Pain Pumps and Intrathecal Medication Pumps—Implantation in Neurosurgery and When Are They Used? An Overview of Pain Pump Implantation

A pain pump is a device that continuously delivers pain medication directly to the site of the pain. This procedure is part of neuromodulation therapy. Neuromodulators are substances that affect the nervous system. The body produces these substances on its own. However, substances introduced from outside the body, such as medications or drugs, are also neuromodulators.

With a pain pump, the patient can adjust the dose of pain medication themselves at any time. For example, they can reduce the dose to minimize the severity of unwanted side effects. A distinction is made between implantable and external pain pumps.

A pain pump continuously delivers a dose of pain medication—preset by the doctor—into a vein or directly to the spinal cord. There, the medication directly interferes with pain transmission. With some pumps, the patient has the option to administer an additional dose. To prevent an overdose, the pump is then locked for a certain period of time, preventing further administration.

Intrathecal pain pump

With an intrathecal pain pump, a catheter is inserted into the spinal cord. The pain pump is usually implanted under the skin in the upper abdomen, below the rib cage. With an implanted pump, the pain medication reservoir must be refilled by a doctor approximately every two months. However, external devices can also be connected to the catheter.

Venous pain pump

With a venous pain pump, a thin tube is inserted into the subcutaneous fatty tissue through a small needle. It can also be placed into a port to provide venous access. The pain pump is then connected externally.

A pain pump is used to continuously relieve pain. In some cases, the patient can adjust the dose themselves © catalyseur7 | AdobeStock

Pain pumps are used

• for patients with severe chronic pain,
• in cancer patients with severe tumor-related pain, and
• after surgery

. After surgery, external devices are generally used. For patients with chronic pain and tumor-related pain, doctors usually implant pain pumps under the skin.

The implantation of a pain pump must be evaluated on a case-by-case basis. It is primarily an option for patients who suffer from severe side effects of pain medications, such as

• gastrointestinal problems or
• liver and kidney strain.

An implanted pain pump provides effective and rapid pain relief for patients with cancer-related pain. It allows cancer patients to lead a largely pain-free and self-determined life.

It is important to

• close monitoring by a pain management specialist and
• the patient’s ability to operate the pump independently.

Patients with the following conditions are not suitable candidates for pain management with a pain pump:

• Allergies to opioids,
• drug or opioid dependence,
• severe depression or active psychosis,
• severe sleep disorders,
• severe cognitive deficits (only in patients not under medical supervision),
• sepsis or active infections,
• uncontrolled blood clotting disorders,
• tumors or adhesions in the spinal region that prevent the free flow of cerebrospinal fluid

The implantation of a pain pump is performed in two steps.

First, a catheter is advanced to the spinal cord and connected to an external pain pump. During the so-called test phase, the doctor and patient can determine whether pain relief can be achieved and at what dose. This phase also assesses whether the patient tolerates the pain medication. If the test phase is successful, the pain pump is permanently implanted.

The following side effects and risks may occur during the implantation of a pain pump:

• Surgical complications (e.g., infection),
• Blood or fluid accumulation at the pump’s implantation site,
• cerebrospinal fluid leak and spinal cord injury,
• Catheter displacement or blockage,
• formation of connective tissue at the tip of the catheter.

The following side effects may occur as a result of the administration of pain medication:

• Nausea and vomiting,
• fatigue,
• urinary retention,
• Itching,
• Muscle twitching,
• Respiratory depression.

What is a pain pump?

A pain pump is an implantable pump designed for targeted pain management. A medication is administered directly into the intrathecal space of the cerebrospinal fluid via a catheter. The intrathecal medication pump provides effective pain relief for chronic pain and can achieve the desired effect with a lower dose than oral medications.

When is a pain pump used?

A pain pump is primarily used for treatment-resistant pain when other pain therapies are not sufficiently effective. Patients with chronic pain, cancer-related pain, or severe neurological disorders often benefit from this treatment. The implantation of a pain pump may also be beneficial in cases of spasticity, cerebral palsy, paraplegia, or following a traumatic brain injury.

How is a pain pump implanted?

A trial phase usually precedes the final implantation. The pump is then implanted in the abdominal area and connected directly to the spinal cord via a thin tube or catheter. The catheter is implanted during a minimally invasive procedure, often under general anesthesia. After the surgery, the dosage is determined on an individual basis and programmed into the pump.

What medications are administered via a pain pump?

Depending on the condition, various pain medications can be used. Morphine, hydromorphone, fentanyl, or other opioid medications are frequently used. Baclofen is often used to treat spasticity. The medication is administered continuously and can act directly at the site of action, which may result in fewer side effects.

What are the benefits of a pain pump?

A key advantage of the pain pump is targeted medication delivery. As a result, a lower dose may be sufficient while simultaneously providing better pain relief. Many patients report a better quality of life, fewer side effects, and improved mobility. Modern pain pumps and medication pumps are programmable and even enable patient-controlled procedures such as PCA pumps, PCEA, or patient-controlled regional anesthesia (PCRA).