Intrathecal Drug Delivery (Pump)

What is intrathecal drug delivery?

Intrathecal drug delivery is an advanced method for managing severe, persistent pain, especially in cases related to cancer. This system consists of two primary components:

1. Pump: A programmable device implanted under the skin, typically in the abdomen. It contains the medication that is delivered to your body.
2. Catheter: A flexible, thin tube that is connected to the pump and positioned in the intrathecal space of the spine, where it delivers medication directly to the area around the spinal cord.

How does it work?

The pump is programmable, allowing your healthcare team to adjust medication doses to optimize pain relief. Medications are delivered continuously, and some systems offer patient-controlled features, enabling you to administer additional doses, within safe limits, if needed.

Typically, a combination of medications is used to enhance pain relief. These may include opioids, local anesthetics, or other medications that work synergistically. Medications can be adjusted or changed based on your pain levels, side effects, or other clinical factors.

Importantly, not responding to similar medications taken orally or intravenously does not mean you won’t respond to them when delivered intrathecally. The direct delivery to the spinal cord can provide effective pain control even when other methods have failed.

Frequently Asked Questions

Am I a candidate for intrathecal drug delivery?

Intrathecal drug delivery can be suitable for any type of cancer-related pain. Oftentimes, we elect for intrathecal therapy if you are experiencing inadequate pain control with oral medications or if you are achieving pain control but having significant side effects from these medications. This makes intrathecal therapy an appropriate option for optimizing your pain management.

If you're having a trial, you might either be given medication directly into the spine in an outpatient setting, or you may be admitted to the hospital with a catheter placed as part of the trial. The specific steps will be determined in collaboration with your healthcare clinician to figure out which approach is most suitable for you to ensure your comfort and safety. However, in urgent situations, your clinician may recommend proceeding directly to implantation without a trial.

What happens during and after the procedure?

The implant procedure is performed in the operating room and typically requires general anesthesia. During the procedure, an incision is made in your back to place the catheter into the intrathecal space, and another incision is made in your abdomen to implant the pump. The procedure is guided by fluoroscopy (X-ray). After the procedure, you may experience some discomfort at the incision sites, which is normal and should gradually improve. You will have regular follow-up appointments to monitor the healing of your surgical sites, adjust the medication delivery settings, and ensure optimal pain control.

It is important to follow your care team’s instructions regarding wound care and activity restrictions to support proper healing and device function. Post-procedure, you will be guided on any necessary activity restrictions and receive comprehensive education and training from the device representative or clinical staff on managing and maintaining your device. Your healthcare team will work closely with you to manage any concerns and optimize your pain relief.

How is the pump refilled?

The pump requires periodic refills, which are done sterilely via a small needle inserted through the skin (“percutaneously”). This is a quick outpatient procedure, scheduled in the pain clinic, and does not require additional surgery. The refill interval varies depending on your medication dose but is typically every few months.

Your well-being is our top priority, and we are here to support you through every step of your pain management journey. If you have any questions or concerns, please contact our office.