Chronic pain can be extremely difficult to treat. In most cases, patients are left with the only of option of using medications to help dull the pain but even then, pain continues. As the dose of medications are increased to combat this pain, so does the likelihood of side effects from these medications. At times, the side effects can be worse than the pain it is trying to alleviate. Long term, the same medications prescribed to help with your pain can have untoward effects on your mind and body, especially your liver and kidneys. Patients often turn toward surgery to “fix” the problem, but the majority of the time surgery is not indicated and/or has made the initial pain worse.
Intrathecal pump therapy is a treatment option targeted to treating your chronic pain at the source where your pain is perceived in your spinal cord. It is meant to decrease your pain by at least 50% while at the same time potentially eliminate the need for chronic medication use. This can increase your overall functional status allowing you to get back to a normal life. Different from any surgical procedure, you can try this therapy to determine whether it will help you or not before anything permanent is done. Think of it as test driving a car before actually buying it. If you do not benefit from the trial, then no surgery is performed. However, if the trial does decrease your pain by at least 50%, decreases your pain medication use AND improves your ability to walk/sit/stand/sleep…., then implantation of this device is right for you. Though it does not cure the underlying disease, it can significantly improve your pain.
Under most circumstances, with the exception of treating severe spasticity (single bolus trial is performed), a catheter is inserted into your spine. You will then be admitted to the hospital for several days. During this time, your catheter will be connected to a pump that delivers pain medication directly to the area of your spine where your pain is perceived. Several times a day, the medication is increased to help alleviate your chronic pain. If your pain improves by at least 50% without experiencing any side effects from the medication, then the trial is a success. Once this is determined, the catheter will be removed and you will be seen back at the clinic to answer any further questions you may have regarding the implant as well as to schedule you for the permanent procedure. If you do not gain relief after being on the medication infusion for several days, the catheter is removed and an appointment will be made at our clinic to discuss other treatment options to help control your pain better.
Some indications include:
- Cancer pain
- Chronic pelvic pain
- Complex regional pain syndrome formerly RSD in your extremities
- Chronic spinal pain
- Continued pain after spinal surgery or any surgery
- Degenerative disc disease
- Herniated/bulging discs
- Pain after shingles has resolved or any type of nerve pain
- Peripheral neuropathy from any cause
- Severe spasticity from any cause
Contraindications/Reasons why you may not have your procedure today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Poorly controlled diabetes
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Allergic reaction
- Nerve and/or spinal cord injury
- Pruritus (intense diffuse itching)
- Back pain
- Inability to urinate
- Nausea +/- vomiting
During the procedure, you will be lying on your stomach. An IV will be started to give you antibiotics prior to the procedure as well as any sedation if needed. An x-ray machine will be used to locate the specific level of the spine where the catheter will be placed to best maximize your pain relief. This is typically placed in your low back. After your skin is cleaned with an antiseptic solution, typically betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. The skin is then numbed with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected. After this point, you should only feel pressure. If anything is too painful for you, please tell your physician as more numbing medicine can be given. A needle is then placed through the numb area and when the needle tip is in the intrathecal space, contrast/dye is injected to confirm this. A catheter is then inserted through the needle and placed at the level of the spine to best maximize your pain relief. You may experience increased pressure in your spine and/or even shooting pains down your leg(s) which is normal. However, if at any time the pain is too intense, please tell your physician. Once the catheter is in the correct position, the needle is removed. The catheter is then secured to your back with a single stitch and an occlusive patch and the procedure is over.
Typical length of the procedure:
15 minutes. Expect to be at the clinic at least 1 hour after you have been checked in by the medical assistant into the preoperative area depending if you require any sedation or not. Please plan accordingly.
How long do you expect pain relief:
The trial duration is typically 2 days. You will be assessed several times a day, likely by a nurse practitioner, while you are in the hospital to determine whether or not you have gained relief from the trial as well as whether or not you have any side effects to the medication. If either of these situations occurs, the medication may be changed. The infusion will be periodically increased during this time barring any side effects.
If you are having a baclofen trial for spasticity, you will be evaluated by a physical therapist to determine the level of your spasticity prior to the trial, immediately after the trial, and 4 hours after the initial bolus. If your spasticity significantly improves, then you would be a candidate for the permanent pump implant.