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 medication to the area around your spinal cord.
This pain management technique is often only used if noninvasive pain management has failed or has negative side effects.
An intrathecal pain pump can be used to manage long-term pain problems caused by: Failed back or neck surgeryCompression fracturesPhantom limb painCancerReflex sympathetic dystrophyComplex regional pain syndrome
Arachnoiditis—inflammation of a space around the spinal cord
Many people have a significant reduction in pain and are better able to function in daily life after having an intrathecal pain pump insertion.
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Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like: BleedingInfectionSpinal headachesCatheter tube becomes blocked and stops workingSide effects from the pain medicationPump-related complicationsNerve injury
Factors that may increase the risk of complications include: Psychological problemsActive infectionAllergy or intolerance to the pain medication or materials being usedBleeding disorders, concurrent anticoagulation therapy
Your doctor may do the following: Physical examBlood testsElectrocardiogram
Chest x-rayMRI of the spine
Before the surgery, you will undergo a trial to see if the pump will actually decrease your pain. Pain medication 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 medication for you will also be found in the trial period.
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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 medications. You may be asked to stop taking some medications up to one week before the procedure, like: Aspirin
or other anti-inflammatory drugsBlood thinnersAnti-platelet drugs
A small incision will be made in the middle of the back. The catheter is placed in a space near the spinal cord and secured with stitches. An x-ray machine will be used to make sure the catheter is in the right place. Once secured, the catheter is run from the spine to the abdomen where the pump is placed. The catheter is run under the skin.
Once the abdomen is opened with a small incision, the pump is put in place below the waistline. The pump will sit in a pocket that is made between the skin and muscles. The catheter will be attached to the pump. After the pump is secured, stitches will be used to close the incision.
After the procedure, you will be taken to a recovery area. Your blood pressure, heart rate, and breathing will be monitored. The staff will watch for potential side effects, like: SedationSlow breathingConstipationItchingNausea and vomitingHeadacheAgitation
You will be under anesthesia for the procedure. You should not feel pain. You will experience some pain after the surgery. It will be managed with medications.
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.Ask your doctor about when it is safe to shower, bathe, or soak in water.
Be sure to follow your doctor's
You will need to carry an Implanted Device identification card because the pump will set off metal detectors. 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 medication at regular intervals.
After arriving home, contact your doctor if any of the following occurs: Redness, swelling, pain, or discharge around the incision siteSigns of infection, including fever and chillsPain that is not controlled with pain medicationsSudden back painLoss of bowel or bladder functionHeadache lasting longer than 48 hoursBeeping noises from pumpSudden onset of leg weakness and spasmNew numbness or tinglingNausea and/or vomitingCough, shortness of breath, or chest pain
Opioid withdrawal symptoms may include: Rapid breathingSweatingRunny noseAgitationIncreased heart rateFeverTremorsTwitching or aching musclesLoss of appetiteAbdominal cramps or diarrhea
If you think you have an emergency, call for medical help right away.
Knight KH, Brand FM. Implantable intrathecal pumps for chronic pain: highlights and updates.
Croat Med J. 2007;48(1):22-34.
Last reviewed June 2013 by Marcin Chwistek, MD; Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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