Intrathecal Drug Therapy
Written by Nevada Advanced Pain Specialists staff
Intrathecal pumps (ITPs) are devices used in the treatment of patients in chronic pain. ITPs are automated pieces of equipment that are programmed to deliver medication into the spinal fluid through a small catheter. These pumps have been proven effective in treating cancer pain, severe back pain, neuropathic pain, and muscle spasticity.
The purpose of the pump is to interrupt pain signals that travel through the spinal cord, which lessens signals to the brain and the patient then experiences relief. Medication is delivered by the pump into the intrathecal space surrounding the spinal cord directly to the pain receptors. Therefore, smaller doses of medication are required to gain relief.
ITP implants are considered when oral pain medications and other methods of pain control have been exhausted or proven ineffective. This exciting pain relief technique has been shown to be both safe and effective for patients.
A great benefit of the ITP technique is the patient will get to “test drive” this therapy and see how it works before committing to the long-term therapy. When an intrathecal medication trial is performed, the medication is placed in the spinal fluid. If pain relief is adequate, an ITP can be permanently placed to control the pain.
The implantation of the device is done with local anesthesia and light sedation (general anesthesia is usually not required). After a sterile scrub, local anesthesia is used to numb the needle entry location and a catheter is placed into the intrathecal space using X-ray guidance. Once the catheter is in the proper location, the pump is then connected and placed under the skin on the lower part of the abdomen. The catheter and pump are tunneled under the skin, and all wounds are surgically closed.
The pump delivers pain medication (opiates, local anesthetics, or muscle relaxants) directly into the intrathecal space around the spinal cord. The medication reservoir in the pump is refilled periodically (depending on the prescribed medication and dose) by a pain physician by injecting the medication through the skin into the pump.
The entire procedure typically takes one to two hours and may be performed on an outpatient or inpatient basis.
What are the Benefits?
ITPs can be used to treat a variety of painful conditions. Nociceptive pain, or pain from tissue irritation, can be effectively treated with uploads like morphine. Nociceptive pain transmission is interrupted at the spinal cord and pain relief is experienced.
Spasmodic pain can also be successfully treated by ITPs. This type of pain is effectively treated with anti-spastic, muscle-relaxing medications like Baclofen. Spasticity may be caused by impairment in the brain or spinal cord and is seen in several conditions, such as stroke, brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis. Spasticity is an abnormal increase in muscle tone and tightening of the muscles.