Implantable Intrathecal Drug Infusion Systems
Intrathecal Drug Infusion systems ("Pumps") pertain to the placement of drugs directly into the spinal fluid. Since the spinal cord is bathed by spinal fluid, placing drugs into the spinal fluid allows the medication to reach the spinal cord at higher strengths that normally occur when drugs are taken by mouth or in other ways.
The drugs used for intrathecal use include the opioids (morphine, for example), antispasticity drugs (baclofen), and nerve blocking agents (ziconitide). The system involves the placement of a long flexible tube (catheter) directly into the spinal fluid through a needle placed into the spine. The catheter is then connected to a drug infusion pump which is placed under the skin of the abdomen.
You doctor may consider placing an opioid (morphine) into your spinal fluid if oral medicines have helped your severe pain problems, but have cause severe side effects. The most common side effects that require the placement of a drug infusion pump are severe drowsiness, incoordination, or nausea and vomiting. Intrathecal morphine administration is most commonly used to treat cancer-related pain, neuropathic (nerve-related) pain, and severe pain after back surgeries.
Oral baclofen is used to treat spasticity (muscle spasms). Occasionally, baclofen taken by mouth causes cognitive side effects or is not sufficiently effective to relieve pain. Intrathecal baclofen is widely used to treat muscle spasticity associated with multiple sclerosis, cerebral palsy, stroke, and spinal cord injury.
The drug infusion system is programmable. This means the pump is externally programmed through an electronic device to deliver the proper amount of drug. Commonly, the dose of the drug is gradually increased to meet your specific needs. Often, many separate physician visits are required to properly adjust the medication.
The surgery is preceded by what is known as a drug "trial." The trial involves the placement of a small amount of the drug into your spinal fluid through a needle or catheter. The trial may be performed on an outpatient basis or a brief inpatient stay may be required. The results of the trial will determine whether the drug is effective and therefore appropriate for long-term use through the infusion pump.
The surgery to place the pump involves admission to the hospital for the procedure. The surgery generally lasts a couple of hours. An incision for the catheter will be placed in your low back region. A separate incision for the pump will be placed in your lower abdomen. The healing time for the incisions is usually two to three weeks. The titration of the drug will proceed after the incisions have properly healed.
Side effects of Implantable Intrathecal Drug Infusion Systems
The complication rate for implantable intrathecal drug infusion systems is similar to other implantable devices and minor surgical procedures. The overall complication rate is less than 10%. More common complications include an infection requiring antibiotics, an infection requiring removal of the device, and catheter migration requiring surgical revision. Less common complications include bleeding, increased pain, kidney failure, bowel or bladder dysfunction, paralysis, and death. These less common side effects usually occur on patients taking strong anti-coagulants or blood thinners, those with a high fever or an active infection, or those with a severe allergy to intravenous contrast. Your physician should be notified if you are taking medications such as Coumadin, Plavix, Ticlid, Lovenox, Aggrenox, Insulin, or Metformin. Your physician should also be made aware of any allergies you have, especially if you are allergic to iodine or contrast. Notify your physician immediately if you have concerns about your condition after the procedure.
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