While the thought of a spinal pump may initially invoke thoughts of extreme discomfort and immobility, spinal pumps can not only effectively manage chronic pain but may allow an individual to lead a normal and gradually active life once the initial post-surgery phase has ended. A spinal pump, or a morphine pump/pain pump, is a round metallic device implanted in a patient’s lower abdomen, near the hip. This device is built to mechanically pumps a very small dose of painkilling drugs immediately into the cerebrospinal fluid of your spinal cord. Because it is a direct infusion, a tiny fraction of the drug is needed, versus what is usually ingested.
The primary benefit to a spinal infusion pump is the continuous mitigation of pain in patients who cannot manage their pain through oral medication, and require a less conservative, more invasive approach. While the procedure and the name itself sounds frightening, knowing how its done and what the possible risks are can assuage some fears and give you an idea of what you can expect before and after receiving a spinal infusion pump.
What Are Spinal Pumps?
Spinal pumps are usually also known as intrathecal pumps, giving you a clue as to how they function. An intrathecal pump usually appears to be a flat, round metal object, similar to a disc, with a catheter attached to it. The metallic object acts as the pump and is either programmed to continuously dispense medicine at a constant rate, or as per a preprogrammed schedule. An external programmer can also be used to check on the pump’s status and reprogram the pump.
The medication is pushed through the catheter through pressure created by an inert gas. A microprocessor controls the rate at which medication is administered. Intrathecal pumps come with an alarm to indicate low volume, at which point it is critical to get your pump checked. Damage to the pump through physical trauma may also interfere with its function, as would something highly magnetic, like an MRI. Your provider will usually use an external programmer to check the pump’s status before considering a more invasive investigation.
The catheter for the pump is fed into the intrathecal space between the spinal cord and spinal sheath, straight into the cerebrospinal fluid. From there, most pain medication can be used at a smaller and more controlled dosage than through oral medication or intravenous medication, thus minimizing side effects as well as complications that usually arise from higher and higher dosages of the drug.
Different pumps have different requirements for maintenance, refill, and replacement. Some pumps and types of medication have to be refilled once a month, others can last for as long as six months. FDA regulations require a refill very six months at the latest. Pumps are replaced for safety reasons once every few years. Baclofen pumps are typically replaced every 5-7 years, for example.
How an Intrathecal Spinal Pump Is Installed
The installation for an intrathecal pump begins with a trial, as with most intervention therapies for chronic pain. Because this is a serious and long-term commitment, a doctor will first implant a temporary catheter and pump to determine whether a spinal pump would be effective at all. In most cases, spinal pumps become an option only after other forms of infusion have been deemed unacceptable due to certain side effects or lack of spasticity control (meaning, trouble swallowing or moving, requiring a more reliable form of pain control and scheduled medication).
If the trial is a success, then the real thing can be installed. The procedure begins with locating the right area for the pump. This depends on various factors, including where you wear certain clothing articles (such as a belt), how you sit, where you lie, details about sensitivities and bone health issues, and more. Once the right location has been chosen, the pump is installed under the skin, while the catheter is fed through the bones of the spinal canal, into the lumbar spine (lower back).
Considerations & Complications
Because it involves surgery, the primary and most immediate risk is infection. It’s important to stay under observation and let the surgery site heal a little, while doctors work on adjusting your dosage during your hospital stay to figure out the best and most efficient way to help you manage your pain.
Meanwhile, some things are to be noted. Doctors may continue to give you pain pills throughout your hospital stay for a short period of time. They will also recommend that you drink plenty of water, and perhaps may recommend caffeinated non-carbonated drinks. This is because caffeinated drinks temporarily relieve pain after a spinal operation, caused by a spinal headache due to cerebrospinal fluid leakage. Tea or plain coffee are your best bet. There are other treatments as well.
It’s also important to lie flat and avoid movement for up to 6-8 weeks. Frequent visits and appointments are scheduled with the surgeon to monitor healing and determine activity levels. It is recommended that patients gradually return to normal activities, engage in walking short distances, and eventually move on to physical therapy or regular exercise.
Living with a Spinal Pump
Life with a spinal pump is expected to be much better than without. In patients where an intrathecal pump becomes a real option for pain relief, relief is usually swift and qualitative. The biggest risk is generally a physical dependence on the pain medication, which is determined through withdrawal symptoms experienced while the medication is not being administered.
Other things to keep in mind include bathing and caring for the incision wound. To avoid infection or rising temperatures, it is important to keep the wound clean and dry. Swelling is common and usually not a big concern but can become dangerous if not inspected by a doctor.
Traveling is possible but be sure to keep your IDI (Implanted Device Identification) card on-hand and be sure to keep your pump refilled and discuss travel plans with your physician. If you are on a complex infusion plan, then the time zone switch may mess up your biological clock and interfere with your plans. Otherwise, only a few specific limitations exist:
- You shouldn’t be more than 8,000ft above sea level, unless you are in a pressurized environment (commercial airplane).
- You shouldn’t be more than 43ft below sea water.
- You shouldn’t be in water warmer than 120°F/49°C.
- You should avoid whiplash and hard stops in a vehicle.
Otherwise, life can go on as normal, for the most part. If the pump is a success and you regain quality of life, then you can be expected to live a healthy and mobile lifestyle.