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Intrathecal Pain Pump Implantation

Intrathecal Pain Pump Implantation pic

What is Intrathecal Pain Pump Implantation?

Intrathecal pain pump implantation is a pain management approach that uses a battery-powered device to deliver regulated amount of medication into the spinal fluid. It involves administration of medication via a pump that is implanted (placed) into a specific region of your spinal cord called the intrathecal space. This ensures medication reaches the cerebrospinal fluid and provides a quicker onset of action.

Intrathecal pain pump implantation is used to numb the spine and block pain sensations. The dose of medication is decided based upon your health condition and your age, weight, pain intensity, and tolerance levels.

What are the Indications for Intrathecal Pain Pump Implantation?

Intrathecal pain pump implantation is recommended for the treatment of pain due to various reasons which may include:

  • Terminal illnesses such as cancer
  • Labour and delivery (obstetrics)
  • Complex regional pain syndrome
  • Failed low back surgery
  • Brain injury
  • Spinal cord injury

Your doctor will recommend an intrathecal pain pump implantation only after other conservative therapies fail to provide relief.

Pre-Surgical Preparation for Intrathecal Pain Pump Implantation

Pre-procedure preparation will involve the following steps:

  • A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anaesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to the surgery.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You should arrange for someone to drive you home after surgery.

A written consent will be obtained from you after the surgical procedure has been explained in detail.

Intrathecal Pain Pump Implantation Procedure

Intrathecal pain pump implantation involves two steps: catheter placement followed by pump implantation.  The general steps for implantation involve:

  • You are covered in a sterile surgical drape and placed on the operating table.
  • To prevent infection, an antibiotic is administered through an IV 30 minutes prior to incision. 
  • Anaesthesia is administered and you are placed on your side. 
  • A midline incision, around 2-3 inches, is made through the skin to expose the spinal cord.
  • A Tuohy needle (a fine hollow needle with a slight curve at the end) is inserted through the incision to place a small catheter towards the intrathecal space in the spine. 
  • Some doctors may use fluoroscopic guidance (live x-ray) to ensure the correct positioning of the catheter.
  • Once the catheter is placed, the needle is carefully removed.
  • A small battery-operated intrathecal pump is placed under the subcutaneous tissue in your abdomen through a small pocket incision.
  • The pump is connected to the catheter with sutures.
  • The incisions are then closed and covered with bandages.

Your blood pressure, heart rate, respiration, and pain response is monitored after the implant surgery. You will be discharged on the same day after the procedure. 

The implanted pump should be refilled every 1 to 3 months to ensure continuous medication is available. 

Post-surgical Care for Intrathecal Pain Pump Implantation

You will be instructed to drink plenty of water and eat high-fibre foods.

  • Medications will be prescribed to minimize pain and suppress inflammation.
  • Apply ice over a towel on the incision site for 15-20 minutes 3-4 times a day to minimize pain and swelling. 
  • Lie flat and consume more caffeinated drinks such as tea and coffee to minimize spinal headaches that may be caused due to leakage of cerebrospinal fluid around the catheter site.
  • Some discharge is normal from the incision site. However, call your doctor if you have greenish/yellow or foul-smelling drainage.
  • Do not apply lotions or ointments over the incision site. Keep it clean and dry until healed.

Avoid the following:

  • Sitting for long hours
  • Bending
  • Lifting heavy objects
  • Performing strenuous exercises
  • Straining while passing stools
  • Driving for long hours
  • Alcohol consumption

What are the Risks and Complications of Intrathecal Pain Pump Implantation?

As with any surgical procedure, intrathecal pain pump implantation may also carry certain risks and complications. These may include:

  • Bleeding
  • Injury to the nerves, blood vessels, or surrounding tissues
  • Infection
  • Improper positioning/misplaced catheters
  • Abnormal fluid accumulation around the incision or catheter
  • Cerebrospinal fluid leak

What are the Benefits/Advantages of Intrathecal Pain Pump Implantation?

Intrathecal pain pump implantation is expected to show a minimum of 50% improvement in pain score. In addition, it helps in:

  • Dose reduction for people on oral medications
  • Reduces the side effects associated with oral medications such as drowsiness, upset stomach, and constipation
  • Minimizes addiction/dependency on opioids
  • Reduces muscle rigidity and spasms
  • Improved body function
  • Improves overall quality of life
  • Outpatient procedure
  • Quicker recovery
  • Can be reversed by removing the pump and catheter
  • The Society of British Neurological Surgeons
  • British Orthopaedic Association
  • Maharshi Dayanand University