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Intrathecal Pain Pump Insertion

Definition

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.

Reasons for Procedure

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:

Many people have a significant reduction in pain and are better able to function in daily life after having an intrathecal pain pump insertion.

Compression Fracture
Compression fracture lumbar
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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like:

  • Bleeding
  • Infection
  • Spinal headaches
  • Catheter tube becomes blocked and stops working
  • Side effects from the pain medication
  • Pump-related complications
  • Nerve injury

Factors that may increase the risk of complications include:

  • Psychological problems
  • Active infection
  • Allergy or intolerance to the pain medication or materials being used
  • Bleeding disorders, concurrent anticoagulation therapy

What to Expect

Prior to Procedure

Your doctor may do the following:

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.

Cervical Injection
Cervical epidural injection
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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 drugs
  • Blood thinners
  • Anti-platelet drugs

Anesthesia

General anesthesia may be used.

Description of the Procedure

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 Procedure

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:

  • 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. You should not feel pain. You will experience some pain after the surgery. It will be managed with medications.

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.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor's instructions.

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.

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.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Redness, swelling, pain, or discharge around the incision site
  • Signs of infection, including fever and chills
  • Pain that is not controlled with pain medications
  • Sudden back pain
  • Loss of bowel or bladder function
  • Headache lasting longer than 48 hours
  • Beeping noises from pump
  • Sudden onset of leg weakness and spasm
  • New numbness or tingling
  • Nausea and/or vomiting
  • Cough, shortness of breath, or chest pain

Opioid withdrawal symptoms may include:

  • Rapid breathing
  • Sweating
  • Runny nose
  • Agitation
  • Increased heart rate
  • Fever
  • Tremors
  • Twitching or aching muscles
  • Loss of appetite
  • Abdominal cramps or diarrhea

If you think you have an emergency, call for medical help right away.

Revision Information

  • American Chronic Pain Association

    http://www.theacpa.org

  • American Academy of Craniofacial Pain

    http://aacfp.org

  • Canadian Pain Coalition

    http://www.canadianpaincoalition.ca

  • Canadian Pain Society

    http://www.canadianpainsociety.ca

  • Intrathecal drug pump. Mayfield Spine Surgery Center website. Available at: http://www.mayfieldclinic.com/PE-PUMP.htm. Updated March 2013. Accessed June 11, 2013.

  • Knight KH, Brand FM. Implantable intrathecal pumps for chronic pain: highlights and updates. Croat Med J. 2007;48(1):22-34.

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