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Implantable Pain Pumps

Significant spasticity and cancer related pains which are not treated optimally with oral and/or transdermal medications can be treated with an intrathecal delivery of pain medication. The medication is delivered directly into the cerebral spinal fluid – the fluid column that surrounds the spinal cord and brain. This allows for a very small amount of medication to be used which is delivered through a pump that is implanted under the skin. This procedure is done in two phases. The first procedure is called the trial phase, medication is injected into the cerebrospinal fluid through a lumbar spine entry point through the skin and trialed for one day. The second phase is not detailed here.

During phase one, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area, is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the lower lumbar spine is identified and the skin is anesthetized. Using a small needle, the dural space is entered using fluoroscopic guidance and confirmed by the presence of cerebrospinal fluid. The appropriate medication, based on clinical assessment, is injected into the cerebrospinal fluid as a test dose and the patient is monitored. Based on efficacy of the medication, the patient may be scheduled for the second phase or another trial with a change in medication or dose may be scheduled. The second phase is permanent implantation of an intrathecal catheter and pump device and is not detailed here.