Intrathecal Pain Pump Archived
The pump is a round metal device about the size of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a catheter, is surgically placed in the intrathecal space of the spine and is connected to the pump. A space inside the pump called the reservoir holds the medication.
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.
- Conservative therapies have failed
- You would not benefit from additional surgery
- You are dependent on pain medication
- You do not have psychological problems
- You have no medical conditions that would keep you from undergoing implantation
- You are not allergic to any of the drugs used in the pump
- You have had positive response with a trial dose of medication
- Single injection: you will receive one injection of intrathecal medicine (morphine or baclofen) via a lumbar puncture.
- Multiple injections: you are given multiple injections over a series of days by either a lumbar puncture or catheter.
- Continuous trial: a catheter is placed in the correct area of your spine and connected to an external pump. The dose is increased every 2 hours until you notice pain relief.
During the trial, the doctor gathers information about the best location for the catheter and the type and amount of drug that works best for you. If the trial is successful, you will be scheduled for surgery.
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.
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.
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.
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 fascial layer overlying the stomach muscles.
The incisions in your back and abdomen are closed with sutures or staples and a dressing is applied.
2. Ask your surgeon before taking nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve). NSAIDs may cause bleeding and interfere with bone healing.
3. Spinal headaches are caused by leakage of cerebrospinal fluid around the catheter or lead site. Lie flat and drink plenty of caffeinated non-carbonated fluids (e.g., tea, coffee).
4. Avoid these activities for 6 to 8 weeks to prevent movement of the catheter/leads:
-do not bend, twist, stretch, or lift objects over 5 pounds
-do not raise arms above your head
-do not sleep on your stomach
-do not climb too many stairs or sit for long periods of time
5. Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
6. Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
7. Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.
8. Gradually return to your normal activities. Walking is encouraged; start with a short distance during the 1st two weeks and then gradually increase to 1 to 2 miles daily. A physical therapy program may be recommended.
9. You may shower as directed by your surgeon. Do not take a tub bath or submerge yourself in water for 4 weeks. Pat your incision dry with a soft towel to avoid irritation.
10. Inspect the incision line twice daily.
11. Fluid may accumulate under the skin around the catheter/leads or the device creating a visible swelling. Call the doctor if this occurs. Seromas usually disappear by themselves but may require a drain.
12. Steri-strips may cover the incision. After showering, gently pat dry the steri-strips. Gently remove steri-strips after one week. Sutures or staples that remain in place when you go home will need to be removed. Ask your surgeon or contact the office to find out when.
13. Wear loose clothing over the incision site to maintain comfort and prevent skin irritation.
14. If your temperature exceeds 101 degrees F or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
15. If your headache persists after 48 hours.
16. If you have sudden severe back pain, sudden onset of leg weakness and spasm, loss of bladder and/or bowel function – this is an emergency – go to a hospital and call your surgeon.
You must schedule medication refills on a regular basis with the surgeon or a pain management specialist. At your refill appointment, the effectiveness of your treatment will be assessed and your pump will be adjusted accordingly. The goal is to find the optimal amount of pain or spasticity control while having minimal side effects. You should tell your doctor if you experience unusual symptoms, drug overdose, or feel that your dosage is ineffective. You may need to take supplemental oral medicine if you have periods of stronger pain.