Pump it Up: How Spinal Pumps Work

Question: 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

chronic pain and related termsAnswer: 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.