This information describes how an intrathecal pump can be used to manage cancer pain.
An intrathecal pump is a small device that holds pain medication. It is placed under your skin and delivers pain medication through a thin catheter (tube) directly to the nerves in your spine (back). When the medication goes directly to the nerves in your spine, it stops you from feeling pain.
Why is the intrathecal pump being considered for me?
An intrathecal pump may help if oral (by mouth) or intravenous (IV; into a vein) pain medications do not control your pain. Also, oral and IV pain medications are absorbed into every part of your body. This can cause unwanted side effects. Most of the medication from the intrathecal pump goes directly to the nerves in your spine, so you will need less medication and should have fewer side effects.
Is there any way to know if the intrathecal pump will work before I decide to use it?
Yes. If you are considering an intrathecal pump, you will be admitted to the hospital for an epidural screening test. This involves putting an epidural catheter into your spine to see if getting pain medication this way works for you. This is the same type of catheter women get for pain relief when they are having a baby. Epidural catheters cannot be used at home.
How long is the epidural screening test?
The screening test usually takes 3 to 4 days. It may take longer if your pain is very hard to control. During this time, you will be in the hospital.
What are the differences between an intrathecal pump and an epidural catheter?
Both devices give pain medication directly to the nerves in your spine through a pump, but there are some differences.
Pump is outside your body attached to a pole
Pump is inside your body
Inserted by your pain doctor with some medication to make you comfortable
Inserted during surgery while you are asleep
What do the results of the epidural screening test mean?
If you had less pain, fewer side effects, or both while you were using the epidural catheter, then the intrathecal pump may be a good option to treat your pain.
When is the intrathecal pump placed?
Usually, the intrathecal pump is put in while you are in the hospital after the epidural screening test. If you and your doctor decide to have the pump put in later, you will have to go back to taking your oral pain medication when you get out of the hospital.
How is the intrathecal pump placed?
The intrathecal pain pump is placed inside your body during a surgery. The surgery usually takes 1 to 3 hours. You will be given general anesthesia (medication to make you fall asleep) during the surgery.
During the surgery, there will be a cut (about 6 inches) made in your abdomen where the pump will be placed. A second cut will be made in your back, and one end of the catheter will be placed near the nerves in your spine. The catheter will be attached to the pump so that it can give pain medication to this area.
What does the intrathecal pump look like?
The intrathecal pump is round. It is about 1 inch thick and 3 inches wide—about the size of a hockey puck. The pump will look like a bulge under the skin of your abdomen (see Figure 1).
Will I have pain after the surgery?
After surgery, the incisions (surgical cuts) on your abdomen and back may be tender. You will be given pain medication for this.
How long will I be in the hospital after the surgery?
Usually 2 to 3 days is enough time for your doctor to determine the kind and amount of medication you will need to keep your pain under control. Once your pain is under control, you will be sent home. You will have a follow-up appointment to refill your pump with medication before it runs out.
Is there anything that I should not do after the surgery?
You should limit your physical activities for about 6 to 8 weeks after the surgery so that you can heal. You should avoid doing the following:
- Twisting your body
- Exposing your body to extreme hot or cold temperatures, such as in a sauna
Talk to your pain doctor about when you can start your normal daily activities again.
Do I have to visit the surgeon after the procedure?
Yes. You will be given an appointment to see your surgeon 1 to 2 weeks after you leave the hospital. Your stitches will be taken out at that visit. If everything is healing well, you may not need to visit your surgeon again and will only need to see your pain doctor.
How often will I need to see my pain doctor after I have the intrathecal pump?
The pump will need to be refilled every 4 to 6 weeks. Between refills, the amount of medication given by the pump may need to be changed if your pain increases. You will need to come to the clinic for refills and for any changes made to the intrathecal pump.
How does the pain doctor adjust the amount of medication?
The doctor puts a programmer on top of the pump. The programmer makes changes to the pump by communicating with it through your skin. This is called telemetry (see Figure 2).
How is the intrathecal pump refilled with medication?
The pump is refilled in the clinic by your pain doctor. Make sure you have an appointment with your doctor for the next pump refill. Call the pain service 1 week before your appointment so that your medication can be ordered in time.
At the clinic visit, your doctor will numb your skin so that you will not feel any pain. Then, your doctor will put a needle through your skin and into the pump. Your doctor takes out any medication that is left in the pump and puts new medication into it (see Figure 3).
Each time the pump is refilled, a small bandage will be put over the injection site. The bandage can be removed after 1 day.
Each time your pump is refilled or changed, you will get a piece of paper with the following information:
- The kind of pain medication that is in your pump
- The amount of medication that the pump gives you
- The date that your pump will need to be refilled with new medication
It is important to keep track of this information so that the pump does not run out of medication.
Will I need additional pain medication?
Maybe. If your doctor thinks you will need extra doses of medication, he or she will give you a device called a Personal Therapy Manager (or PTM). This handheld programmer will allow you to give yourself an extra dose of medication from the pump, if you need it. The amount of this extra dose is preset by your doctor.
Even with the pump and the PTM, you may still need to take oral pain medication to control your pain.
Will the intrathecal pump set off metal detectors?
In most cases, yes. It is important to have your identification card with you to show to security personnel.
Can I have MRI (magnetic resonance imaging) with the intrathecal pump in place?
Yes. An MRI will cause your intrathecal pump to stop working for a short time. It may sound an alarm while it is stopped. The pump should work normally after the MRI is done, or shortly after. If you are having an MRI, tell your technologist that you are using an intrathecal pump.
How long will the intrathecal pump work?
The battery in the intrathecal pump usually lasts for 4 to 7 years. If the battery starts to wear down, it will alert your doctors when they program it. They will have enough time to replace the pump.
When should I call my doctor?
Call your doctor if the following happens:
- Your pain gets worse
- Your side effects, like nausea or sedation, get worse
- Your legs feel numb or weak
- You have pain or redness at the pump site
- You hear a beep from the pump