space around your spinal cord. The pump itself is a metal device, about the size of a hockey puck, that is surgically implanted beneath the skin of your abdomen. A catheter is surgically placed and connected to the pump, then placed in the intrathecal space of the spine. The pump is programmed to release medication over a period of time. When the reservoir housing the medicine is depleted, a doctor or nurse refills the pump with the use of a needle inserted through your skin. Generally speaking, the medication needed to relieve pain is typically 1-10% of the medication required to experience similar relief if that medication had been taken by mouth. For example, a dose of 100 mg of morphine by mouth may only require 1 mg through the use of a pump. This is significant, as with less medication needed, patients will likely experience fewer side effects (such as grogginess, confusion, forgetfulness and more).

Who is a candidate for pain pump therapy?

Despite the clear benefits of taking less medication, this type of procedure is typically a last-resort approach. We introduce this as an option for our patients who visit our locations in and around New Orleans when:

• Conservative therapies have failed
• Additional surgery would not provide any true benefit
• You are dependent on pain medication to sustain normal life
• You are not allergic to any of the drugs used in the pump

We've used this pump to help decrease pain caused by such ailments as:

1. Pain following failed back surgery
2. Pain related to cancer
3. Reflect sympathetic dystrophy
4. Arachnoiditis
5. Chronic pancreatitis
6. Causalgia

These pumps can also decrease spasticity caused by:

1. Cerebral palsy
2. Multiple sclerosis
3. Stroke
4. Brain injury
5. Spinal cord injury

It should be noted that this surgery is 100% reversible.

Leading up to the procedure

Following consultations with our team, if you and we feel that an intrathecal pump is the right course of action, we'll perform a trial to see if the narcotic used is, in fact, effective in reducing your pain. This trial will also help us monitor any potential side effects.

The procedure

We can perform this procedure under IV anesthesia or general anesthesia, with fluoroscopic guidance. During the procedure, our team will place the catheter within the intrathecal space, above the spinal cord, and will secure it with sutures. We'll then add an extension catheter under the skin, from the spine, around your torso, to the abdomen where the pump will be implanted. We'll then create a 4-6-inch skin incision in the side of your abdomen, below the waistline. Our surgeon will create a pocket for the pump between the skin and muscle layers. We'll then connect the pump to the extension catheter. We'll then ensure proper positioning of the pump, and will suture it to the thick fascia layer overlying the stomach muscles. We'll finish off the procedure by closing the incision in your back and abdomen.

Following the procedure

Following the procedure, your pain will be managed with narcotic medications for at most 2-4 weeks. You may experience what is known as "spinal headaches." This is caused by leakage of cerebrospinal fluid around the catheter. Lie flat and drink plenty of caffeinated non-carbonated fluids. You should avoid the following activities for up to 2 months following the procedure:

1. Bending, twisting, stretching or lifting objects over 5 pounds
2. Raising of arms above your head
3. Sleeping on your stomach
4. Climbing too many stairs
5. Sitting for long periods

You should also not drive for 2-4 weeks, until you consult with your surgeon. You should avoid housework or yard-work as well, until after your first follow-up visit. We recommend you call our offices, following your procedure, if your temperature exceeds 101 degrees F, or if the incision begins to separate or show signs of infection. You should also contact us if you have a headache that persists for longer than 48 hours, or if you experience sudden and severe back pain or leg weakness/spasm. We encourage you to contact our team directly to learn more about intrathecal pump surgery and how Southern Pain Clinic of Louisiana can help you conquer your pain and regain a higher quality of life.