OVERVIEW

Intrathecal Drug Delivery Systems or Pain Pump

Intrathecal drug delivery, also known as a “pain pump,” is a targeted therapy used in interventional pain management and spasticity control. This technique involves delivering medication directly into the intrathecal space around the spinal cord, where it can reach the pain receptors in the central nervous system much more effectively and with smaller doses than oral medications.

Indications

• Severe Chronic Pain: Particularly in patients with cancer pain, failed back surgery syndrome, or neuropathic pain who have not had adequate relief from oral medications or other treatments.
• Spasticity: Commonly associated with conditions like multiple sclerosis, cerebral palsy, or spinal cord injury, where muscle relaxants and other oral medications are ineffective or cause intolerable side effects.

How does it Work?

• Device Components: The system consists of a pump and a catheter. The pump is a programmable, battery-operated device that stores and dispenses medication. The catheter is a small tube that delivers medication from the pump to the intrathecal space around the spinal cord.
• Implantation Procedure: The pump is usually implanted under the skin in the abdomen, and the catheter is threaded into the intrathecal space of the spine. The placement of the pump and catheter is done surgically under anesthesia.
• Medication Delivery: The pump is programmed to slowly release prescribed doses of medication directly into the spinal fluid, bypassing the gastrointestinal tract and significantly reducing the medication needed to control pain or spasticity.
• Medications Used
  • Opioids: Such as morphine or hydromorphone, used for pain management.
  • Antispasmodic Agents: Such as baclofen, used for managing spasticity.
  • Local Anesthetics: Such as bupivacaine, sometimes used in combination with other medications for synergistic effects.
  • Clonidine: An alpha-2 adrenergic agonist, used for both pain management and treatment of severe spasticity.

What are the Procedure for Implanting a Pain Pump?

Implanting a pain pump is a sophisticated procedure designed to provide continuous pain medication directly to the spinal fluid, bypassing the gastrointestinal system and potentially reducing systemic side effects. The procedure is performed under anesthesia and the surgeon makes a small incision in the abdomen where the pump will be placed. A pocket is created under the skin that is big enough to hold the pump. A catheter is placed under the skin from the spine to the abdominal incision and connected to the pump.

What are the Benefits?

• Efficacy: Direct delivery into the spinal fluid enhances the effectiveness of drugs, allowing for lower doses and reducing systemic side effects.
• Reduced Side Effects: Lower doses of drugs mean fewer side effects compared to oral medications, particularly important for opioids and antispasmodics.
• Continuous Relief: Provides consistent and continuous pain relief or spasticity control, improving quality of life for patients with severe chronic conditions.
• Customizable: The pump can be adjusted and reprogrammed as needed to change the dosage or timing of medication delivery, providing flexible management of symptoms.