Intrathecal Pain Pump – A Review
The intrathecal pump is among the most advanced treatments for relieving chronic, intractable pain. It is a long-term, reliable, and low risk solution when other therapies have failed to provide adequate pain relief.
But what exactly is an intrathecal pain pump? What does intrathecal mean? What does it pump and how does it do it? We answer these questions and more to pull back the curtain on this miraculous marvel of medical technology.
- What is an intrathecal pump used for?
- Is an intrathecal pump the same as taking opioids?
- What conditions does an intrathecal pump treat?
- How well does an intrathecal pump work?
- Where is an intrathecal pump placed?
- How often does an intrathecal pump need to be refilled?
- What are the risks of an intrathecal pump?
- Is an intrathecal pump covered by insurance?
What is an intrathecal pain pump used for?
First, let’s answer the question, what does intrathecal mean? The word intrathecal describes the fluid filled space that exists between thin layers of tissue covering your brain and spinal cord. The intrathecal space contains cerebrospinal fluid (CSF), a clear fluid that surrounds the brain and spinal cord to help cushion them from injury and provide nutrients. This composition also makes the intrathecal space a common application site for certain kinds of medications.
An intrathecal pump, also called a pain pump, is a device that automatically introduces medication into the body’s cerebrospinal fluid at a controlled rate. The medication spreads through the (CSF), where it bathes nerves and reduces pain. Also called targeted drug delivery, this intrathecal delivery method can provide as much pain relief as oral opioids while minimizing the negative side effects.
The intrathecal pump system is comprised of two components, the pump itself and a catheter. Both elements are connected to each other and permanently implanted into the body. The pump is filled with medication via a tiny needle. Small amounts of the medication are pumped through the catheter and delivered directly into the intrathecal space.
Is an intrathecal pump the same as taking opioids?
An intrathecal pump does use some of the same medications that one might take as part of an oral opioid medication regimen. However, the medications are in a concentrated, liquid form and are introduced directly into a specific part of the spine where they will be the most effective. This form of delivery requires a much smaller dose of medicine. This is why the therapy is often referred to as micro dosing.
Micro dosing via an intrathecal pump provides similar pain relief to oral opioids, while reducing the risks, such as:
- Tolerance: Using low dose intrathecal medication decreases the risk of tolerance, whereby your body “gets used to” the drug and needs higher doses to get the same level of relief.
- Addiction: The deceptively pleasant feeling of euphoria often caused by oral opioids is a result of the medication crossing the blood brain barrier. The blood brain barrier is a protective layer of cells that prevents certain substances from entering the cerebrospinal fluid. Medication that is administered intrathecally does not cross the blood brain barrier. As a result, the medication significantly relieves pain without causing the euphoria that can be so addictive.
- Overdose: Since micro dosing administers such small amounts of medication via controlled settings, the risk of overdose is drastically less than oral opioids.
- Hyperalgesia: Low-dose treatment also decreases the risk of developing opioid-induced hyperalgesia, which occurs when opioids cause chemical changes in your brain that actually make you more sensitive to pain.
What conditions does an intrathecal pump treat?
An intrathecal pain pump can effectively treat a variety of chronic pain conditions, including:
- Back pain
- Neck pain
- Post-surgery pain
- Complex regional pain syndrome (CRPS)
- Cancer pain
An intrathecal pump can also be filled with a medication called Baclofen, which can be used to treat spasticity in patients with:
- Cerebral palsy
- Multiple sclerosis
- Stroke
- Brain injury
- Spinal cord injury
Intrathecal pump therapy is commonly prescribed for patients who have tried other, more conservative therapies to treat their chronic pain, but have had little to no success.
It is important to note that pain pump therapy does not eliminate the source of your pain or cure any underlying conditions. But it can help manage your pain so you can enjoy a better quality of life.
How well does an intrathecal pump work?
Studies published by Medtronic, one of the world’s leading experts on and producers of intrathecal pumps, indicate that pumps have a significant positive impact on the recipient’s quality of life.
- On average, pump patients experienced a 60% reduction in pain after six months1
- 87% of patients rated their quality of life as fair to excellent1
- 74% of patients reported increased activity levels1
- 66% of patients successfully reduced their disability at 12 months1
- 51% of chronic non-malignant pain patients eliminated systemic opioids within one year of receiving a pump implant1*
These promising results are supported by extensive clinical research. But as with any medical procedure, no specific result can be guaranteed. Each patient may respond differently to intrathecal pump therapy. However, the evidence suggests that an intrathecal pump implant is extremely likely to provide improved quality of life.
Where is an intrathecal pump placed?
The intrathecal pump is typically placed in a small space, or “pocket,” in the lower back or upper buttock. A small incision is made in the skin and the pump is positioned by the surgeon in the proper location. The device is implanted near the surface of the skin to allow for easy refilling. The incision is then stitched back up and a bandage applied.
A pump implant is a minimally invasive outpatient procedure that generally takes no more than an hour. The patient returns home the same day.
Since the pump is placed securely under the skin, it can do its job for many years without interfering with the patient’s daily routine.
How often do you refill an intrathecal pump?
How often a pain pump needs to be refilled depends on the concentration and amount of medication your therapy uses. Refills may occur every six weeks up to every six months. Your pain management provider will inject the refill medication into the pump via a small needle.
Refill appointments are brief outpatient visits. Your provider will also take this time to check that the pump is working correctly and adjust the dosage if necessary.
What are the risks of an intrathecal pump?
Like most procedures, an intrathecal pain pump implant does come with certain risks. It is important to remember that all these risks are very uncommon, with the more severe complications being especially rare.
Many of the risks associated with a pump implant are the same that come with any surgical procedure. These include bleeding at or near the incision site, infection, and nerve damage.
Some other medical risks more specifically associated with the intrathecal pump implant include:
- The formation of an inflammatory mass at the tip of the catheter – this is known as a granuloma and as it grows, it can infringe on nearby nerves and cause neurological pain.2
- Cerebrospinal fluid (CSF) leakage – when the needle used to place the catheter is removed from the intrathecal space, some leakage of CSF may occur.2
Your physician has methods to detect these kinds of abnormalities and can take steps to treat them if they occur.
Lastly, the pain pump itself may experience certain mechanical issues, including:
- The pump becoming dislodged from its pocket and moving2
- Fracture or breakage of device2
- A kink in the catheter2
- A puncture in the catheter2
- A leak in the pump2
- Catheter becoming disconnected from the pump2
Once again, these risks are exceptionally rare, and even if a complication does present itself, your care team will be well trained to address and treat it.
Is an intrathecal pain pump covered by insurance?
Intrathecal pump implant procedures are generally covered by most insurance carriers. Your pain management provider will need to obtain approval from your insurance carrier before the procedure can be performed. Approval criteria might vary by carrier and your pain management clinic will help ensure those requirements are met.
For more information on insurance plans that we accept and our insurance process, you may visit our insurance and billing page.
Conclusion
Intrathecal pump therapy is an advanced, highly effective treatment for a variety of chronic pain conditions. Its unique and direct method of administering medication makes it a long-term, low risk alternative to opioid medications. For a real life example of how big an impact an intrathecal pump can have, check out our patient success story.
Still have questions?
- Learn more about our intrathecal pump procedure process>>
- Schedule a consultation>>
References
- https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/neurological/targeted-drug-delivery/clinical-outcomes/chronic-pain.html
- Knight, K. H., Brand, F. M., Mchaourab, A. S., & Veneziano, G. (2007, February). Implantable intrathecal pumps for chronic pain: Highlights and updates. Croatian medical journal. Retrieved May 9, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/
