Intrathecal Pumps

Intrathecal pumps are mechanical devices used to deliver medications directly into the area of the spinal cord. These devices consist of a computerized pump, a resevoir and a catheter. The resevoir can be filled with various medications including opioids, Clonidine, Baclofen, Bupivocaine and Ziconatide. The medications are used at much lower concentrations than necessary for systemic absorption and side effects are generally lower.

Studies have been done with intrathecal opioids that show less side effects than oral medication. Drowsiness is improved, as is nausea and constipation. Improvement in pain control is particularly effective with multiple medications aimed at different parts of the pain control system. Another advantage of the intrathecal pump is that Medicare will pay for parenteral medications, while they will not pay for oral medications. Additionally these pumps can improve compliance with patients who have trouble regulating their oral medications due to addiction or pseudoaddiction.

Intrathecal medication delivery also has its drawbacks. Implanting a pump is not an inocuous procedure. It causes significant cosmetic alteration at the implant site, that is unacceptable to many patients. The pump is a mechanical device that is prone to problems ranging from glitches and mechanical compromise, to total mechanical failure. Rare instances of catheter tip granulomas can cause significant neurological symptoms. The patient is dependent on refills of medications and adjustment of the pump to the few professionals and delivery organizations available to do this and expertise is still still developing. If a patient with a pump is in an accident, the pump can stop working and the catheter can be displaced. Emergency room physicians and personnel are usually not well versed in how to deal with pump patients.

There is still considerable question about whether intrathecal delivery of opioids shows any statistical advantage from a pain standpoint over oral medication delivery. While statistically it appears that oral delivery is just as effective as intrathecal delivery, it appears that for patients who have failed oral opioid treatment or received only limited benefit, a trial with indwelling epidural catheter may prove more effective. If so, than the use of intrathecal opioids may prove to be more effective for the individual patient.

There are patient oriented groups on the internet that can give perspectives, advice and experiential information. For many people who have tried less invasive alternatives the pump can make a huge difference in improved pain control and quality of life.