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Lumbar Intrathecal Pain Pump

What does “Lumbar Intrathecal Pump Implantation” mean?

Here is the meaning of each word:

  1. Lumbar: area of the spine located in the low back.
  2. Intrathecal: into the spinal fluid which bathes the spinal cord
  3. Pain Pump: a mechanical device which pumps pain medication into the spinal fluid
  4. Implantation: the permanent placement of a device into the body

Altogether, “Lumbar Intrathecal Pain Pump Implantation” means implanting a permanent pump into the patient which delivers pan medication to the spinal cord.

Why is an Intrathecal Pain Pump implanted?

Intrathecal Pain Pumps are often implanted to control severe pain which has been difficult or impossible to control with other means. Intrathecal Pain Pumps deliver medication directly to the spinal cord where we have receptors for pain. Normally medication we take by mouth has to first travel through the stomach, then into our blood stream and eventually to the spinal cord. Only a small amount of the original medication reaches the spinal cord. However, with an Intrathecal Pain Pump, the medication goes directly to the spinal cord.

What medication can an Intrathecal Pain Pump deliver?

An Intrathecal Pain Pump can deliver a wide variety of medications. However, only certain medications are approved and available in a form which does not harm the spinal fluid or spinal cord. One of the first medications used was Morphine. This is why these pumps are sometimes called “Morphine Pumps”. Nowadays, many other narcotic pain medications, local anesthetics, and other non-narcotic pain medications can be used.

How does an Intrathecal Pain Pump deliver medication?

The Intrathecal Pain Pump is in fact a mechanical pump. The pump has an empty space     inside (reservoir) which is filled with a medication. The pump is powered by an internal battery which turns a driver. Each time the driver turns, it pushes medication out from the reservoir and into the catheter. The end of the catheter is located in the spinal fluid and delivers the medication there.

What is the difference between a Spinal Cord Stimulation device and an Intrathecal Pain Pump for control of pain?

A Spinal Cord Stimulation device sends electrical impulses to the spinal cord to interrupt pain, while an Intrathecal Pain Pump delivers medication for pain relief to the spinal cord.

How is an Intrathecal Pain Pump implanted?    

Here are some of the steps of how this surgery is performed:

1. An intravenous catheter (IV) is placed. Antibiotics are given through the IV.

2. This procedure is done in an Operating Room or Procedure Room.

3. The patient is placed on the back (supine) and a General Anesthetic is given.

4. The patient is then carefully placed on their side.

5. The spine and the abdomen are cleaned with a sterile surgical solution. Sterile sheets are used to keep the surgical area clean and sterile.

6. An X-Ray machine is used to locate a certain level in the spine which is chosen by the doctor.

7. A specialized needle is placed through the skin and advanced between the vertebrae into the spinal fluid.

8. A specialized catheter is placed through the needle into the spinal fluid.

9. A contrast dye (fluid which appears black on an X-Ray) is injected through the catheter and into the spinal fluid. This is done to verify that the catheter is in the correct location.

10. A cut (incision) is made around the area where the needle goes through the skin.

11. The tissue under the skin is divided until the spinous process of the vertebra is seen.

12. The needle is carefully taken out while the catheter is kept in the spinal fluid.

13. The catheter is secured to the spine (sutured) with small, specialized anchoring devices.

14. At this point, the pump is filled with medication. It is then programmed to deliver a certain amount of the medication per day.

15. Another small cut (incision) is made in the abdomen. A “pocket” is created under the skin for the Intrathecal Pain Pump.

16. The end of the catheter outside the patient is brought under the skin to the cut in the abdomen. It is then connected to the pump.

17. The pump is placed into the “pocket”.

18. Both cuts (incisions) are closed with stitches (sutures).

19. Bandages (dressings) are placed over the incisions.

20. The patient is turned on their back and awoken from Anesthesia.

21. The patient is taken to the Recovery Area for observation.

How long does it take to implant an Intrathecal Pain Pump?

The implantation of an Intrathecal Pain Pump often takes 1.5 to 3 hours to complete.

What is the recovery like from an implantation of an Intrathecal Pain Pump?

Here are some steps of the recovery:

  1. The patient is usually admitted to the hospital overnight.
  2. A soft brace (binder) is often placed around the abdomen and spine to keep swelling down.
  3. Often the pump is inspected with a specialized computer which can communicate with the pump through the skin (telemetry).
  4. The patient is given specific instructions on limiting physical activities for a period of time.
  5. The patient is usually reevaluated by the doctor within 1 week.
  6. The incisions may take 2-4 weeks to heal completely.

What benefit can patients gain from an implanted Intrathecal Pain Pump?

Intrathecal Pain Pumps can control pain for long periods of time. Over time, different medications and combinations of medications can be used to improve the pain control. The amount of medication is slowly increased over time if the patient becomes used to it (tolerance).