Intrathecal Pump Implant
What is an intrathecal pump implant?
Intrathecal pumps (ITPs) are devices used in the treatment of many chronic pain states including cancer pain, severe back pain, neuropathic pain, and muscle spasticity. ITPs are an automated piece of equipment that is programmed to deliver medication into the spinal fluid through a small catheter. The purpose of the pump is to interrupt pain signals that travel through the spinal cord.
Who is a good candidate for intrathecal pump implant?
ITP implants are considered when oral pain medications and other methods of pain control have been exhausted or proven ineffective.
ITPs can be used to treat a variety of painful conditions. Nociceptive pain, or pain from tissue irritation, can usually be effectively treated with opioids like morphine. Nociceptive pain transmission is interrupted at the spinal cord and pain relief is experienced.
Neuropathic pain, peripheral or central nervous system pain, tends to be receptive to treatments with local anesthetics more than opioids. Examples of neuropathic pain syndromes include CRPS (complex regional pain syndrome or reflex sympathetic dystrophy), cancer pain, phantom limb pain, post-herpetic neuralgia (shingles), carpal tunnel syndrome, failed back surgery syndrome, and peripheral neuropathy (from diabetes mellitus or vitamin deficiencies).
Spasmodic pain can also be successfully treated by ITPs. This type of pain is effectively treated with anti-spastic muscle-relaxing medications like Baclofen.
How intrathecal pump implants work
Before an ITP is placed, an intrathecal medication trial is performed. Medication is placed in the spinal fluid. If pain relief is adequate, an ITP can be permanently placed to control your pain.
Placement of the ITP can be performed in an outpatient setting or in the hospital. The implantation of the device is done with local anesthesia and sedation Once the area is numb, a larger needle and catheter are placed into the intrathecal space using X-ray guidance. Once the catheter is in the proper location, the pump is then connected and placed under the skin on the lower part of your abdomen. The catheter and pump are tunneled under your skin, and all wounds are surgically closed.
The pump delivers pain medication (opiates, local anesthetics, or muscle relaxants) directly into the intrathecal space around the spinal cord. The medication reservoir in the pump is refilled periodically (every four to six weeks) by your pain physician by injecting the medication through your skin into the pump. The entire procedure typically takes one to two hours.