Intrathecal Pain Pump For Chronic Pain Treatment. Who Should Consider it?

Intrathecal Pain Pump

Various published epidemiology study has estimated that 20 to 30% of general population in USA are suffering with chronic pain and have seen physician for pain at least once in their lifetime. Approximately 10 to 15% of population suffers with malignant or nonmalignant chronic pain for longer than 5 years. Oral pain opioid is the gold standard to treat chronic pain lasting more than 6 months. Opioid resistance and tolerance causes opioid dependence resulting in increased requirements of opioids. Rapid acceleration of dosage causes severe side effects with inadequate pain relief. Few patients are addicted to opioids. Self-adjustment of dosage of opioids often causes fatal side effects and death because of side effects caused by extremely high dosage of opioids. Intrathecal pain pump is an alternative to oral opioids for treatment of chronic pain. The dosage of opioid delivered intrathecally by intrathecal pain pump is very small compared to oral pain opioids.

Intrathecal Pain Pump For Chronic Pain Treatment

Why Intrathecal Pain Pump?

Intrathecal pain pump is recommended to achieve better pain relief, prevent opioid abuse and opioid addiction.

Intrathecal Pain Pump Helps Achieve Adequate Pain Relief-

  • Chronic pain is associated with malignant cancer and non-malignant pain generating diseases.
  • In United State, population over 65 years of age has increased during last decade as people are living longer.
  • During last ten years, number of non-cancer chronic pain patients have escalated in numbers because of increased geriatric population and increased awareness of chronic pain.
  • Degenerative disk disease, multiple sclerosis, fibromyalgia and arthritis are geriatric diseases causing chronic severe pain.
  • These patients are treated with oral opioids. Treatment has resulted in opioid resistance, tolerance and dependence.
  • Intrathecal pain medication delivered through intrathecal pain pump prevents these side effects.

Intrathecal Pain Pump Helps Prevent Opioid Abuse-

  • Opioids are abused by drug seeking patients; though numbers of drug seekers are lot less than honest pain patients.
  • Lately, Federal, State and Health Service Providers are prudently scrutinizing opioid prescriptions.
  • In late 1996, chronic pain patients were encouraged to demand pain medications by politicians, health service providers and insurance companies.
  • Obviously several patients were suffering with pain and not receiving any opioid medications for pain prior to 1996.
  • Awareness of chronic pain resulted in demand for prescription of opioids to maintain normal standard of living.
  • Opioid prescription numbers escalated 800 times in 10 years. Drug addicts and drug seekers were bundled with honest pain patients to get opioid prescription for chronic pain.
  • Health provider and ER health providers occasionally treat few honest chronic pain patients like drug addict and criminals because of frequent visit or appearance.
  • Reliable statistical data is not available to relate number of drug seekers to real chronic pain patients.
  • Intrathecal pain pump delivers preset quantity of opioids intrathecally. The instillation of opioids in pump and delivery amount is controlled by the pain specialist and nurse coordinator who is managing the pump.
  • Shifting opioids management from patient to physician prevents opioid abuse.

Is Opioid Safe When used in Intrathecal Pain Pump?

  • Medications used for treatment of chronic pain are oral opioids, NSAIDs and adjuvant pain medications. Opioids are the gold standard in regards to potency and analgesic efficacy of all pain medications.
  • Opioid has several side effects which include tolerance, resistance, addiction and dependence.
  • Pain impulse is transmitted from peripheral receptors to spinal cord by peripheral nerve. Central pain receptors are located over dorsal horn of spinal cord.
  • Cerebrospinal Fluid (CSF) surrounds spinal cord and opioid in Cerebrospinal Fluid (CSF) blocks the pain receptors. Despite large daily oral opioid dosage, concentration of opioid in Cerebrospinal Fluid (CSF) is extremely low because of pharmacodynamics of Cerebrospinal Fluid (CSF) barrier.
  • In contrast, intrathecal analgesic dosage of opioid needed to achieve 50% or more pain relief is about 1 to 5% of oral dosage. Addiction and dependence is rare in a group of patient receiving intrathecal opioids.
  • Intrathecal opioid is safe when experienced pain specialist manages intrathecal pain pump.

Pump Implant in Intrathecal Pain Medication

Pain Medications Used In Intrathecal Pain Pump

  • Cancer pain was treated by intrathecal opioid in 1979 by J. Wang, M.D. Later same year external pump was used to deliver pain medications (morphine) through intrathecal catheter during normal delivery in obstetric practice.
  • First programmable implanted pump was used in 1981 to deliver intrathecal pain medication to treat malignant pain.
  • During last 20 years several scientific research papers were published regarding safety, efficacy and complication of device and intrathecal pain medication.
  • FDA has approved only three drugs Baclofen, Morphine and Ziconotide for intrathecal use.
  • Several other opioids have been tried and used for chronic pain. Opioids delivered into cerebrospinal fluid for chronic pain are morphine, Dilaudid, fentanyl and sufentanil.
  • Intrathecal pain pump is indicated for malignant and non-malignant chronic pain. Patient needing very high dosage of opioids and no other treatment is available then intrathecal pain pump is the treatment of choice.

Who Should Consider Intrathecal Pain Pump?

Intrathecal Pain Pump For Patients Suffering From Malignant Pain-

  • Chronic malignant pain is treated with oral opioids by oncologist.
  • Pain relief is satisfactory during first few weeks with escalation of small dosage.
  • Few patients may develop tolerance and resistance to opioids.
  • These patients do not respond to small escalation of opioid dosage. Rapid escalation may or may not provide satisfactory pain relief and in few cases provokes side effect such as nausea, vomiting, constipation or somnolence (sleepiness).
  • Patient may be a candidate for permanent placement of intrathecal catheter and pump for intrathecal opioid treatment if trial succeeds in relieving pain over 50%.
  • All patients may not be candidate for intrathecal pain medications.
  • Terminally ill patients with life expectancy of less than 3 months may not be a candidate for intrathecal opioids; instead it is beneficial to treat such patients with oral, I.V. or epidural route of opioids.

Intrathecal Pain Pump For Patients Suffering From Non-Malignant Pain-

  • Chronic pain patients suffering from spinal stenosis, compression of spinal nerve at foramina or spinal canal and failed back syndrome may have tried and failed physical therapy, oral opioids, interventional pain therapy and surgery.
  • Population of chronic pain patients who have failed conservative treatment should be given a choice of intrathecal pain medications after psychological evaluation.
  • Patient should be considered for permanent placement of catheter and pump if pain relief is over 50% after intrathecal opioid trial dosage.
  • It is important for the surgeon to obtain pre-operative CT or MRI to check for spinal canal stenosis, arachnoiditis, or other intraspinal abnormalities.
  • These disorders would make insertion of intrathecal catheter difficult.
  • The non-malignant chronic pains treated by intrathecal pain pump are as follows-

Am I A Candidate for Intrathecal Pain Pump?

  • If you are a patient suffering with non-malignant chronic pain or malignant chronic pain lasting over 6 months and not responding to high dosage of oral opioid pain medication then you are a candidate for evaluation of intrathecal pain medication.
  • If you are suffering with chronic intractable severe pain caused by cancer and pain relief is inadequate then you are a candidate for intrathecal pain pump.
  • If you are drowsy and sleepy all the time, as well as having inadequate pain relief then you are a candidate for intrathecal pain pump.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:October 31, 2022

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