Pump it Up: How Spinal Pumps Work

Lawrence M. Kamhi, MD
Interventional Pain Management
Beth Israel Hospital
New York, NY

My doctor told me that I'm a good candidate to have a spinal pump. Honestly, I feel like I've tried every other treatment out there: surgery, spinal cord stimulator, pain medications, physical therapy…but nothing helps, and I'm in constant, terrible pain. Do you think a spinal pump will relieve my back pain? Also, how do the doses work? For example, if I have a bad pain day, can I increase the dose? -Fayetteville, AR

I'm going to answer your last question first because it's such a common concern. Patients usually wonder about two things with spinal pumps: if it's possible to accidentally overdose and if the pump will give extra medication when they absolutely need it.

No and no. Now, let me elaborate…

Is it possible to overdose?
Your spinal pump will be programmed by your doctor to release a continuous infusion of medication. In the pump, there's a computer chip that determines the exact dosage and when it's released into your body. The pump has a lockout interval, meaning it limits how much medication can be delivered during a period of time. There is no opportunity for you to make a mistake and take too much medication.

Is it possible to get an "extra" dose?
If, however, you have acute pain (a flare-up of pain that's different from your chronic pain), you won't be able to give yourself an extra "burst" of medication from your pump. In those instances, your doctor may recommend taking an oral medication to relieve your pain. Be sure to discuss those medications, doses, possible side effects, and interactions with your doctor.

With that background information, I can explain a little more about spinal pumps and how they work.

A spinal pump is round and about the size of a hockey puck. During the surgery, it will be placed under the fat in your abdomen or buttock, and then a catheter will run from the pump to the thecal sac (the area around your spinal cord that's filled with cerebrospinal fluid). Generally, this is an outpatient surgery that takes just one to two hours, so you should be able to go home the same day.

As I said above, your doctor will determine the exact dosage. He or she will also determine what medications go in your pump. Typically, two types of medications are used: opioids like morphine and powerful muscle relaxants like baclofen.

Recently, a new class of potent pain medication was approved by the FDA for use only intraspinously (it must be delivered through a pump into the cerebrospinal fluid). Ziconotide, which is marketed as Prialt®, is now a good option for patients who can't tolerate morphine but still need a very powerful medication for pain relief.

The main advantage of a spinal pump over oral medications is that it will give you a steady amount of pain medication over a period of time. This stability should result in more consistent pain relief. For patients like you, who are in chronic pain and have tried many other treatment options without relief, a spinal pump is usually a good option.

Of course, I cannot guarantee that a spinal pump will completely relieve your back pain. Before having it permanently implanted, your doctor will do a screening test to see if a pump will reduce your pain. Using an external pump, the medication will be delivered through a catheter into the thecal sac. If the test reduces your pain by 50% or more, your doctor is likely to recommend that you have a spinal pump implanted.

Last Updated: 03/26/2008
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Interthecal Pump
After eight spinal fusions I would have expected some type of relief. I am fused to the L3-L4 level due to worn out vertebrae and after the last fusion in December I was making progress until two weeks ago when the pain started up again. At this point, I think talking to my Pain Mgmt. physician about the pump will be my final option. I've had everything else prior to surgery from acupuncture, physical therapy, the chiroprator, etc. to no avail. This could be the last straw and I'm only 52 yrs. old.
Sam Dottin - 03/26/2008 - 08:53 pm
Help
I have had two back surgeries,numerous pain medications, physical therapy, spinal blocks, accupuncture, Chiropractice Care, MRI's, CAT Scans, Myleograms and far to many X-Rays. A trial period of a, "Spinal Cord Stimultor" was tried for a five day period. The, "Stimulator" produced approx. 20 percent relief coupled with my nervous system's inability to tolerate its placement. How would the, "Interthecal Pump" benefit vs. the, stimulator? The Laminotomy/Forminotomy done in Floria has left me with non-remitting pain in the, coccyx, vulva and buttocks area. I have lost 38 lbs. and exercise by walking on a daily basis for 2 hrs. daily. I have had to stand to eat, read plus watch TV for over a year. To drive any distance over 50 miles in an auto is almost impossible. gt
gerene taylor - 03/27/2008 - 05:04 am
pain
i have had two surgeries at t-11-t-12 with a fussion and cage with plates and screws my spinal cord was 50% involved in both cases and i have degeneritive diease in all areas especially. In the last year i have been diagnosed with lupus and a form of myositis does this give me the option of any kind of pain implant device?
Bonnie - 03/27/2008 - 05:07 pm
chronic pain,I truly understand
Yes, I truly do because I've had all there is to be done,now muy pain mgmt. doctor wants to put the stimulator,in I've explained to him,that this life is so hard for me.pain is so critical,chronic pain Idon't know what else to do.im in the medical field profession,and i've heard many of my patients,complain of their back pain,but I've never could imagine their pain.Now I truly understand,my back pain,has affected my legs,I can't walk normal,I'm 48 yrs. old and i have a walker and a cane,when I go to the stores such AS WALMART,I HAVE TO SIT IN their chairs just to shop.I walk like I'm 99 yrs. old. I truly hope this stimulator,give my some relief,my pain is so severe/chronic,daily I get no free time.to breathe,play w/my grandchild,the park is out can't play w/her.It's a shame,yes I take morphine,baclofen,lyrica,motrin 800mg,and still daily PAIN.I wish everybody well,in whatever your next treatment is just remember you're not alone ,ok.Try to keep your head up,like I'm trying to do.best wishes to all,oh my pain is due to a fall at work,housekeeping waxed my chair didnt put a sign in it,and of course I went to work,happy go lucky as usually,and I slide out the chair,unto the floor,in 2005,3yrs.later i'm still suffering.and driving is hard for me to.
Beverly Cornell - 03/27/2008 - 11:26 pm
Dr. needs updated info...
I read the post about what they are calling spinal pumps. The doctor is wrong in saying you can not give yourself a bolus when you are having break through pain. They now have something called a PTM, it is basically a remote that allows you to give youeself a bolus when you are having break through pain. It works with the newer pump called the SyncromedII. Med-tronics, the maker of the PTM is waiting for the FDA to approve the new PTM's, as they are all out of the older ones. Med-tronics bought a lot of Palm-pilots and put their device on to them. They are all out of the older PTM's and are just awaiting approval from the FDA on the new ones like I already stated. The new PTM's are said to be much more user friendly according to the Med-tronics rep that I talked to on the 19th of March when I had pump #3 put in.

I tried nerve blocks, R.F.T.C, spinal cord stimulators on each side then a pump. I got my first pump in July of 99, #2 went in Feb. of 2002, last but not least #3 like I stated March 19th.

I am 44 and have total body RSD/CRPS-reflex sympathetic dystrophy-comples regional pain syndrome...which is a chronic pain disorder...what RSD is basically is where your sympathetic nervous system goes into over-load ans starts going into overload and won't turn off. I have had it for over 10 years as result of an on the job injury. I stressed fractured a bone in the top of my right foot. By the time my employer was done taking me through workers comp hearings and appeals, all of which I won, it was 8 or 10 days short of a year from the date of my injury. By allowing that much time to go by before I was able to get into a doctor that knew anything about RSD it allowed the RSD to spread from a spot less than the size of a half dollar to my whole body.

My life will NEVER be the same. I can no longer wear shoes or socks...let alone anything close to my skin, I have days that just air topuching my skin is very painful. Not only do I have a pump but I am also on 9 other medications not counting the 3 that are in my pump.

Like I stated in the top of this post I just wanted to let you all know out there that this doctor does not have the most up to date information on pumps. If you have any questions please go to a group on yahoogroups called Pumpsters. You have to send them a letter to join the group if you are thinking about getting a pump or just looking for more information I would go there...I have learned far more from the people there than I ever have any doctor or nurse.

Blessings to all...
Claudia Runyon - 03/28/2008 - 04:21 am
consider OIH?
I wonder if some of the problems compounding the chronic pain issues are related to the chronic Opiate intake. What was once considered "increased tolerance" to the opiates, is now considered possibly Opiate Induced Hyperalgesia (OIH). Having been on opiates myself for almost 9 years due to a spinal injury, I developed increasing serious pain issues after about a year on the medications that seemed to effect my entire body. I describe it as my body "screaming" in pain. It got to the point that no amount of medication was helping. As I managed to wean off the narcotic medications, for the most part, the pain has been more tolerable. It didn't happen immediately, but over time, the level of pain improved. A paradoxical reaction, and I noticed that there is an increasing interest in this phenomenon. I just want those who are suffering to consider this, do some research, and perhaps try weaning and cutting back on their opiate medications for about 2 weeks using more non-narcotic methods to ride out the severe pain (hot baths/hot tubs /massage) etc...to see if there is an improvement in their level of pain. It is a rough two or three weeks, but then, the body seems to try to correct itself, and the pain becomes less severe. Opiate Induced Hyperalgesia is a relatively new discovery, but frankly, I discovered this phenomena before reading about it recently, and wanted to mention it, hoping it might help some.
DJC. - 03/28/2008 - 12:02 pm
CPS, is their a Doctor in Spokane, WA that treats this?
I have been living with chronic leg pain since 2001, my pain even with all the pain meds is getting worst. A doctor who recently saw me said he believe's I have Central Pain Syndrome. I can't seem to find a Doctor in my area that has ever dealt with this horrible condition. If anybody knows of a doctor, please let me know, I do not want to live the rest of my life in bed. I am a 49 year old women, who is now obese, because any excercise such as walking to the restroom, brings on the pain worst. Even in bed, the pain is constant, but any walking, etc.. makes it worst. So please any advice would be greatly accepted. From a fellow chronic pain sufferer.
Renee' Mace - 04/01/2008 - 01:25 pm
Increased pain after surgery
I had a spinal fusion Dec 06, and the pain after my surgery was horendous!!! I then have had several MRI's that appear normal but I have extreme pain in my lower back and both legs. The pain in my legs is worse than the pain in my back. I can't seem to get no help. The pain in my legs gets worse the more is walk,sit or stand. You can't even touch my skin on my legs. One doctor did suggest the stimulator, I'm at a loss but I need some relief. This pain has cosumed my life and I'm to young for this. Married with one child.
anita - 04/10/2008 - 10:49 pm
back and hip pain
after 8 surgeries, constant pain is unbearable. I take morphine and all other pain meds the dr. will give me.
they are exploring the possibilities of implanting a pain pump. i currently have a electronic nerve stimulator that has not been "hooked" up since my last 2 surgeries. the pain specialist indicates that it would do no good to re-hook the dsc because it is primarily for leg pain. the last two surgeries have cured my leg pain but a trail from my spine to my right hip is a very large rod heated to umteen degrees and hurts very bad. (that is what it feel like). will a pain pump work is my question, are they cracked up to what they should be? WOULD LIKE TO KNOW ASAP.

THANK YOU
DAN KEENER
Dan Keener - 04/22/2008 - 04:50 pm
I've had a stimulator for 6+ years..
I can relate to everything all of you have said. I am 55 years old and have had constant chronic pain since I was 45. I've been the same route. Chiroprators, Pain specialist, all of the narcotic pain pills, morphine patches, basically anything that was available. I have chronic neck/shoulder/lumbar/leg and hip pain. The only time I don't hurt so bad is when I'm laying flat. I finally decided to have the spinal cord stimulator implant done in July 2001. In the beginning, it seemed to help more than it does now. Now I only use it when I wake up in the middle of the night. It does help me fall back to sleep. (The implant leads only go to the lumbar area.) My neck/shoulder pain has worsened over the years. (4 car collision in 1985) It is almost imbearable. I've had all kinds of injections, a procedure called MUA (manipulation under anesthia) just recently. Nothing helps. So....I am now considering the morphine pump. I feel like it is the only way to get my life back. I'm sick and tired of going thru my days in pain. As for my stimulator...I would never have it taken out and would not take anything for it. It does help and I feel as I get older, it will come in handy even more. But....when you have chronic pain top/bottom of your spine, you have to do something. I used to be so active but can now only do the bare neccesities around my home. I feel like the pump is my last resort. And, I like the fact it only takes a fraction of medication to control the pain. I wish you all the best....Carol
Carol - 04/29/2008 - 08:45 am
I have failed back surgery lumbar region, because one of the screws misfired, and went through my spinal cord, result chronic permanent pain. After trying mostly everything else, I was given a date for a spinal stimulator trial, but had to cancel it because I suffered several prolapses...enterocele, rectocele, uterus, bladder and V. vault. After all of that was repaired, I was given another date, but then my bowel packed in, and they tried sacral nerve stimulation to see if they could get it working again...no luck, so I had it removed, and was left with an ileostomy, and still the chronic pain. Then they changed their mind and decided that after all I was not a good candidate for a spinal cord stimulator, so they wouldnt give me one, maybe they reckoned that as everything else had failed, it would be bound to, so I am condemned to the b....pain potions for ever.
mary - 06/04/2008 - 03:09 pm
chronic pain
I'm 40 years old, and have had 8 back surgeries and none a success. I am fused from T-1 to my hips . The only vertabraes not fused is my cervic I can only turn my neck, and my doctor says my neck needs to be fused, (they say to much stress from all the other fusions) I have 28 screws and 10 bars up and down and across) I also have a part of my vertbrae at l4 -L5 cut out in a "V"
Was doing great untill 6 weeks after my last surgery. I was told I have archnoiditis. They tell me this is what will cripple me!!!! There is no cure. !!!! It s--ks ! I was not told about this side effect, till after !!!! I have a medi-tronic pump and it gets me around during the day,
they say this is to prolong my life, a little. Thanks, constant pain medicine, thru a pump, and additionable pain meds taken through out the day, Oh ya best past I can't go the bathroom with out medicine. And no period since pump put in (that is good thing - but they are worried)

thanks for reading,
.Tracey R - michigan - 06/18/2008 - 05:38 pm
arachnoiditis
my son was diagnosed with leaukemia in 2001, treatments for leaukemia for him were spinal injections of methotrexate, he had just under 22 spinal intrathecal injections, each time he had an inejction they stuck him anywhere from 6-27 times before they drew clear spinal fluid, fluid at all or were able to progress on with the procedure which was to draw out clear spinal fluid, as much as they were going to put back in of chemotherapy. Thus, he is alive and in remission from leukemia, but has arachnoiditis and takes methadone, morphine, tegratol, neurontin, glucosamine chondroitin, just to get through the day can't drive since he takes narcotics, not that they do much anymore, but it is still in his blood if he would get in a wreck or something, so he is pretty much homebound, and now he is 23. They are wanting to do a pump but supposedly they only help leg pain, he has all nerve back pain.
Paula/Illinois - 07/14/2008 - 04:38 pm
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