An intrathecal pump is a pump used to relieve pain in chronic pain states. The pain medication is given directly into the area around the spinal cord. The usual pain medication is morphine or an equivalent medication that can provide as much pain relief as is possible.
In the system, there is a small pump that is implanted surgically underneath the skin and a catheter implanted around the spinal cord. It can work whenever all other attempts at pain control have failed and when the maximum amount of oral pain medication fails to control the pain. Smaller doses of medication need to be used during this method. This also means there are fewer side effects.
The space around the spinal cord is filled with fluid and is also called the “subarachnoid space” or “intrathecal space”. The fluid around the spinal cord is called cerebrospinal fluid. It takes up pain medication at one point in the CSF, allowing it to flow throughout the CSF fluid. You need only to give one three hundredth the amount of morphine or baclofen by pump when compared to oral administration.
The pump itself is the size of a hockey puck and is about the shape of one. It involves a reservoir implanted under the skin in the back. This is connected to a plastic catheter that leads into the intrathecal space. The reservoir is where the medicine is placed. Doctors program the pump so that it gradually releases the medication over time. Different types of dosage schedules can be programmed into the system. The medication goes through the skin and into the reservoir in order to fill the reservoir. The reservoir empties at different rates, depending on what the pump says. The process is completely reversible as the reservoir and catheter can be removed through surgery.
Why have an Intrathecal pump?
Those people who are candidates for an intrathecal pump include those where:
- No further surgery will help relieve pain
- All other conservative therapies have failed
- Addiction to pain medication has occurred
- There are no underlying medical conditions that would make it difficult to have an implant
- The patient isn’t allergic to pump mediations
- A trial dose of the medication has been successful
Indications for having an intrathecal pump:
There are many types of symptoms that would benefit from an intrathecal pump. These include the following:
- Pain from cancer
- Pain from failed back surgery
- Causalgia
- Reflex sympathetic dystrophy
- Inflammation of the meninges
- Chronic pancreatitis
- Multiple sclerosis
- Cerebral palsy
- History of stroke
- Spinal cord injury
- Brain injury