Pain Pumps

A Patient's Guide to Pain Management: Pain Pumps


Pain pump delivery of narcotic drugs is a rather new option available to persons with cancer and non-cancer pain. It is also called intraspinal (within the spine) or intrathecal (within the spinal canal) delivery. It was first used in 1979 after the discovery of narcotic receptors in the spinal cord. The use of an implant device to deliver medications directly in the area of the spinal cord was first used in 1981 for cancer pain. Since then, the pain pump has been used for chronic non-cancer pain such as failed low back surgery syndrome and spasticity from neurological conditions like multiple sclerosis, spinal cord injury, and cerebral palsy.

This guide will help you understand:

  • what parts of the spine are involved
  • what is the surgeon trying to achieve
  • what the pain pump looks like
  • what happens during surgery
  • what are possible complications


What parts of the spine are involved?

The spinal cord is a nerve tube that is housed within the bony spine. A thin, delicate membrane called the pia mater covers it. The second membrane layer surrounding the spinal cord is called the arachnoid mater. The outermost covering of the spinal cord is called the dura mater and is somewhat tough. The fluid filled space between your spinal cord and the arachnoid mater is called the subarachnoid or intrathecal space. This is where the pain pump delivers medication. It is then mixed with the cerebral spinal fluid.

Cerebral spinal fluid is a clear liquid that bathes and cushions the spinal cord and brain. If the cerebral spinal fluid leaks out of this space, it can cause a headache of variable severity.


What does my surgeon hope to achieve?

The pain pump was first used in 1979 after the discovery of opiate receptors in the spinal cord. Opiate receptors are the connections on the nerve cells where medications such as morphine actually connect to the cell. These receptors are necessary for the medication to create the signals to the cell to reduce pain. Prior to 1979, no one believed that pain medications worked on the nerves of the spinal cord. We now know that much of the pain control achieved by medications such as morphine occurs in the spinal cord nerves. It makes sense that we should try to deliver the medications directly to the receptors so the medication(s) has the greatest effect.

The other great benefit of the pain pump is that less medication is required to get the same effect. When you take pain pills, the medication must travel through your bloodstream in the same concentration throughout your body. This causes side effects when the medication affects different organs systems, such as the bowels, kidneys, and liver. By placing the medication directly into the spinal canal, there is less medication in the bloodstream. Less medication in the bloodsteam means fewer unwanted side effects.


How should I prepare for surgery?

Talk to your surgeon about all medications you are taking before the procedure is scheduled.

Follow your surgeon's pre-op instructions, they may include the following

  • Do not eat or drink for at least six hours before the procedure. You will be able to take your usual medication with a small amount of water. If you have diabetes, do not take your insulin or diabetic pills until after the procedure.
  • You will need a driver to return home.
  • Do not take any aspirin or aspirin-containing medication at least eleven days before the procedure. They may prolong bleeding.
  • Wear loose fitting clothing that is easy to take off and put on.
  • Take a shower the morning of the procedure, using a bactericidal soap to reduce chances of infection.
  • Do not wear jewelry.

Surgical Procedure

What happens during the operation?

Before we discuss the surgery, lets look at the pain pump itself.

Pain Pump

The pain pump is a round metal device that your surgeon places just under the skin of your abdomen. It is about the size of a hockey puck. Inside the device there is a space called a reservoir. This holds the medication(s). Attached to the pump is a catheter or small plastic tube. The catheter is surgically placed near the spinal cord in the intrathecal space. The tubing is then tunneled under the skin and connected to the pump. The tubing is what delivers the medication stored in the pump to the spine.

The pump is programmed to dispense the medication at a certain rate throughout the day. The pump stores the information. It can be adjusted when needed. The medication lasts one to three months depending upon the amount infused. When the pump needs to be refilled with medication, a doctor or nurse inserts a needle into the top of the pump through your skin. The medication is then refilled through the needle.

Chronic non-cancer pain can be complicated by physical, psychological, and behavioral factors. Candidates for pain pump undergo evaluation for untreated addiction, psychological problems, and evaluation for medical contraindications such as risk for infection.

Criteria used to determine whether or not you are a good candidate for placement of a pain pump include but are not limited to the following

  • You have tried multiple conservative therapies such as physical therapy, chiropractic, massage, relaxation, acupuncture and spinal injections and they have failed to provide significant benefit
  • You are not a candidate for surgery
  • You do not have psychological or addiction problems
  • You have no medical conditions that would be considered a complication
  • You are presently taking oral pain medication and are having significant side effects
  • You benefited from a trial of epidural anesthesia

Once it is decided that you are a candidate for an intrathecal pump, you will have a trial period with medication delivery to the intrathecal space. Usually this involves placing a catheter (small plastic tubing) into the intrathecal space. It is then connected to an external pump. The trial period lasts for two to three days. Sometimes a trial period will consist of just a single or multiple injection of medication placed in the intrathecal space by a lumbar puncture.

A 50 percent or greater improvement in pain (or spasticity) and function would suggest that the implanted device is reasonable to consider. The doctor then knows best where to place the tip of the catheter and what medication(s) is effective.

If during this trial period the medication is not tolerated or does not provide relief, the implantable device is not considered. The implanted pump is not necessarily permanent as it can be removed at any time.

The Procedure

What happens during the procedure?

Anesthesiologists, neurosurgeons, and other doctors who specialize in spine disorders implant the pump. Surgery is performed as an outpatient. It is a two-part process and usually takes three to four hours. You will have anesthesia during the procedure. Most patients are discharged to home the same day as the procedure.

The catheter or small plastic tubing is inserted into the intrathecal space through a small incision near the spine and secured there. Careful placement of the catheter is important as the medication is only beneficial if placed in the area surrounding the spinal cord, the intrathecal space. Once the catheter is in place, an extension catheter is threaded under the skin around to your abdomen where the pump will be implanted.

Next your surgeon makes a four to six inch incision in the side of your abdomen, below the waistline. The pump is then inserted between the skin and muscle layers. The catheter is then attached to the pump. Medication is then allowed to flow from the device through the tubing.

Positioning of the catheter is checked with fluoroscopy. Fluoroscopy is an imaging technique using a continuous X-ray beam that is passed through the body part being examined. You are placed between the X-ray beam and a fluorescent screen. The image is transmitted to a TV-like monitor so that live video images can be played. This allows the physician to watch the procedure he/she is performing to ensure proper placement of the catheter. It also allows them to check and make sure the medication from the pump is delivered correctly.


When opiates for pain relief are determined to be necessary, the most commonly used opiate in the pain pump is morphine. Another commonly used opiate is hydromorphone. There is significant amount of research and clinical experience using these medications.

Other medications that can be administered by the pain pump include bupivacaine and clonidine. Sometimes one of these medications is used in combination with a narcotic.

Baclofen is another medication this is safe to use in the intrathecal space and is helpful for the management of spasticity. Spasticity is the abnormal contraction of a muscle making it somewhat rigid. This causes the muscle to have difficulty relaxing. This also interferes with normal movement. As a result, spasticity can be painful.

Other medications that have been studied for use in a pain pump include fentanyl, methadone, and ziconotide.

Oral medications are more likely to cause side effects than intrathecal medications. Usually the amount of medication required is significantly less when delivered directly to the spinal cord. A reduction in side effects such as sedation, nausea, and constipation should be expected. However, limb numbness, swelling of the lower legs, orthostatic hypotension (sudden drop in blood pressure), and difficulty starting urine flow (urinary retention) are the most common side effects of intrathecal medications.

Most patients have a significant decrease in pain and improvement in functional abilities. You should be able decrease or discontinue oral medications altogether. If the pump is implanted because of spasticity, a reduction in spasticity should be noticeable.

Possible Complications

What might go wrong?

Implanting the intrathecal pump can have complications, the most common ones are infection, bleeding, neurological injury, and cerebral spinal fluid leaks.

The use of anticoagulants such as coumadin (Warfarin), aspirin, most of the antiinflammatories, and some herbal supplements can interfere with the ability of your blood to clot. This can increase the risk of bleeding. Your surgeon will ask you to discontinue these medications several days before the procedure. Bleeding that occurs around the spinal cord is a problem as it may cause spinal cord compression and neurological damage. Emergency surgery to remove the blood may be necessary to avoid neurological damage. If not recognized or treated early, weakness of the muscles or paralysis, change in sensation, and loss of control of bowel and bladder can be permanent.

Because the tubing of the pump is placed in the space around the spinal cord, an infection or bleeding could be dangerous and even life threatening. It can cause permanent nerve damage and even paralysis. Use of a pain pump is usually considered only when other therapies have failed and surgery is not an option. Infection of the surgical site needs to be identified early and treated aggressively to prevent serious complications. Most surgeons take several precautions to decrease the risk for an infection. Antibiotics are given intravenously during the surgery. Your surgeon may want to do a nasal swab to determine if you have a resistant bacterium that can be carried on your skin.

Neurological injury can also be caused by catheter placement. It can be the result of inflammation that can occur at the tip of the catheter. It can cause a mass or granuloma at the tip of the catheter.

Cerebral spinal leaks may cause you to have a headache and if the leaking continues, it can cause stiffness of the neck (nuchal rigidity) and even neurological damage.

Although less likely, there is the risk of pump failure. If a opiate is being delivered by the pain pump, withdrawal symptoms will likely occur. Withdrawal can be caused when medication runs out, the pump malfunctions, or the tubing breaks. Withdrawal symptoms can make you feel like you have the flu. Body aches, nausea, stomach cramping, nervousness, and chills are some of the symptoms reported. There is always a risk of overdose and even death.

One other potential inconvenience is that there are few professionals available to refill and adjust the pump in some areas. This may complicate your care and necessitate travel to a center that can provide this service.

After Care

What happens after surgery?

You will have a follow up appointment with your doctor seven to 10 days after surgery to remove sutures or staples. Adjustment in medications can be made also.

You will be allowed to shower but not bathe or submerge your incisions for four weeks. Watch for visible swelling or leaking of fluid from the incisions. You should wear loose clothing over the incision sites.


What should I expect during my rehabilitation?

You will be asked to avoid bending, twisting, stretching, reaching overhead, or lifting objects over five pounds for the first six to eight weeks. This is to avoid movement of the catheter near the spinal cord. You may not be allowed to drive for two to four weeks after the procedure. Sexual activity may also be limited at first.

Usually walking is advised following the procedure. Gradually you will be allowed to return to daily activities. You may be asked to see a physical therapist for formal education and exercise instruction.

 Post to

 Email to a Friend

Pain_Pumps.pdf1.26 MB


i like these precautionary

i like these precautionary elements that you have discussed in this very informative article, i truly believe that after reading and applying the things for precautions i will get relief.
mobile application development
mobile applications development


really these precautionary elements discussed in this very informative article i like this
my Blogs: cityville cheats | master cleanse

The research focuses on

The research focuses on biomechanical properties of spinal implants. Others focus on clinical questions such as the overall outcomes of spine surgery, exercise, and rehabilitation.Thanks for sharing the info.
married women cheating

Nice information, valuable

Nice information, valuable and excellent design, as share good stuff with good ideas and concepts, lots of great information and inspiration, both of which we all need, thanks for all the enthusiasm to offer such helpful information here.Recent studies and an FDA alert have identified pain pumps as a likely cause of chondrolysis and severe cartilage damage.. Buying Investment Property

I've always had excellent

I've always had excellent health and no back problems. Everyone else at work had back pain but not me. Now I've had some unexpected back pain myself.
mexican Radio

The artificial disc is

The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion.
Rachmaninov Symphony 2

I found this article really

I found this article really beneficial for those people who have been suffering from back pain and many other related diseases. In my opinion one should practice yoga everyday to get relief from back pain.
over watering

Bend your knees and lift

Bend your knees and lift your legs so that your shins are parallel to the ground. Cross your ankles. From this position, lower your legs until your feet are about 3 inches off the ground, then hold for a count of four. Raise your legs back up. Repeat 8 times.
dependable auto shippers

Wie man bei Shirtbuster

Wie man bei Shirtbuster drucken kann.

Bei PKV-Capital testen. Wie

Bei PKV-Capital testen.
Wie ein Kreditantrag funktioniert.

Love the design you use in

Love the design you use in your site. Do you mind if I reference to this blog from my newsletter? Thanks.
Custom Signs 

To support your lower back,

To support your lower back, you can lie on your side and put a small pillow or rolled up towel just above your waist and a pillow between your knees. If you lie on your back, put a small pillow under your knees. To support your neck, you can try rolling a bath towel and sliding it in the pillowcase, on top of the pillow. This roll supports your neck when you lie on your back or side.
Trade in Iphone

There is no harm if young

There is no harm if young kids are being provided the mobile...But there should be hard and strict rule on using it while driving.
car repair

Thanks for sharing this

Thanks for sharing this info! I have always been curious about that..
minneapolis movers

Useful information shared.I

Useful information shared.I am very happy to read this article.thanks for giving us nice info.Fantastic walk-through. I appreciate this post.Thanks
Custom Remodelers

Social research scientists

Social research scientists call this the response shift phenomena. The patient has adapted to the new level of ability and then his or her expectations change. It's a bit like a moving goal post or using a shorter yardstick for measuring desired outcomes. Showing the benefit of treatment becomes a challenge because patients change their internal standards for how they view their pain or other symptoms. They may reassign importance of one symptom over another.


After looking at the diagrams and reading the procedure on how it is placed, I think it's really painful to have one on.

It seems more painful than my recent operation, to be honest.

Woodworking Plans

one of my friend have this

one of my friend have this problem and this is very useful article for him.
Buses for sale

Nutrients are the chemical

Nutrients are the chemical elements that make up a food. Nutrients are the basics of what you eat that give your body what you need for "running the show", that is, for metabolism. Certain nutrients such as carbohydrates, fats, and proteins provide energy. Other substances such as water, electrolytes, minerals, and vitamins are needed for metabolic processes.
great essays

The backbone is the complete

The backbone is the complete support for the man to do his daily routine and we need to take care of it.
domestic cleaning services

This is a good breakthrough

This is a good breakthrough for media communication to be used in such rural community and this should be also done in such a way whether or not people would spare their valuable time.
dependable auto shippers

Psychologic factors are as

Psychologic factors are as important in recovery as physical factors. Worrying won't help. In fact, worrying can slow down and even halt your return to normal. A positive attitude goes a long way in a situation like yours.
my computer is slow

Diabetics should avoid

Diabetics should avoid exercises that involve pushing or pulling heavy objects and lifting weights. Blood sugar levels and blood pressure are raised during this kind of exercise.

Yes I agree with you that

Yes I agree with you that The patient also reports fatigue. All of these symptoms are present in early adulthood. Some patients recall similar symptoms in childhood.
german speaking countries

Avoid doing anything that

Avoid doing anything that makes the pain worse or carries the risk of re-injuring your back. What exercises are safe to do depends on the activity and on what exactly is wrong with your back.
Car Loans


It's no what considered to be a traditional way of medicine, but I am sure it's highly effective. hyip monitor

Scoliosis is an abnormal or

Scoliosis is an abnormal or exaggerated curve of the spine from the side or from the front or back. Adult degenerative scoliosis is different from the type of scoliosis that occurs in teenagers. Adult degenerative scoliosis occurs after the spine has stopped growing and results from wear and tear of the spine. The condition most often affects the lumbar spine.
virility ex

Many physical therapists

Many physical therapists subscribe to this theory and are trained in the McKenzie technique. But there hasn't been enough evidence so far to prove the technique is a reliable predictor of long-term results.
digital agency

Switching from using X-rays

Switching from using X-rays to ultrasound when doing nerve blocks is possible now that today’s ultrasound machines produce high quality images.And the devices are small enough to be portable making the procedure available in a clinic rather than in the radiology department.
boys clothes


there are few professionals available to refill and adjust the pump in some areas. This may complicate your care and necessitate travel to a center that can provide this service.

Comment viewing options

Select your preferred way to display the comments and click "Save settings" to activate your changes.

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C.. Content is the sole property of Medical Multimedia Group, LLC and used herein by permission.

Back to top

MySpace Tracker