A pain pump is an alternative for treating cancer pain or severe spasticity. In this procedure, medication is delivered directly to the area of the spinal cord via a catheter. The pain pump along with spinal cord stimulation and spinal ganglion stimulation is one of the neuromodulation techniques used to specifically influence signal transmission in the nervous system.
When to use a pain pump?
Applications for a pain pump include:
- Spasticity, for example in cases of
- infantile cerebral palsy
- multiple sclerosis
- spinal cord injury
- stroke
- traumatic brain injury
- tumor pain
What are the advantages of a pain pump?
Patients with tumor pain or spasticity often have to take high doses of medication to relieve their symptoms. Depending on the medication, a certain habituation effect can occur over time, which means that even higher doses are still needed to achieve an effect. This leads to increased side effects and eventual drug dependence, which significantly affects the quality of life of those affected. For example, opiates in high doses can lead to constipation, fatigue and drowsiness, and may ultimately even increase pain, which is referred to as opiate-induced hyperalgesia.
The advantage of the pain pump is that much smaller doses of medication are needed to achieve the desired pain-relieving or spasticity-reducing effect. For morphine, for example, the conversion ratio of oral to intrathecal administration is assumed to be 300:1. The oral dose can thus be significantly reduced or even discontinued entirely.
How is the pain pump implanted?
Test phase
In cases of tumor pain, the pain pump is implanted directly under general anesthesia without a preliminary trial phase.
For patients with spasticity, a trial phase is conducted to determine whether they would benefit from a pain pump. For this purpose, a temporary catheter is inserted under general anesthesia through a small puncture into the spinal canal and connected to an external pump.
For patients with spasticity, the duration of this trial period varies depending on the severity of the spasticity. In cases of very severe spasticity, the trial period may also be combined with rehabilitation.
If the patient does not respond to the therapy, the catheter is removed.
For other chronic pain conditions, the Inselspital employs other neuromodulation strategies, in particular spinal cord stimulation.
Implantation of the permanent pain pump
If the treatment proves effective during the trial phase, the permanent implantation of the catheter and the pain pump is then performed under general anesthesia. The pain pump is implanted under the skin in the abdominal area.
After permanent implantation, rehabilitation may follow, depending on the patient’s clinical condition.
The length of hospital stay is typically two to three days for both the trial phase and the permanent implantation.
The pain pump must be refilled at regular intervals. This is done on an outpatient basis via a small needle puncture through the skin. The interval between refills depends on the concentration of the medication used and the required dosage.