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Intrathecal Pump – A Review

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May 9, 2022 Jeff Blanchard

Intrathecal Pump – A Review

Medtronic Intrathecal Pump next to vial of pain management medication

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 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.

  1. What is an intrathecal pump?
  2. Is an intrathecal pump the same as taking opioids?
  3. What conditions does an intrathecal pump treat?
  4. How well does an intrathecal pump work?
  5. Where is an intrathecal pump placed?
  6. How often does an intrathecal pump need to be refilled?
  7. What are the risks of an intrathecal pump?
  8. Is an intrathecal pump covered by insurance?

What is an intrathecal pump?

First, why don’t we 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.

This is relevant because the intrathecal space is a common application site for certain kinds of medications. When taken orally, many medications get stopped by the body’s natural defenses before they can work their magic. When administered “intrathecally,” the same medications bypass those defenses, allowing the recipient to get the maximum benefit.

With that in mind, an intrathecal pump is a specialized device that automatically introduces medication into the intrathecal space. The system is comprised of two components, the pump and a catheter, which are permanently implanted into the body. The pump is filled with medication via a tiny needle. Small amounts of the medication are pumped at a controlled rate through the catheter and delivered directly into the intrathecal space. This process is also commonly called targeted drug delivery.

 

Medtronic Synchro II Intrathecal Pump System

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. But the intrathecal mode of administration allows for similar (and often better) results with a much smaller dose.

Since such a small amount of medication is automatically administered under controlled conditions, an intrathecal pump reduces the risks commonly associated with oral opioid medications, such as tolerance, addiction, and overdose.

Bottles of opioid medication next to text explaining the reduced risks of intrathecal pump therapy

What conditions does an intrathecal pump treat?

An intrathecal 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 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.

Illustrated list of conditions treated by an Intrathecal Pump

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.

Image of various colorful graphs demonstrating the positive results of intrathecal pump therapy

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 does an intrathecal pump need to be refilled?

How often a 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 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 intrathecal 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 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?


References

  1. https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/neurological/targeted-drug-delivery/clinical-outcomes/chronic-pain.html
  2. 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/

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