Intrathecal Pump Implants

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Intrathecal Pump Implants 2016-11-17T09:51:21+00:00

What Is An Intrathecal Pump Implant?

An intrathecal pump implant is a device that is used to help relieve chronic pain. An intrathecal pump implant uses an implanted device to deliver medication into the intrathecal space, which is the area surrounding the spinal cord. The cerebrospinal fluid is located within this space and flows through the spinal cord to the brain. The medication delivered to the intrathecal space helps to block pain signals from being perceived by the brain, thereby helping to control pain. The delivery of medication using an intrathecal pump bypasses the normal routes used by oral medications which is why they are often very effective for pain management in patients who do not respond to oral medications.

Intrathecal pump implants were approved for use in 1991 in the United States. At the present time, intrathecal pump implants are commonly used to treat various conditions including cancer pain and severe spinal pain among other debilitating pain conditions.

There are multiple benefits of intrathecal pump implants, including:

  • A significant reduction in pain
  • Lower medication doses
  • Improved functioning and ability to perform activities of daily living
  • The pump is reversible

Furthermore, the medication can be adjusted to account for the patient’s activity level and needs, and a trial of the therapy can be carried out before placing a permanent device.

One of the most significant benefits of this treatment is the need for a lower medication dose. Since the medication is delivered directly to the spine, patients will often report a significant improvement of symptoms with a much smaller dose than if the medication was taken orally. Research has shown that the ratio of medication used via an intrathecal pump compared to an oral dosage is 1:300. The benefit of a smaller dose is that the risk of side effects that are often associated with high dose oral medication, including nausea, vomiting, upset stomach, constipation, and sleepiness, are minimized.

How Is An Intrathecal Pump Implant Performed?

An intrathecal pump implantation procedure is a relatively safe and quick procedure, often taking place in an outpatient clinic and lasting approximately one to two hours. An intravenous line is started to deliver a local anesthetic and sedation to the patient prior to the procedure.

The skin on the patients’ stomach and back is then sterilized and prepared for pump implantation. A fluoroscopic X-ray is used to help guide a catheter into the intrathecal space. Once the catheter is in the proper position, the physician makes an incision at the side of the abdomen to allow for pump placement. At the end of the procedure, the incision is closed with either staples or sutures and a dressing is applied.

Once the pump is implanted it gradually releases pain medication into the intrathecal space. The intrathecal pump is programmed to release a specific amount of medication throughout the course of the day. Physicians refill the medication in the intrathecal pump every four to six weeks by injecting the pain medication through the skin and into the pump device. Additionally, the device saves the medication delivery schedule so the physician can periodically review it and make changes as needed.

Intrathecal pump implants are considered a safe and effective treatment option for patients suffering with chronic pain. However, similar to all medical procedures, there are risks associated with intrathecal pump implantation. These risks include bleeding, infection, nausea, vomiting, facial flushing, constipation, and sleepiness.

Conditions Related To Intrathecal Pump Implants

Before considering an intrathecal pump implant, patients have typically failed to respond to conservative methods for pain management, including the use of oral pain medications. In addition, before implantation patients are given trial doses of the medication to determine if there are any allergies. A thorough assessment of the patient is also completed to eliminate other potential medical conditions that may interfere with pump implantation.

A trial, lasting between four and seven days, will first be conducted to determine if an intrathecal pump implant will help to provide a patient with pain relief. If a good level of pain relief is obtained, then it may be recommended that the patient receive a permanent intrathecal pump implant.

Optimal candidates for intrathecal pump implants require continuous delivery of pain medications to help manage their chronic pain. The current medical literature supports the use of intrathecal pump implants for the following pain conditions:

Since 1991 a significant amount of research has been conducted to investigate the safety and efficacy of intrathecal pump implants. Much of the research has focused on its effectiveness for managing cancer pain. Findings of the research suggest that patients experience pain relief, as well as reduced side effects that are commonly associated with oral pain medications. Additional studies have also looked at the effectiveness of intrathecal pump implants for severe back pain and other chronic pain conditions and have shown positive results.

Conclusion

When patients suffering from chronic pain syndromes fail to respond to conservative pain management therapies, physicians may recommend an intrathecal pump implant for pain relief. This treatment method is considered safe and effective and many studies have supported its use for pain management. Patients who suffer from chronic pain that is not responding to traditional pain management therapies are encouraged to speak with their physician about the possibility of implanting an intrathecal pump to help manage their pain symptoms.

References

  1. Allen JP, Nissan A, Picon AL, Kemeny N, Dudrick P, Ben-Porat L. Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases. J Am Coll Surg. 2005;201(1):57-65.
  2. Belverud S, Mogilner A, Schulder M. Intrathecal pumps. J Amer Soc Exper Ther. 2008;5(1):114-122.
  3. De Leon-Cassasola O. Implementing and managing intrathecal pumps. Techniques in Anathesia and Pain Management. 2011;15:115-157.
  4. Singh M, Singh P Singh A. Programmable morphine pump (an intrathecal drug delivery system) – A promising option for pain relef and palliation in cancer patients. Ind J Med Paed Onc. 2012;33(1):58-59.
  5. Smith T, Swainey C, Coyne P. Pain management, including intrathecal pumps. Current Pain and Headache Reports. 2005;9:243-248.

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