Intrathecal Therapy
When conventional treatments have not helped your pain, intrathecal pump therapy can deliver pain medications directly to the spinal fluid.
This system uses a small pump, inserted under the skin of the abdomen or buttocks, to supply medicine via a tube in the spine.
The device delivers individualized doses of a variety of medications, which might include local anesthetics (numbing medication), nerve pain agents, opioids or muscle relaxant depending on your diagnosis and therapy needs.
Benefits of Intrathecal Therapy
Intrathecal therapy reduces the need for daily pills, and can be more effective than pills.
Since the medicine bypasses the digestive system, the medicine can be given in smaller doses, increasing the effectiveness while reducing side effects.
Conditions Intrathecal Therapy Treat
Intrathecal therapy is a pain management treatment options we turn to when more conventional treatments – like physical therapy, injections and medications – are not successful.
At University of Maryland Pain Medicine, we may use this treatment for a variety of conditions, including:
- Arachnoiditis
- Back pain that continues or gets worse, even after surgery to correct it
- Complex regional pain syndrome (CRPS)
- Multiple sclerosis
- Spasticity
- Spinal cord injury
- Stump pain
Intrathecal Therapy Procedure
Before recommending a permanent intrathecal pump, we will place a temporary catheter in a separate trial procedure. You'll stay in the hospital so our medical team can observe the effectiveness of the injections.
If the trial is effective, we'll implant the pump system with a short surgical procedure. Refilling the pump occurs every one to two months, depending on your dose, with an injection during an office visit.
Patient Information: Intrathecal Therapy
How do I prepare for the procedure?
Your pain management team will give you instructions for how to prepare for this procedure. This will include when you can eat prior to the procedure and what medications you can and cannot take. If you are diabetic, pregnant or taking blood thinners, such as Coumadin (warfarin) or Plavix, let your doctor know.
You should arrange to have someone drive you home from the procedure.
What happens during the trial procedure?
The implantation of an intrathecal pump involves two separate procedures. First, we place a temporary catheter to see if this type of drug infusion helps your pain.
In this temporary trial, lasting three to five days, your health care team will adjust the dose and determine if permanent placement is right for you. The procedure takes about one hour, and you will remain in the hospital for two to three days.
During the trial procedure, you will lie on the X-ray table on your stomach, and a local anesthetic will numb the site. The doctor will place a catheter into the spinal space. This catheter will be dosed with medication or connected to an infusion while you are in the hospital.
What happens during the intrathecal pump implantation procedure?
If the temporary catheter greatly reduces your pain, your doctor may recommend a permanent pump placement. The pump will be implanted a few weeks later.
During the procedure, which takes about one to two hours, you will be asleep with general anesthesia. We'll insert the pump under the skin of your abdomen or buttocks through a small surgical incision.
The pump runs on a battery that lasts up to five to 10 years. You will need another surgery to replace the battery.
What will happen after the procedure?
You will remain in our recovery area about 30–60 minutes while we monitor your vital signs. If undergoing the temporary trial, you will be admitted to a hospital room. If undergoing the permanent implant, then you will likely be able to go home the same day. A representative from the device company will teach you about the device. You will receive verbal and written discharge instructions.
What are the risks of the intrathecal therapy?
As with most procedures, there is a risk of bleeding, infection or allergic reaction to the medications used. Some mild short-term side effects include headache, nausea or dizziness.
Specific risks of intrathecal therapy and implantation also include the following:
- Cerebrospinal fluid leakage
- Damage to the nerves that come out of the spine, causing paralysis, weakness, or pain that does not go away
- Infection of the catheter or battery site (If this occurs, the hardware usually needs to be removed.)
- Movement of or damage to the generator or catheter that requires more surgery
- Pain after surgery
- Problems or malfunction of the pump
The intrathecal pump device may limit your ability to undergo MRI. Discuss this with your health care provider.