Intrathecal Drug Delivery
Intrathecal drug delivery, sometimes referred to as a "pain pump," helps if you have severe pain from cancer or from benign causes such as post-laminectomy syndrome (otherwise known as failed back syndrome) or complex regional pain syndrome. We also use this approach for certain neurological conditions, such as cerebral palsy or spinal cord injury that can cause spasticity of muscles in the body and before surgery.
To use intrathecal drug delivery, we inject medication into the space between the membrane covering your spinal cord and the spinal cord itself. In order to provide medication in this way, we implant a pump into your abdominal area, under the skin. The pump is attached to a catheter that we insert into the intrathecal space. It emits small doses of medication at timed intervals. We program in the dosage and frequency and we can adjust the programming based on your response. We can keep enough medication in the pump’s reservoir to last for several months and can refill it with a needle injection, on an outpatient basis.
This approach targets the medication directly into the fluid that bathes your spinal cord, which means that you get pain relief with much smaller doses of medicine than if you received it orally or by a systemic (body-wide) injection. Often, if we provide this medication orally or by injection, it can cause sleepiness, constipation, nausea, vomiting, and dizziness. With intrathecal drug delivery, side effects are minimal or nonexistent and pain control is often much better. Studies generally show that well over half of patients that receive intrathecal drug delivery for pain report increased ability to carry out daily living tasks and experienced lower levels of disability one year out.
We usually use lidocaine, morphine, and phenol. We prefer Baclofin to treat spasticity.
“When patients reach dosages of pain medications during standard medical therapy that increase the side effects to untenable levels, intrathecal drug delivery is considered because we can achieve high levels of the drug right where it is needed with systemic side effects,” says Dr. Brian Kopell, Director of the Center for Neuromodulation.