Spinal Drug Pumps For Pain and Spasticity

Pain pumps have been used since 1981, initially for cancer pain but are now widely used for severe pain of non-cancer origin in patients with normal life expectancy. Such pumps have developed from patient-activated bolus devices and constant infusion systems to complex programmable units. 

Baclofen has been the most widely used drug in treating spasticity since its introduction in 1971. However, when taken orally it crosses the blood-brain barrier very poorly so that high blood levels of the drug are required to achieve satisfactory levels in the cerebrospinal fluid and nervous system. This often results in unpleasant side effects and lack of efficacy. The direct intrathecal administration of baclofen was first reported in 1984 and, dose for dose, achieves a concentration in the cerebrospinal fluid approximately 400 times higher. Intrathecal baclofen has proved to be extremely effective in controlling spasticity due to spinal cord injury and diseases such as multiple sclerosis and can also be effective in spasticity of cerebral origin (brain injury, stroke, hypoxia). 

Benefits of Pain Pumps

• Usually, pain patients are treated with oral medications which may include opioids. Oral medications have to pass through our digestive system before they produce the desired effect by acting on receptors for pain control. Hence we need higher doses orally compared to the spinal delivery of medications where medication is delivered directly to the nervous system. The usual ratio is 300:1 respectively.
• Control -  New pump devices give patients much more flexibility where they can get medication around the clock and also are able to give themselves bolus on demand. This is similar to taking a pill which may take up to 45min to be effective whereas spinal delivery may be effective in less than 5 min.
• Allows patients to be free of confusion about the accountability of the pills.
• Allows a safer environment for the patient and family in today's environment of opioids crisis. Help reduce the stigma attached to opioids.

• Reduce or Eliminate Pain Medication – Most patients find that they can reduce or eliminate the use of oral pain medication once they have in intrathecal pump implanted.
• Fewer Side Effects – Intrathecal pumps typically have much fewer side effects when compared to oral pain medication because the medication is more specifically targeted.
• Flexibility – The dosage of pain medication administered through the pump can be changed as your needs change. If you experience more pain, the medication can be increased and vice-versa.
• Trial Test – You don’t have to commit to the treatment right away. Patients undergo a trial test to see how it works for them and a decision can be made afterward.
• Not Permanent – Unlike some surgeries, like back surgery, getting an intrathecal pump does not have to be permanent. The device can be turned off or removed at a later time

Risks

• Surgical Complication – While rare, surgical complications are still possible. Some potential complications include an infection or spinal fluid leak.
• Inflammation – Some patients report inflammation in the area around the catheter.
• Device Malfunction – It the device malfunctions, surgery may be needed to fix it. Some possible malfunctions include a broken catheter or the pump moving within the body. However, these are rare occurrences.

A comprehensive pain center physician will perform evaluation and trial to determine if you are a good candidate for the spinal pump. Contact Comprehensive pain centers today if you have any questions or you’d like to book an appointment with one of our experienced Comprehensive pain centers physicians.