Intrathecal Pain Pump Insertion Overview

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.

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.

Cervical Injection © 2009 Nucleus Medical Media, Inc.

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:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Anesthesia

Local, spinal , or general anesthesia may be used.

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 Procedure

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:

• Sedation

• Slow breathing

• Constipation

• Itching

• Nausea and vomiting

• Headache

• Agitation

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.

Post-procedure Care

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.

RESOURCES:

American Chronic Pain Association
http://www.theacpa.org/

American Pain Foundation
http://www.painfoundation.org/

CANADIAN RESOURCES:

Canadian Pain Coalition
http://www.canadianpaincoalition.ca/

Canadian Pain Society
http://www.canadianpainsociety.ca/

References:

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.