An intrathecal drug delivery system (pain pump) delivers pain medication directly into the intrathecal space surrounding the spinal cord. Because the medication goes directly to the pain receptors, dramatically smaller doses are needed — typically 1/300th of the oral dose.
Conditions treated include chronic intractable pain, cancer pain, failed back surgery syndrome, and severe spasticity from multiple sclerosis, spinal cord injury, or cerebral palsy.
The pump reservoir is refilled every 1-6 months through a simple office procedure. The pump battery lasts 5-7 years before replacement is needed.
A small catheter is placed in the intrathecal space (the fluid-filled space surrounding the spinal cord) and tunneled under the skin to a programmable pump implanted in the abdominal wall or upper buttock. The pump delivers medication on a continuous or programmable basis directly to the site of action.
Common medications used include opioids (morphine, hydromorphone, fentanyl), local anesthetics (bupivacaine), clonidine, and baclofen (for spasticity). The combination of medications can be customized for each patient's specific needs.
The pump implant procedure takes 1-2 hours under general anesthesia or conscious sedation. The catheter is placed in the intrathecal space and connected to the pump, which is implanted in a subcutaneous pocket.
After implantation, the pump is programmed externally using radiofrequency telemetry. Flow rates and medication concentrations are adjusted based on the patient's response.
Activity restrictions for 4-6 weeks after implant include no bending, twisting, or heavy lifting. Patients can return to desk work within 1-2 weeks. Driving is permitted after clearance from the surgeon.
Refills are performed in the office every 1-6 months. The pump is refilled through the skin using a special needle. Each refill takes 15-30 minutes.
Intrathecal drug delivery is appropriate for patients who have failed or cannot tolerate systemic medications. The procedure is contraindicated in patients with active infection, untreated coagulopathy, or conditions that would interfere with proper device operation.
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