Intrathecal Pain Pump Insertion
(Pain Pump Insertion)
Intrathecal pain pump insertion is a procedure to help with pain management. A small pump will be inserted in your body. The pump will be able to deliver pain medicine to the area around your spinal cord.
Reasons for Procedure
This pain management technique is often only used if noninvasive pain management has failed or has negative side effects. An intrathecal pain pump can be used to manage long term pain problems caused by:
- Failed back or neck surgery syndrome
- Compression fractures
- Phantom limb pain]]>
- ]]>Reflex sympathetic dystrophy]]>—nervous system disease
- ]]>Causalgia]]>—burning pain due to peripheral nerve injury
- Arachnoiditis—inflammation of the spinal nerves
- Chronic ]]>pancreatitis]]>—inflammation of the pancreas
Complications are rare, but no procedure is completely free of risk. If you are planning to have a pump inserted, your doctor will review a list of possible complications, which may include:
- Spinal headaches
- Catheter tube becomes blocked and stops working
- Side effects from the pain medicine
- Pump-related complications
- Nerve injury
Factors that may increase the risk of complications include:
- Psychological problems
- Active infection
- Allergy or intolerance to the pain medicine or materials being used
- Bleeding disorders, concurrent anticoagulation therapy
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam
- Blood tests
- Electrocardiogram]]> (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle
- ]]>Chest x-ray]]>—a test that uses radiation to take a picture of structures inside the body
Before the surgery, you will undergo a trial to see if the pump will actually decrease your pain. Pain medicine will be injected into the area around your spine one or more times. In some test trials, a catheter may be placed in the area around your spine. The catheter is then connected to an external pump. The proper placement of the catheter and ideal dose of medicine for you will also be found in the trial period.
Leading up to your procedure:
- Do not eat anything after midnight the night before your surgery, unless directed otherwise by your doctor.
- Arrange to have someone drive you to and from the procedure.
- Arrange for help at home after your procedure.
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
Description of the Procedure
To place the catheter, a small incision will be made in your back. A small tube (called a spinal catheter) will be placed near your spinal cord. It will be secured with sutures. Your doctor will use an x-ray machine to help guide the catheter. The catheter will travel under your skin from your spine, around your torso, and into the abdomen. The doctor will make a pocket under the skin of your abdomen. The pump will be placed into this pocket.
Once the device is in place, you will be awakened. The pump will be tested. The incisions in your back and abdomen will be closed with sutures or staples. The area will be covered with bandages.
After the procedure, you will be taken to a recovery area. Your blood pressure, heart rate, and breathing will be monitored, as well as any potential side effects, like:
- Slow breathing
- Nausea and vomiting
How Long Will It Take?
About 3-4 hours.
Will It Hurt?
You will be under anesthesia for the procedure, so you should not feel pain. You will experience some pain after the surgery, but it will be managed with medicines.
After returning home, you should do the following:
- Avoid bending, twisting, stretching, lifting objects over five pounds, raising your arms above your head, sleeping on your stomach, climbing a lot of stairs, or sitting for long periods of time for 6-8 weeks.
- Avoid driving for 2-4 weeks after surgery.
- Do not do housework or yard work or resume sexual activity until you have had your follow-up appointment with your doctor.
- Gradually return to your normal activities.
- Walk short distances at first, and after 2 weeks, gradually increase to 1-2 miles daily.
- Be sure to follow your doctor's instructions.
You will need to carry an Implanted Device identification card, since the pump will set off metal detectors (eg, at airport security gates). The battery in your pump will need to be replaced every 5-7 years. You will need to go for regular visits to your doctor to have the pump reservoir refilled with medicine at regular intervals.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Redness, swelling, pain, or discharge around an incision site
- Uncontrolled pain or pain that is progressively getting worse
- Sudden back pain
- Opioid withdrawal symptoms: rapid breathing, perspiration, runny nose, agitation, increased heart rate, fever, tremors, muscle twitching, aching muscles, loss of appetite, abdominal cramps, diarrhea]]>
- Signs of infection, including fever and chills
- Loss of bowel or bladder function
- Headache lasting longer than 48 hours
- Beeping noises from pump
- Sudden onset of leg weakness and spasm
- Nausea and/or vomiting
- Cough, shortness of breath, or chest pain
In case of an emergency, CALL 911.
American Chronic Pain Association
American Pain Foundation
Canadian Pain Coalition
Canadian Pain Society
Implantable technologies: spinal cord stimulation and implantable drug delivery systems. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/MyTreatment/news_implantabletherapy.asp#implantable. Accessed April 20, 2007.
Intrathecal drug pump. Mayfield Spine Surgery Center website. Available at: http://www.mayfieldclinic.com/PE-PUMP.htm. Accessed April 20, 2007.
Jain K. Intrathecal administration of drugs. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Medlink website. Available at http://www.medlink.com. Accessed May 31, 2008.
Miller RD. Miller’s Anesthesia. 6th ed. Philadelphia, PA: Elsevier; 2005.
Walsh D, et al. Palliative Medicine. Philadelphia, PA: Saunders; 2009.
Last reviewed November 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.