Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates
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The system uses a small pump that is surgically placed under the skin of your abdomen and delivers medication liquid diladid for pain pumps a catheter to the area around your spinal cord — similar to an epidural that women may have during childbirth. A pain pump may be a treatment option if all other traditional methods have failed to relieve your long-term symptoms.
Because the medication is delivered directly to the spinal cord, your symptoms can be controlled with a much smaller dose than is needed with oral medication. The goal of a drug pump is to better control liquid diladid for pain pumps symptoms and to reduce oral medications; thus reducing their associated side effects. The fluid filled space around your spinal cord is called the subarachnoid or intrathecal space.
Cerebrospinal fluid CSF flows through this area, bathing and protecting your brain and spinal cord. An intrathecal drug pump works much more efficiently than oral medication because it delivers medicine directly into the CSF, bypassing the path that oral medication takes through your body.
The pump is a liquid diladid for pain pumps metal device about the liquid diladid for pain pumps of a hockey puck that is surgically implanted beneath the skin of your abdomen. A small plastic tube, called a liquid diladid for pain pumps, is surgically placed in the intrathecal space of the spine and is connected to the pump Fig.
A space inside the pump called the reservoir holds the medication. The pump is programmed to slowly release medication over a period of time. It can also be programmed to release different amounts of medication at different times of the day, depending on your changing needs.
The pump stores the information about your prescription in its memory, liquid diladid for pain pumps your doctor can easily review this information with the programmer.
When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.
A pump can help lessen spasticity muscle rigidity and spasms that make movement of the arms and legs difficult caused by:. Neurosurgeons and doctors liquid diladid for pain pumps specialize in pain management and spine disorders implant drug pumps. Determining whether an implantable drug pump will be a good pain management option for you is a complex process.
Before a permanent pump can be implanted, you must undergo a trial to see if the device decreases your level of pain or spasticity. Depending on your particular condition, one of the following screening tests will be necessary:. During liquid diladid for pain pumps trial, the doctor gathers information about the best location for the catheter and the type and amount of drug that works best for you.
If the trial is successful, you will be scheduled for surgery. You may be scheduled for presurgical tests e. In the doctors office you will fill out paperwork and sign consent forms. Patients are admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery.
An intravenous IV line is started in your arm. An anesthesiologist will explain the effects of anesthesia and its risks. There are two parts to the procedure: There are five main steps of the procedure. The operation generally takes 3 to 4 hours. Once asleep, your body is rolled onto its side. Next, the areas of your back and stomach are shaved and prepped where the catheter and liquid diladid for pain pumps pump are to be placed.
The bony arch lamina of the vertebra is exposed. The catheter is placed in the subarachnoid, or intrathecal space, above the spinal cord and secured in place with sutures Fig. The surgeon creates a pocket for the pump between the skin and muscle layers. The extension catheter is attached to the pump. Next, the pump is correctly positioned under the skin and sutured to the thick fascia layer overlying the stomach muscles. You will wake up in the postoperative recovery area, called the PACU.
Your liquid diladid for pain pumps pressure, heart rate, and respiration liquid diladid for pain pumps be monitored, and your pain will be addressed.
Most patients are discharged home the same day. You will be given written instructions to follow when you go home. Right after surgery, pain is managed with narcotic medications. Because narcotic pain pills are addictive, they are used for a limited period 2 to 4 weeks. Also, their regular use may cause constipation, so drink lots of water and eat high fiber foods. Thereafter, pain is managed with acetaminophen e.
NSAIDs may cause bleeding and interfere with bone healing. Spinal headaches are caused by leakage of cerebrospinal fluid around the catheter or lead site. Lie flat and drink plenty of caffeinated non-carbonated fluids e.
Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon. Housework and yard-work are not liquid diladid for pain pumps until the first follow-up office visit. Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise. Gradually return to your normal activities.
Walking is encouraged; start with a short distance during the 1st two weeks and then gradually increase to 1 to 2 miles daily. A physical therapy program may be recommended.
You may shower as directed by your surgeon. Do not take a tub bath or submerge yourself in water for 4 weeks. Pat your incision dry with a soft towel to avoid irritation. Inspect the incision line twice daily. Call the doctor if this occurs. Seromas usually disappear by themselves but may require a drain. Steri-strips may cover the incision. After showering, gently pat dry the steri-strips. Gently remove steri-strips after one week. Sutures or staples that remain in place when you go home will need to be removed.
Ask your surgeon or contact the office to find out when. Wear loose clothing over the incision site to maintain comfort and prevent skin irritation. When to Call Your Doctor If your temperature exceeds degrees F or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage. If your headache persists after 48 hours. Results will vary depending on the underlying condition being treated and its severity. Chronic pain patients may experience a reduction in pain, as well as overall improvement in activities of daily living .
Spasticity patients may experience a reduction in rigidity and muscle spasms . Oral medications are reduced because the medicine is delivered directly to the spinal cord and much smaller dosages are needed.
Side effects for intrathecal drug pumps are minimal, although they do exist. As with all surgeries, complications may include infection and bleeding. The catheter could move or become blocked, or the pump could stop working rare. Accumulation of fluid cerebrospinal fluid leak can occur around the pump causing a clear watery discharge from your incisions or a headache.
These usually disappear on their own, but may require a drain. Reasons for removal of the device include infection, failure to relieve pain, and patient misuse. Side effects from the drugs over- or underdose may include respiratory depression, twitching, muscle spasm, urinary retention, constipation, nausea, vomiting, dizziness, anxiety, depression, and edema. Depending on liquid diladid for pain pumps much medication the pump delivers, the battery will eventually need to be replaced every 5 to 7 years.
You must schedule medication refills on a regular basis with the surgeon or a pain management liquid diladid for pain pumps. At your refill appointment, the effectiveness of your treatment will be assessed and your pump will be adjusted accordingly. The goal is to find the optimal amount of pain or spasticity control while having minimal side effects. You should tell your doctor if you experience unusual symptoms, drug overdose, or feel that your dosage is ineffective.
You may need to take supplemental oral medicine if you have periods of stronger pain. Just like a cardiac pacemaker, other devices such as cellular phones, pagers, liquid diladid for pain pumps, security doors, and anti theft sensors will not affect your pump. Be sure to carry your Implanted Device Identification card when flying, since the device is detected at airport security gates.
This may indicate that the pump needs liquid diladid for pain pumps, battery needs replaced, or other maintenance. Withdrawal symptoms from the medication you are receiving may cause you some discomfort or in extreme cases may require emergency treatment. Inform family members and friends about what to do in an emergency; always carry your Emergency Information and Procedure cards with you at all times.
We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.
Patients who come to Mayfield with neck and back problems are given a rapid review of their medical condition within a few days, not weeks. It's a treatment process called Priority Consult. Nearly 80 percent of our spine patients are able to recover with nonsurgical treatment. But when physical therapy, medications, and spinal injections fail to relieve neck or back pain, we help patients with surgery.
We surgically implant pain pumps for a wide range of conditions, including chronic back pain, cancer pain, and spasticity. To make an appointment call