Demystifying Intrathecal Pain Pumps: What to Expect
By Dr. Ryan Michaud
Intrathecal pain pumps can sound intimidating, but they’re actually a great option for patients with severe chronic pain who haven’t yet found a treatment that works well for them. An intrathecal pain pump is placed under the skin and administers pain medication at a regular rate to combat severe chronic pain.
The pain pump itself is a reservoir that holds the medicine and is connected to an intrathecal catheter which runs through the thecal sac, the area around the spinal cord that is filled with fluid. The pain medication is delivered to this thecal sac area at a steady rate where it is absorbed and activated.
Intrathecal pain pumps can be incredibly helpful for patients suffering from cancer pain, chronic pancreatitis, or for a person who’s had a failed neck surgery and is experiencing pain from that. Classically, neck surgeries are executed through the front of the neck, but if you’ve had a surgeon operate on your neck through the back, there’s likely a large amount of scarring. This scarring can make it hard to use other alternatives like a spinal cord stimulator. However, an intrathecal pain pump will work well, because the intrathecal catheter is so small and can easily run underneath the scarred areas.
Intrathecal pain pumps can also be a good choice for patients that are unable to tolerate opioids or other pain medications taken as a pill. The medications used in an intrathecal pain pump are delivered directly to the localized area of the thecal sac where they will do the most good.
Getting an Intrathecal Pain Pump: What To Expect
Before any patient is approved for an intrathecal pain pump, we conduct a pain pump trial to make sure that they are a good fit for the treatment. The pain pump trial takes the form of a spinal injection of pain medication into that very same thecal sac. We monitor how a patient’s pain responds to this spinal injection. If they do well and experience substantial relief, they are likely a good candidate for the pain pump.
The implant procedure itself takes about 45 minutes to an hour to complete. It’s an outpatient procedure that takes place at one of our surgery centers. First, we make a tiny incision and the intrathecal catheter is inserted. We run the catheter along the back and into the thecal sac with a needle technique. Then, we make a larger incision and insert the pump itself which is connected with the catheter. The placement of the pump is up to each patient’s preferences and needs but is usually placed around the lower abdomen area or lower flank of the back.
After the procedure, patients may experience some soreness and pain. However, the post-op recovery process is quick, because the surgery is relatively noninvasive. The catheter is inserted through a very small incision and placed with the minimally invasive needle method. The largest incision is made where the pain pump itself is inserted, but luckily, we don’t have to dissect or cut any muscles, tendons, or ligaments. Most patients can recover quickly with a small amount of postoperative pain medication.
The pain pumps come in two different sizes: 40 milliliters and 20 milliliters, depending on the rate that the medication is being administered. Some patients require more medication at a quicker rate and may benefit from the larger pain pump size to cut down on the number of refills that they have to get. However, all patients with intrathecal pain pumps have to come in every few months to get a refill of their medication. The refill procedure is a simple one, done with a quick injection. Most patients don’t even need local anesthetic or numbing medication. These refills usually take place every 3-4 months.
Each pain pump can last between 7-10 years before being replaced. In that period we can adjust your medication, the amount administered, and how many times a day you receive pain medication. It’s a constant process of communication between you and your doctor, to get to the best possible place with your intrathecal pain pump.
Getting Comfortable with the Prospect of Your Intrathecal Pain Pump
Over the years, we’ve learned that these pain pumps work best for more localized pain relief. When intrathecal pain pumps were introduced, doctors believed that the medicine would swirl around the entire thecal sac, from top to bottom, and provide pain relief to a broader area of the body. However, we now realize that the medicine stays in the general area of the thecal catheter and tends to provide relief to a smaller area of the body. This means that intrathecal pain pumps work best for patients who need pain relief in a confined area, such as the left lower abdomen or the neck.
As an anesthesiologist and interventional pain management specialist, I work with patients to decide what the best treatment options are to cut down on their pain. If you qualify for an intrathecal pain pump, there’s a good chance that it will totally change your relationship with chronic pain. These pain pumps have a high success rate and I am always astounded seeing the difference reflected in my patients’ lives after they receive their pain pump and achieve relief.
It can be daunting for patients to consider the prospect of an intrathecal pain pump, but I am committed to demystifying the process and letting you know how they can really help. At APC, we listen to each patient’s concerns and do our best to address any worries that they have. A large part of this comes down to effective communication and empowering patients with the knowledge of what to expect. For intrathecal pain pump patients, the pain pump trial is a great way to get acclimated and excited about the idea of an intrathecal pain pump.
If you’re a good candidate for the procedure, chances are that you’ll experience immediate and significant relief after the pain pump trial. An intrathecal pain pump could be just the right treatment option to help you take back your life from chronic pain. The constant and steady doses of pain medication can battle even the most severe pain, to help you get back to being active, engaged, and involved in the things you love to do.