What is an Intrathecal Pain Pump?
An intrathecal pump is a battery-powered device that administers medications straight into the spinal canal. Intrathecal pumps are sometimes used to treat cancer-related pain, as well as chronic pain or spasticity. The pump is a round metal device roughly the size of a hockey puck that is surgically placed beneath the skin of your abdomen. A short plastic tube called a catheter is surgically implanted in the intrathecal space of the spine and attached to the pump. The drug is kept in a reservoir inside the pump.
The subarachnoid or intrathecal space is the fluid-filled cavity around your spinal cord. It is where cerebrospinal fluid (CSF) flows, nourishing and protecting your brain and spinal cord. Because it bypasses the path that oral medication takes through your body, the intrathecal drug pump is more efficient than oral medication. In addition, when using a pump, you only need around 1/300 the quantity of drug (morphine or baclofen) that you would when having it orally.
Why is an Intrathecal Pain Pump Performed?
Its main goal is to disrupt pain sensations traveling via the spinal cord. Medication is administered into the intrathecal space directly. Intrathecal pumps can assist in the treatment of several severe pain disorders. It can help with three types of pain:
- Neuropathic pain
- Spasticity pain
- Nociceptive pain
Neuropathic Pain
It can go away on its own, although it is frequently chronic. It might be persistent and alarming sometimes. Its frequent cause is nerve injury or a dysfunctional neurological system. The effect of nerve damage is an alteration in nerve function at the site of the injury and areas surrounding it.
Neuropathic pain frequently appears to have no clear explanation. However, the following are some of the most common causes of neuropathic pain:
- Alcoholism
- Amputation
- Chemotherapy
- Diabetes
- Facial nerve problems
- HIV infection or AIDS
- Multiple myeloma
- Multiple sclerosis
- Shingles
- Spine surgery
- Syphilis
Spasticity Pain
Spasticity is caused by a disturbance in muscle movement patterns, causing muscles to contract at once. A complex system generally controls muscular motions, allowing some muscular contractions while others relax. Injuries to nerves in the central nervous system can cause the pattern to be altered. As a result, several muscles may contract at the same time.
Its causes include:
- Traumatic brain injury
- Cerebral palsy
- Stroke
- Multiple sclerosis, and
- Spinal cord injury
Nociceptive Pain
Its cause is the harmful stimuli recognized by nociceptors located throughout the body. Nociceptors are a kind of receptor that functions to detect any pain that may be induced by injury to the body. Mechanical or physical damage to various parts in the body might be harmful.
The skin, muscles, bones, and other tissues, for example, could be affected. Nociceptors can also detect chemical and thermal damage. Contact with poisonous or harmful chemicals causes chemical damage. The thermal injury occurs when exposed to extremely hot or cold temperatures.
Its causes include:
- Bruises
- Burns
- Fractures
- Overuse pain or joint injuries, such as arthritis or sprains
How is an Intrathecal Pain Pump Performed?
Several days before surgery, your doctor may ask for presurgical diagnostics (e.g., blood test, ECG, chest X-ray). You will complete your paperwork and sign consent forms at the doctor’s office.
On the morning of the procedure, patients are admitted to the hospital. An intravenous (IV) line is inserted into your arm. An anesthesiologist will discuss the effects of anesthesia and the risks involved.
This procedure has five main steps.
1. Get The Patient Ready
You are sedated and put on the operating table. When you fall asleep, your body rolls onto its side. The areas of your back and stomach where the catheter and pump will be put are shaved and prepared.
2. Insertion Of The Catheter
In the center of your back, a little skin incision is made. The vertebra’s bony arch (lamina) is visible. Sutures are used to place the catheter in the subarachnoid, or intrathecal, the region above the spinal cord.
3. Tunneling Of The Extension
Once the catheter is in position, the doctor will insert an extension catheter through the skin from the spine to the abdomen.
4. Pump Placement
On the side of your abdomen below the waistline, a 4-6 inch skin incision is made. The pump is placed in a pocket created by the surgeon between the skin and muscle layers. The pump is connected to the extension catheter. The pump is then positioned beneath the skin and sutured to the thick fascia layer covering the stomach muscles.
5. Close The Incisions
Sutures or staples close the incisions in your back and abdomen, and a dressing is placed.
What To Expect After an Intrathecal Pain Pump
Side Effects Associated With Intrathecal Pain Pump
In general, intrathecal pump implants are safe and effective for pain treatment. Most of the side effects are less connected to the pump and more related to the drugs.
Some of the most typical adverse effects of pain drugs include:
- Nausea
- Vomiting
- The sensation of itching
- Flushing of the face
- Constipation
- Sleepiness
- Respiratory depression
The procedure of intrathecal drug delivery has many risks. These risks can be associated with the drug and procedural or catheter complications. The risk factors include:
- Drug withdrawal symptoms
- Return of underlying symptoms
- Underinfusion of the drug
- Damage to the spinal cord
- Inflammatory mass
- Sensory changes (numbness, tingling)
- Hyperesthesia
- Sleep disturbances
- Myelopathy
- Paralysis
- Drug toxicity
- Constipation, nausea
- Spinal headaches
- Bleeding
- Meningitis
Recovery:
Complications and infections are rare. The most common concern is pain at the site of the pump implant. To alleviate the pain, your doctor will prescribe pain relievers. Your doctor will also explain when you can resume your regular activities.
Please keep in mind the following things for six to eight weeks after your surgery to prevent the catheters from moving out of place:
- Do not bend, twist, stretch or lift objects of more than five pounds
- Avoid raising your arms above your head.
- Do not take a nap on your stomach
- Do not climb stairs or sit for a long time
