Pain Management Specialist: Intrathecal Pump or Pain Pump ... Is it for you?

Share

Report Abuse

Next Blog

Create Blog

Sign In

Pain Management Specialist

Tuesday, August 7, 2012 Blog Archive 2012 (3) August (1) Intrathecal Pump or Pain Pump ... Is it for you?... May (1) April (1)

Intrathecal Pump or Pain Pump ... Is it for you?

This week I had another patient ask me about the Intrathecal Pump or Pain Pump as many people call it. As with many patients, he had many misconceptions about what this Pain Pump actually is and what it does so I thought of writing this blog for anyone who considering this as a treatment option for their chronic pain. The device delivers pain medication directly on the spinal cord. It consists of a catheter that is placed into the spinal cord via a needle and anchored outside the spine. The part of the catheter that is outside the spine is then connected to a reservoir which is usually placed underneath the skin, at the buttock area or lower abdomen. The implantation of the device is a minor surgical procedure and patients usually recover from in a day or two. Before the implantation however, most doctors would place a temporary catheter in the spine that is just taped to the back for a trial. During the trial the doctors will play with different doses of medications and also different combination of medications. This usually requires a short hospital stay. Currently there are only 3 FDA approved drugs for the device; morphine, baclofen and prialt although many practitioners put non approved drugs in the pump such as local anesthetics. Morphine is the classic drug used for chronic pain pumps where as baclofen is often used in the pump when patients have neurological disorders that cause intense muscle spasms. Prialt is actually a toxin harvested from a sea slug and there is some data that it may help with pain. My only mention about prialt is that it comes with many side effects and from my experience it does not work that great. So I wanted to focus on morphine and other opioids (dilaudid, fentanyl etc) medications that have been used in the pump. When these medications are delivered directly on the spinal cord they can have the same pain relief effect as their oral counterparts but only at a small fraction of the dose. Smaller doses mean fewer side effects. So who is best suited for the device? The patients that would otherwise obtain relief from opioids but cannot tolerate the side effects. In general this is the elderly population. The other group of patients that would benefit is the cancer population whose pain requires such large doses of medication that side effects become an issue. This is in essence the only real advantage of the pump. Everything else is conjecture. Below is a few of the more common misconceptions:

About Me Dr. Robert Zhang Dr. Robert Yu-Fan Zhang is an Interventional Pain Management Specialist with extended expertise in treating back pain, head and neck pain, and cancer pain. He is board certified in anesthesiology and fellowship trained in interventional pain management. After graduating from Albert Einstein College of Medicine, he completed his residency at Yale New Haven Hospital and pain management fellowship at University of California of San Francisco Mount Zion Hospital. After practicing as an attending for Kaiser Permanente in California, he now serves as the Director of Pain Management at Queens Medical Associates. Dr. Zhang has extensive experience in a variety of interventions including epidurals, facet therapies, nerve blocks, neurolytic procedures, and radiofrequency ablation. View my complete profile

Pump Myths: 1. You do not develop tolerance or dependence to the drugs in the pump: False. You develop tolerance to intra spinal morphine just like you would develop tolerance to oral morphine. Invariably the doses will need to be increased with time to provide similar pain relief which causes a problem because there is a recommended max dose for morphine in the spine. Going over this dose will run the risk of toxicity. In the elderly and terminally ill population there is not likely enough time for this tolerance to occur so that is why they are considered good candidates. Just like oral medications patient will also become dependant on the medication and if the pump runs out of medications due to a miss refill visit, the patient will go through withdrawals. 2. I will no longer need oral pain pill: False. While many patients can initially cut down on the amount of oral pills needed the majority of patients will still need them. This is because the pump releases a continuous dose of medication but it does not adjust for breakthrough pain such as when a patient is more active or during certain parts of the day. I will not be able to get an MRI with the pump: False The pump will deactivate while you are in the MRI machine but after the MRI, the pump can be restarted without any malfunction. The pump will work for all types of pain: False. Again the pump works well when the patient obtains relief from oral opioids. Certain painful conditions such as nerve induced pain due not respond well to opioids. I am taking a whole lot of pain medications without any pain relief but switching to the pump will

3.

4.

5.

http://drrobertzhang.blogspot.com/2012/08/intrathecal-pump-or-pain-pump-is-it-for.html[8/9/2012 3:13:35 PM]

Pain Management Specialist: Intrathecal Pump or Pain Pump ... Is it for you?

finally give me some relief: False. As mentioned before you have to obtain relief from the oral counterparts to justify the device. If you are not and you are on high doses it is likely that you have developed tolerance to the medication and switching to the pump will not change that. In these cases you may very well need a drug holiday where you come off of the medications for some time to allow your body to reset or you may need to be switched to another type of opioid that your body has never seen before. 6. The pump will lead to damage of my spine: False While this is theoretically possible it is highly unlikely. What we are concerned about is malfunctioning of the pump because of damage to the reservoir or catheter from falls/trauma or, sometimes, inexplicable reasons. Also scar tissue can form around the tip of the catheter, blocking the medication from reaching the spinal cord. When this happens the catheter will need to be changed out in the OR.

Hope this answers some of the questions out there and makes people realize that the pump is not for everyone. As with any implanted devices there is a huge responsibility on the patient. For example, if there are plans of relocating, a patient needs to find a PMD at the new location to monitor and take over refills. In addition, some patients have been left hanging when there PMD decides to shut down or change locations. Posted by Dr. Robert Zhang at 11:37 AM
Recommend this on Google

No comments: Post a Comment

Comment as:
Publish Preview

Select profile... Select profile...

Home
Subscribe to: Post Comments (Atom)

Older Post

Awesome Inc. template. Powered by Blogger.

http://drrobertzhang.blogspot.com/2012/08/intrathecal-pump-or-pain-pump-is-it-for.html[8/9/2012 3:13:35 PM]