Intrathecal Morphine Pumps

Understanding an Intrathecal Pain Pump Implant

An intrathecal pain pump implant is a way to relieve some kinds of long-term (chronic) pain or cancer pain. It sends pain medicine through a thin, flexible tube. The tube is inserted into the space around the spinal cord. The area between the spinal cord and the tissue (membrane) covering the cord is called the intrathecal space. This space contains a liquid called cerebrospinal fluid (CSF).

The tube is connected to a small, round pump. Both are implanted under your skin in a minor surgery. A small electronic device controls the pump. The device stays outside your body. The pump contains medicine and sends it through the tube into the CSF. The medicine reaches nerves along the spine. It helps prevent them from sending pain signals to the brain.

How to say it: in-trah-THEE-kuhl

Why an intrathecal pain pump implant is used

An intrathecal pain pump implant may be used if you have chronic pain or cancer pain from an injury or a disease. It can help ease pain when other types of pain care have not worked or have caused severe side effects. It may be used after you have tried pain medicine by pill, liquid, or injection. Or it may be used if surgery to treat the source of pain is not an option.

How an intrathecal pain pump is implanted

Before having an intrathecal pain pump implanted, this type of pain care is tested to make sure it will work for you. This is called a trial. You may have an injection of pain medicine. Or you may have a short-term (temporary) test of an intrathecal pain pump. During this procedure:

  • You lie face-down on a medical table. An area in your back over your spine is numbed. You may be given medicine to relax you or make you sleep.
  • The healthcare provider makes a small cut (incision) in your skin over part of your spine. He or she puts a stiff tube through the skin. It goes into the space around the spinal cord (intrathecal space).
  • The provider then puts a thin, flexible tube (catheter) through the first tube and moves it farther into the intrathecal space. Pain medicine is sent through this tube for a few days to see if it helps your pain.

If the pain relief trial works for you, a pump will be implanted. For this procedure:

  • You lie face-down on a medical table. You are given medicine to relax you or make you sleep through the procedure.
  • The healthcare provider removes the first catheter you had. He or she puts a new catheter under your skin.
  • The provider then puts a pump about 1 inch under your skin on one side of your lower belly (abdomen). The pump is a disk about 1 inch thick and 3 inches wide. It contains medicine and has a battery that lasts for 5 to 7 years. The catheter is connected to the pump.
  • The provider connects the pump to a small device outside your body. The provider uses this device to control the pump.

The pump may be programmed by the healthcare provider. Or it may be set to a certain amount. The type of medicine used in the pump will depend on your type of pain and other factors. The pump will need to be refilled with medicine when needed. This may happen every 1 to 3 months.

Risks of an intrathecal pain pump implant

  • Infection
  • Small growth of tissue near the catheter (granuloma)
  • Mistakes in programming the device that may make the medicine dose too high or too low
  • Tear in the catheter that stops medicine from getting to nerves
  • Side effects of opioid or other medicine
  • Damage to the nerves on the spine
  • Leaking of cerebrospinal fluid (CSF) that causes headache and other symptoms
  • A pocket of CSF under the skin (hygroma)
  • A pocket of other fluid under the skin (seroma)
  • Changes in endocrine function
  • Need for higher doses of medicine over time

Lumbar radiculopathy is a combination of symptoms consisting of back and lower extremity pain caused by the lumbar nerve roots.

Causes of Lumbar Radiculopathy:

  • Herniated Disc
  • Foraminal Stenosis
  • Tumor
  • Osteophyte Formation
  • Infection.

Signs and Symptoms:

  • Pain
  • Numbness
  • Tingling
  • Weakness
  • Referred Pain
  • Muscle Spasms
  • Back Pain

Testing:

  • Plain X-rays
  • MRI
  • CT
  • Myelography
  • Bone Scan
  • Electromyography
  • Nerve Conduction Testing
  • Lab Work

Diagnosis:

Lumbar radiculopathy is a clinical diagnosis that is supported by a combination of clinical history, physical examination, and diagnostic studies/testing.

Treatment:

  • Drug Therapy
  • Physical Therapy
  • Spinal Nerve Root Injection

In between each of the five lumbar vertebrae (bones) is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and discs.

Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots. Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc. A herniation may develop suddenly or gradually over weeks or months.

Many factors increase the risk for disc herniation:

  • Inadequate nutrition
  • Age
  • Natural biochemical
  • Poor posture
  • Incorrect body mechanics
  • daily wear and tear
  • Tobacco use
  • Injury

Signs and Symptoms:

  • Low back pain
  • Sharp pain/burning pain/stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

Obtaining a vocational history is also very important because many skilled laborers or assembly line workers perform the same offending motion at work. Also a very comprehensive medical history along with proper testing can determine diagnosis as well as what type of herniation is involved.

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Spinal Cord Stimulator
  • Psychotherapy
  • Behavioral methods of pain control

Discogenic back pain is considered a “degenerative” or aging process, patients with discogenic back pain often improve over time. Most patients with discogenic back pain will improve with time and some simple treatments.

Signs and Symptoms:

  • Back pain associated with activities such as: Sitting, Bending forward, Coughing, Sneezing
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Radiating pain (called radiculopathy) down leg while: Sitting, Standing, Walking

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • Discogram

Diagnosis:

A comprehensive medical history along with proper testing and a vocational history is important, because many skilled laborers or assembly line workers perform the same offending motion at work.

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

The iliolumbar ligament runs from the transverse process (side) of the 5th lumbar vertibrae to the back of the iliac crest. Damage to this ligament may cause pain in the sacroiliac joint area and it can be virtually impossible to tell the difference between this injury and a sacroiliac joint injury. Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and results in the relaxation of ligaments in preparation for childbirth.

Signs and Symptoms:

  • Low back pain
  • Chronic groin pain
  • Hip pain
  • Pelvic pain
  • Rectal pain
  • Testicular pain
  • Vaginal pain of unknown origin

Testing:

  • Physical exam
  • X-Ray

Diagnosis:

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatment:

  • Drug therapy
  • Physical therapy
  • Anesthetic/Corticosteroid Injections
  • Osteopathic manipulation

Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include, Scar tissue that forms around the surgery site, interrupting normal neurological functioning.

The technicalities of the operation are not successful:

  • The performing surgeon had poor technique, and/or there is iatrogenic injury present.
  • The surgery is not performed at the site that causes the pain.
  • The surgery performed is not actually necessary.
  • The patient is a poor fit for a successful surgery.
  • The diagnosis was incorrect or Complications of surgery arise.
  • Most patients with FBSS have accompanying psychological, social and/or vocational

Signs and Symptoms:

  • Low back pain
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

A comprehensive physical exam and medical history to establish an understanding of an individual’s pain and characteristics of the pain such as: onset/offset, character/radiation of pain, associated symptoms, time pattern, exacerbating/ameliorating factors and severity.

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

What causes vertebral compression fractures?

The leading cause of vertebral body fractures is osteoporosis. The following factors will increase the likelihood of acquiring osteoporosis:

  • Thin or underweight
  • Elderly
  • Low calcium intake
  • Female
  • Steroid use
  • Post menopausal
  • Smoking
  • Eating disorders
  • Family history of osteoporosis

Signs and Symptoms:

  • Sudden, severe back pain
  • Worsening of pain when standing or walking
  • Some pain relief when lying down
  • Difficulty and pain when bending and twisting
  • Loss of height
  • Deformity of the spine
  • Testing
  • Plain X-Rays
  • CT Scan
  • MRI

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.

Treatment:

  • Drug Therapy
  • Application of Heat/Cold
  • Orthotic Device
  • Bed Rest
  • Vertebroplasty
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