SPINE PROCEDURES

Treatment of Chronic Pain with Implantable "Morphine Pump"

Many patient are plagued with chronic pain that can not be adequately controlled by oral medications. Syndromes of cancer related pain, "failed back" syndrome, reflex sympathetic dystrophy (RSD) and painful peripheral neuropathies may fall into this category.

Treating people with chronic, intractable pain often requires a series of treatments from a team of health care professionals. This team may include your doctor, other specialized doctors, nurses, physical therapists, occupation therapists, and psychologists.

When non-invasive treatments or surgery fail to provide pain relief implantation of a SynchroMed® Morphine pump may be useful in achieving better pain control. This type of treatment is both non-destructive and reversible. The physicians at Long Island Spine Specialist will know whether this type of treatment may benefit you by going through a selection process. You may be a candidate for "morphine pump" if:

• non-invasive treatments have failed
• corrective surgery would not help your pain
• you have no untreated chemical dependency problems
• routine psychological testing has been done
• you have no infections
• you are not allergic to any of the drugs used in the pump
• you have successfully completed a screening test

The screening test can help predict whether your pain can be relieved with APT. The screening test for Neurostimulation involves applying mild electrical stimulation to the spinal cord (see our article of Spinal Cord Stimulation). The screening test for placement of an intrathecal pump involves giving a trial dose of intrathecal morphine.

Intrathecal Screening Test
Testing for an intrathecal pump can be done as an outpatient procedure, or you may be admitted for a short hospital stay. Your doctor will closely monitor your response to the pain medication given in this test and work with you to determine if you are a candidate for long-term therapy. Most people who experience a successful test can expect good to excellent pain relief when a pump is surgically placed. One of two standard procedures is usually used to determine whether you experience significant (at least 50% improvement) pain relief.

Bolus Injection(s). This procedure uses either a single injection or several injections of a small amount of pain medication into the intrathecal space (where fluid flows around the spinal cord).

Continuous Infusion. This procedure uses a continuous infusion of pain medication that is delivered using a temporary catheter placed in the intrathecal or epidural space and attached to an external pump. You may stay in the hospital, or you may return home with the external pump for several days or weeks. This test method is more similar to the therapy delivered by the SynchroMed Infusion system.

SynchroMed Pump®
An intrathecal uses a small pump that is surgically placed under the skin of the abdomen to deliver medication directly to the intrathecal space (the fluid around the spinal cord). The surgeons at Long Island Spine Specialist use the SynchroMed Pump, which is manufactured by Medtronic, Inc. The pump was introduced in the United States in 1988 as the first programmable, implantable intrathecal pump. It has been used in thousands of patients worldwide.

The medication is delivered through a small tube called a catheter that is also surgically placed. The spinal cord is like a highway for pain signals on their way to the brain, where the feeling of pain is experienced by your body. Because the drug is delivered directly to the spinal cord, where pain signals travel, intrathecal narcotics can offer dramatic pain control, with a tiny fraction of the dose that would be required with pills. This helps minimize side effects.

The SynchroMed® Infusion System has two parts that are both placed in the body during a surgical procedure: the catheter and the pump. The catheter is a small, soft tube. One end is connected to the pump, and the other is placed in the intrathecal space (where fluid flows around the spinal cord.)

The pump is a round metal device that stores and releases prescribed amounts of medication directly into the intrathecal space. It is about one inch (2.5 cm) thick, three inches (8.5 cm) in diameter, and weighs about six ounces (205 g). It is made of titanium, a lightweight, medical-grade metal.

The reservoir is the space inside the pump that holds the medication. The fill port is a raised center portion of the pump through which the pump is refilled. Your doctor or nurse inserts a needle through your skin and through the fill port to fill the pump. Some pumps have a side catheter access port that allows your doctor to inject other medications or sterile solutions directly into the catheter, bypassing the pump.

Intrathecal pumps deliver medication directly to the spinal cord, where pain signals are transmitted. In contrast, medications taken orally will have a systemic effect--they "flood" the whole body rather than staying concentrated in any single area. This often causes side effects such as sleepiness and confusion. These side effects may prevent your doctor from prescribing greater amounts of pain medication.

While it may not be possible to completely eliminate your pain, Intrathecal medications may help you control it so you are more comfortable. Your doctor may prescribe additional oral medication (pills) to relieve pain which occasionally "breaks through" the treatment.

Your doctor will determine whether you still need to take other medications after the pump is inserted. To prevent any negative side effects, do not make any changes in your current medication unless your doctor has directed you to do so.

Drug addiction is rare and very unlikely in the face of chronic pain syndromes treated with intrathecal morphine. Addiction refers to compulsive drug-seeking behavior and using pain medications for emotional gratification. People in pain rarely get addicted because they use morphine to control pain, not for emotional gratification.

Any pain treatment can cause side effects. For example, because the pump and catheter are surgically placed, infections are possible. The catheter could become dislodged or blocked, causing an interruption in pain relief In rare cases, the pump could stop working, with the same result. Drug-related side effects can occur. They may include sleepiness, constipation and upset stomach/vomiting. It is important that you discuss with your physician the potential risks, complications, and benefits about this therapy prior to giving your informed consent for treatment. The medical staff at Long Island Spine Specialists will be able to answer any questions you may have.

Depending on your size and shape, the pump will likely not be noticeable under regular clothes.

Medicare approves the system and many insurance carriers will pay for placement of an intrathecal morphine pump. However, as with many therapies, your doctor will have to get approval from your insurance company before you can receive the implant. Our insurance department will be happy to help you with any questions.

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