Intrathecal Pain Pump: Treating Difficult Cancer Pain

Apr 3, 2019 | Jason Eldrige | @jasonseldrigemd

women with cancer and friend

Of all the challenges patients may face, one of the most difficult scenarios may be pain related to cancer.  In addition to being a serious medical problem that warrants immediate concern over one’s well-being, patients often worry about suffering with physical discomfort during treatment or in the case of disease progression.  Fortunately, for most patients, cancer-related pain can be managed by their primary care physician or oncologist.  Typically, as with other causes of painful symptoms, medical providers initiate trials of conservative therapy which escalate (in step-wise fashion) to more potent medications until appropriate pain control is achieved; these options may include acetaminophen, NSAIDs, special neuropathic medications that suppress pain signals or opioid therapy such as morphine.  Many times, due to the intensity of symptoms or if the cancer grows or spreads, patients may require ongoing or increased opioid medication dosing to treat the pain.

position of pain pump

Oral opioid medication is typically effective for the majority of  patients, but sometimes the oral medication dose leads to significant side-effects (fatigue, mental cloudiness, nausea, and constipation) or the pain relief is not sufficient.  In these situations, when oral opioid medication is problematic, despite increased dosing, some patients with cancer may benefit from consideration of a pain pump.  While most opioid pain medications are taken by mouth, use of an pain pump allows a highly concentrated liquid form to be delivered directly into the spinal fluid.  In this manner, medication from a pain pump is many times stronger (300x) than its oral opioid pill equivalent.  Furthermore, because the drug is delivered into the spinal fluid instead of the blood stream (as with pills), it is usually possible to lessen the side effects associated with the medication.  All of these factors may lead to less fatigue, improved mental sharpness, and fewer side-effects generally.  In addition, new and different pain medications may be given through pain pumps that are not available to take orally — local anesthetics, such as bupivacaine, are one such option.

The best way to determine if this device will help is to seek evaluation with a pain medicine specialist.  They will review your clinical situation in great detail, and be able to discuss all of the pros and cons for the various pain-related therapies available.  If deemed an appropriate candidate, your pain medicine physician will also review or order spine imaging (such as MRI) in order to assist in safely placing the device.  The pain pump device does require a simple surgery to implant beneath the skin, and typically involves an overnight hospital stay for monitoring and medication dose adjustment.  Used in the right patient situations, implantable pain pump devices have been shown to increase the quality of life and lessen the pain related to cancer symptoms.   Your oncologist or primary care provider can refer you to the Pain Medicine Clinic, at which point the entire list of possible pain relieving therapies can be reviewed.

pain pump

Implantable Pain pumps (aka ITP, IDDS, "pain pumps") include a central reservoir to store liquid medication, that is connected by a tiny tube that delivers the drug to the spinal fluid. The entire system is implanted beneath the skin, with medication refills occurring every few months during a simple outpatient clinic visit.

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