Intrathecal drug delivery, or “pain pump,” is a method of giving medication directly to your spinal cord.
The system uses a small pump that is surgically placed under the skin of your abdomen and delivers medication through a catheter to the area around your spinal cord – similar to an epidural that women may have during childbirth. A pain pump may be a treatment option if all other traditional methods have failed to relieve your long-term symptoms. Because the medication is delivered directly to the spinal cord, your symptoms can be controlled with a much smaller dose than is needed with oral medication.
The goal of a drug pump is to better control your symptoms and to reduce oral medications; thus reducing their associated side effects. The pump is programmed to slowly release medication over a period of time. It can also be programmed to release different amounts of medication at different times of the day, depending on your changing needs. The pump stores the information about your prescription in its memory, and your doctor can easily review this information with the programmer. When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.
Conditions Treated by Pain Pump
A pump can help lessen chronic pain caused by:
- Failed back surgery syndrome: failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure.
- Cancer pain: constant pain caused by tumors compressing the spinal nerves, or scarring from previous radiation therapy.
- Reflex sympathetic dystrophy: a progressive disease of the nervous system in which patients feel constant chronic burning pain.
- Causalgia: a burning pain caused by peripheral nerve injury.
- Arachnoiditis: painful inflammation and scarring of the meninges (protective layers) of the spinal nerves.
- Chronic pancreatitis: chronic abdominal pain caused by inflammation or blockage of the pancreatic duct.
A pump can help lessen spasticity (muscle rigidity and spasms that make movement of the arms and legs difficult) caused by:
- Cerebral palsy: a nervous disorder that impairs control of body movement.
- Multiple sclerosis: a disorder of the brain and spinal cord caused by damage to the outer layer (myelin) of nerve cells.
- Stroke: damage to the brain from lack of oxygen; due to an interruption of the blood supply.
- Brain injury
- Spinal cord injury
Benefits of Pain Pump
For many people, drug delivery therapy has increased comfort and the relief of chronic pain so they can rejoin their lives. Some have been able to reduce or even eliminate oral/systemic pain medications.
There are two parts to the procedure: 1) placement of the catheter in the intrathecal space surrounding the spinal cord, and 2) placement of the pump/reservoir in the abdomen. There are five main steps of the procedure. The operation generally takes 3 to 4 hours.
Step 1: prepare the patient
You are placed on the operative table and given anesthesia. Once asleep, your body is rolled onto its side. Next, the areas of your back and stomach are shaved and prepped where the catheter and the pump are to be placed.
Step 2: placement of the catheter
A small skin incision is made in the middle of your back. The bony arch (lamina) of the vertebra is exposed. The catheter is placed in the subarachnoid, or intrathecal space, above the spinal cord and secured in place with sutures (Fig. 2).
Step 3: tunneling of the extension
Once the catheter is in place, an extension catheter is passed under the skin from the spine, around your torso to the abdomen where the pump will be implanted.
Step 4: placement of the pump
A 4-6 inch skin incision is made in the side of your abdomen below the waistline. The surgeon creates a pocket for the pump between the skin and muscle layers. The extension catheter is attached to the pump. Next, the pump is correctly positioned under the skin and sutured to the thick fascia layer overlying the stomach muscles.
Step 5: close the incisions
The incision in your back and abdomen are closed with sutures or staples and a dressing is applied.
Results will vary depending on the underlying condition being treated and its severity. Chronic pain patients may experience a reduction in pain, as well as overall improvement in activities of daily living. Spasticity patients may experience a reduction in rigidity and muscle spasms. Oral medications are reduced because the medicine is delivered directly to the spinal cord and much smaller dosages are needed.
If you have questions about spinal stenosis or the minimally invasive spine procedures offered by DISC of Louisiana, please contact us to schedule an evaluation at one of our clinics across the south Louisiana region.
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