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All Posts Tagged: Intrathecal pump therapy

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ROLE OF INTRATHECAL THERAPY IN PAIN MANAGEMENT

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An intrathecal pump therapy is a method of giving medication directly to your spinal cord. The therapy uses a small pump that is surgically placed under the skin of your abdomen. The pump will deliver medication through a catheter to the area around your spinal cord. Because the drug is delivered directly to the area which delivers pain signals, your symptoms can be controlled with a much smaller dose than is needed with oral medication and also reduces the side effects of medications.

Who is a candidate for intrathecal pump therapy?

You may be a candidate for intrathecal pump therapy if you meet the following criteria:

  • Conservative therapies have failed
  • You do not have benefitted from additional surgery
  • You are dependent on pain medication
  • You do not have psychological problems
  • You have no such medical conditions that would keep you from undergoing implantation
  • You are not allergic to any of the drugs used in the pump
  • You show positive response with a trial dose of medication

An intrathecal pump therapy can help to lessen chronic pain caused by:

  • Failed back surgery syndrome; failure of one or more surgeries to control persistent leg pain (sciatica), but not technical failure of the original procedure.
  • Cancer pain; persistent pain caused by tumors compressing the spinal nerves, or scarring from previous radiation therapy.
  • Reflex sympathetic dystrophy; a progressive and degenerative disease of the nervous system in which patients feel constant chronic burning pain.
  • Causalgia; a burning pain which is caused by peripheral nerve injury.
  • Arachnoiditis; painful inflammation and scarring of the meninges of the spinal nerves.
  • Chronic pancreatitis; chronic abdominal pain caused by inflammation or blockage of the pancreatic duct.

An intrathecal pump therapy can help to lessen muscle rigidity and spasms that make movement of the arms, and legs difficult caused by:

  • Cerebral palsy; a nervous disorder which impairs control of body movement.
  • Multiple sclerosis; a disorder of the brain and spinal cord caused by damage to the outer layer (myelin) of nerve cells.
  • Stroke; brain damage from lack of oxygen; due to an interrupted blood supply.
  • Brain injury
  • Spinal cord injury

 

Which medicines are using in intrathecal pump therapy?

The intrathecal pump therapy uses following medicines for pain management;

  • Baclofen
  • Bupivacaine
  • Clonidine
  • Morphine
  • Ziconotide

These medicines are delivering in this manner that intrathecal pump therapy minimize the side effects which are often associated with the higher doses used in oral or intravenous delivery of these drugs.

Procedure of the surgery

There are two parts of the intrathecal pump therapy procedure first is the placement of the catheter in the intrathecal space surrounding the spinal cord, and second is the placement of the pump/reservoir in the abdomen. There are five main steps of the procedure. The operation usually takes 3 to 4 hours.

  • Preparing the patient for the procedure
  • Catheter placement in the intrathecal space
  • Tunneling of the extension
  • Placement of the pump
  • Close the incisions

What to do after intrathecal pump therapy?

  • Take pain killers as directed by your doctor.
  • Ice your incision 3 to 4 times a day to reduce pain and swelling.
  • Do not lift heavy things for 2 weeks.
  • Do not drink alcohol for 2 weeks.
  • No strenuous activities for 2 weeks.
  • Avoid sitting for too long.
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Intrathecal Pump Therapy Procedure and Possible Complications and Who Are the Suitable Candidates for Intrathecal Pump Therapy

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This is a technique for delivering medication straight to the spinal cord. In case, all other traditional techniques have been unsuccessful to relieve long term symptoms, then a pain pump might be an alternative treatment. Based on the fact that the medication is delivered straight to the spinal cord, it can work in a way to control the symptoms with a much smaller dose than is required with oral medication. The objective of intrathecal pump therapy is to efficiently control the symptoms and to diminish oral medications.

The Anticipated Outcomes after the Procedure

The patient will wake up in the postoperative recuperation facility. Furthermore, the patient’s blood pressure, heart rate, and respirations will be observed, and the pain will be addressed. In most cases, the patient is allowed to go home the same day. The patient will be provided with the written instructions to follow. Outcomes will differ contingent upon the underlying condition being dealt with and its seriousness.

Possible Complications after Intrathecal Pump Therapy

In this case, the adverse effects are minimal, in spite of the fact that they do exist. Similarly, as with all surgeries, complications may incorporate infection and bleeding. The catheter could move or end up blocked, or the pump could quit working (however, rare). The fluid can gather around the pump resulting in a clear watery discharge from incisions or result in a headache. However, these normally vanish on their own but may require a drain.

Adverse effects from the medications may incorporate:

  • Respiratory Depression
  • Twitching
  • Muscle Spasm
  • Urinary Retention
  • Constipation
  • Nausea
  • Vomiting
  • Dizziness
  • Anxiety
  • Depression
  • Edema

Contingent upon how much medication the pump delivers, the battery will eventually be required to replace.

Possible Limitations after Intrathecal Pump Therapy

The patient will be advised to stay away from particular activities for around six to eight weeks in order to avoid movement of the catheter. Moreover, no bending, twisting, stretching, raising the arms over the head or lifting heavy objects. Prevent sleeping on stomach. No climbing stairs or sitting for extensive periods.

The patient will be advised to avoid driving for 2 to 4 weeks after surgery or until examined with their surgeon. Furthermore, housework and yard-work are not allowed until the first follow-up office visit. This incorporates gardening, mowing, vacuuming, ironing, and loading/unloading dishwasher, or dryer.

Who Are The Suitable Candidates?

This procedure incorporates individuals for whom traditional treatments have been unsuccessful. The decision of treatment relies upon the sort of pain, how serious it is, and how you react to pain treatment. In the event that the doctor thinks you are a decent candidate for intrathecal pump therapy, you can go through a trial screening test so you can go through the treatment to check whether you are a decent candidate.

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2018-08-04

New innovations are a step towards pain free life

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An intrathecal pain pump implantation, or targeted drug delivery, is often considered as an option to relieve chronic pain. This therapy has been recommended as an advanced therapy for patients with cancer and non-cancer pain after systemic medicines have failed. Intrathecal pump therapy for cancer pain reduces pain by delivering medication directly to the area surrounding the spinal cord, thus requiring much smaller doses of medication for relief.

A pump and catheter are surgically implanted beneath the skin by an IPI physician. The pump, implanted in the abdominal area, is connected to the catheter, which is tunneled under the skin to the specific site where the medication is needed. Intrathecal therapy involves the administration of analgesic and antispasmodic medications directly into the spinal fluid for control of pain and spasticity.

When using intrathecal therapy in the management of pain, the physician often uses much lower doses of analgesics to improve pain control, thereby limiting the side effect burden associated with higher doses of systemic analgesics. Pain management with intrathecal therapy has been shown to improve pain control and side effects over systemic analgesics alone.

However, significant side effects and complications can occur with implantation and management of these devices. In addition to routine complications that occur with any surgical procedure, the pumps, catheters, and drugs infused in the pumps all carry their own complications. The pain pump and catheter are implanted under the skin which is why surgical complications are a possibility. The side effects embrace infection, spinal fluid leak, and headache. You should avoid the implant procedure if you have an active infection at the time scheduled for implant.

Once the infusion system is implanted, device complications may occur, which may require surgery to resolve. Drug overdose or underdose can result because of these complications and have serious and even life-threatening adverse effects. Further potential complications include the catheter or pump moving within the body or wearing through the skin. The catheter could leak, tear, kink, or become disconnected.

However, there are a lot more advantages which is why hundreds of people opt for this method to reduce their pain. The following advantages may convince you to think about it;

  • It’s safe and effective when used as directed
  • Does not involve permanent changes to the spinal cord or nerves
  • Can be adjusted to dispense medication according to your activity level and pain patterns
  • Lets you try the therapy for a short period of time before committing to long-term therapy
  • Is reversible—the therapy can be turned off, or if desired, it can be surgically removed

Still feeling confused? Call us at 815-464-7212 and get Dr. Zaki’s expert opinion. Dr. Zaki Anwar, MD an Anesthesiologist and Interventional pain management professional offers its patients a range of exceptionally personalized treatments and services to help facilitate the patients in struggling with severe pain. Hurry up! Before it’s too late!

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2018-05-10 (1)

Treating cancer pain

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An Intrathecal drug administration or Intrathecal pain therapy has been the backbone for the management of excruciating uncontrollable pain to systematic pain treatments. Since the therapy is well accepted in there are still some complications observed in clinical practices to its implementation with patients with cancer.

With advanced clinical practices, there are potential chances that access to therapy for the management of cancer pain will increase

Cancer pain continues untreated and a potential number of patients with cancer perish while enduring severe untreated pain every year. Moreover, on an average at least 1.7 million new cases of cancer are diagnosed, which are expected to rise

A wide range of chronic cancer pain can be managed by drug therapies, still many patients fail to achieve adequate relief  despite of the availability of many conventional methods. Treatment of cancer pain has taken a new turn to chronic pain management strategies, particularly among cancer pain survivors.

An Intrathecal drug therapy is one of the game changing treatment and provide a substitute for the administration of  pain killers and relieve pain while minimizing side effects

Candidates for ITT

Since a range of cancers is accompanied with greater onset of pain, appropriate patient screening for Intrathecal drug therapy is crucial to evaluate who may benefit from Intrathecal pain pump

The patient selection procedure involves

  • Patient diagnoses and survival chances
  • History of Opoids taken
  • Location and type of pain
  • Catheter location
  • Tolerance of an Intrathecal pain pump’s treatment
  • Psychological and cognitive status

Prior to implantation, it is important to get a clear diagnosis, a complete physical exam and psychological evaluation. Once it is conclusively proved that an Intrathecal Pain Pump therapy beneficial for the patient, the patient must address psychiatric issues that can negatively impact treatment outcome

In addition, all patients should have realistic expectations of  Intrathecal Pain pump therapy for pain relief and understand how it may impact their daily life

Generally an Intrathecal pain pump is recommended after several attempts of conventional pain relieving treatments. Intrathecal drug delivery involves the implantation of highly concentrated solutions in the intrathecal space. The medication restricts pain signals to the brain. When administered Intrathecaly the Opioids may offer greater pain relief at the potentially lower doses with minimal side effect

Complications

In spite of its comparatively small doses of Opiods, increased doses of Intrathecal Opioids may lead to complications including, nausea, vomiting, constipation, respiration problems , sexual dysfunction, urinary retention, and sedation.

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How an Intrathecal Pain Pump can help with Chronic Pain

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The FDA has recently approved an Intrathecal pain pump delivery method of medications that may eliminate or reduce the need for structured Opoids

The basics about the Intrathecal Drug Delivery System

The Intrathecal pain pump is an implantable pump that provides targeted delivery for chronic pain and severe spasm. The Intrathecal pain pump delivers medications straight to the fluid surrounding the spinal cord, which Dr. Zaki Anwer, MD, says, provides relief at minimal dosage as compared to the oral medications in sufferers with chronic pain and severe spasm

The pain pump is designed to ease therapy management by providing physicians with perceptible aid and intuitive workflows

The most suitable candidates for the Intrathecal pain pump are the chronic pain sufferers, unmanageable pain and severe muscle contraction, other treatments have failed to provide relief and have endured unbearable side effects with medications

Reducing or Eliminating Systemic Opioid Use

Dr. Zaki Anwer, MD, at The Pain Management Institute, Chicago, Frankfort says “ With continuous Opoid crises the ability to minimize the use of structured Opoid and efficiently manage my patients with pain is more important than ever.”

He adds “The pain pump aids in simplifying the therapy management, enabling me to focus on providing my patients with pain relief through the Intrathecal delivery of medications so that structured Opioids are reduced or eliminated entirely”

How it’s performed

An Intrathecal pump is surgically implanted under the skin by an expert physician. The pump is implanted in the abdominal area, is linked with the catheter, which digs under the skin to a specific area where the medication is required

The therapy has been proven to be safe and effective when used as directed

  • Does not involve permanent changes to the spinal cord or nerves
  • Can be adjusted to dispense medication according to your activity level and pain patterns
  • Lets you try the therapy for a short period of time before committing to long-term therapy
  • Is reversible the therapy can be turned off, or if desired, it can be surgically removed

Conclusion

In addition to the usual risk of surgery and anesthesia at the time of introducing the pain pump and catheter tubes a variety of side effect may occur directly associated to the pump, the catheter mechanism, the drugs and the refilling process at the time of surgery or following the surgery when the pain pump remains in the position, patients are notified of the infection, failure to control pain development of spinal headache, spinal cord or nerve injury, drug overdose, or adverse reaction to the drugs and equipment malfunction can all occur at, or around, the time of insertion.

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Are you enduring chronic back pain and lost hope?, here is what you need to know

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After years of enduring tormenting chronic back pain and being told there was no probability of improvement CiaraCollins of New York finally got her happy days back, thanks to unique treatment she received at The Pain Management Institute. The excruciating pain was due to chronic nerve damage the 28 year old mother of two, encountered after several lower spine surgeries she has undergone five years earlier. Doctors informed her that there is no treatment that can help with the pain and she has to endure it for the rest of her life. The candle of hope lightened when Ciara met Dr. Zaki Anwer, MD, the Pain Management Institute, where she was implanted with Intrathecal Pain Pump to manage her debilitating chronic pain

Ciara had travelled to visit Dr. Zaki Anwer, MD, a pain management specialist, after loosing hopes by several other doctors. Dr. Zaki Anwer, MD, tried a few treatment options including injections and medications. However, after no results he suggested an Intrathecal pain pump trial, a procedure in which a small amount of Opoid pain medication is injected into the epidural space, the trial was exceptionally successful for reducing Ciara’s pain and Dr. Zaki Anwer, MD, referred her a permanent placement of Intrathecal Drug Pump at Pain Management Clinic

The Pain Management Institute is a collaborative, multidisciplinary effort to alleviate pain and restore function by application of technology and medicine,” says Dr. Zaki Anwer,MD, “For the suitable candidate the spinal cord stimulation or Intrathecal Pain Pump therapy can potentially reduce pain and improve the quality of life”

The Intrathecal pain pump therapy is a treatment option for patients enduring chronic pain that does not respond to other treatment options. The is a hockey puck sized that is surgically implanted into the abdomen and works by pumping medications straight the area where the spinal cord is found, also known as the Intrathecal Space. The medication then affects the pain receptors in the spinal cord and the brain to reduce the pain.

Since the medication is released continuously, it is much more effective than oral. Consequently, less medication is taken to manage the pain and the patients are likely to experience fewer side effects, such as nausea, drowsiness, constipation and mental fogginess

Following a successful surgery of having implants Intrathecal Pain Pump and weeks later refilled with medications, Ciara was finally able to manage her pain. She praises the dedicated yet sympathetic staff of the Pain Management Institute helping her get back her happiest days. “Dr. Zaki Anwer, MD, gave me something that I lost hope of, the light of hopes after a very dark period” said Ciara, “My words are limited to express how thankful I am to have an amazing Pain Management Specialist’s care for me”

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What you need to know about the benefits and risks of Intrathecal pump therapy?

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Overview

The Intrathecal pump therapy is the process of providing medications directly into the spinal cord. The therapy is followed by the use of a small device attached to a thin tube called catheter. The device is surgically implanted under the skin the basic purpose of the pump is to relive pain and  reduce side effects from oral medications

Advantages

There are several advantages of Intrathecal pump therapy that may include

Immediate and long term pain relief, Increased mobility of the spinal cord, participation in routinely activities and physical workouts,  Less intake of oral medications, resulting in lower side effects and reducing dependency on oral medications. The Intrathecal pump therapy is potentially safe and highly effective. The Intrathecal pump therapy does not include any permanent changes in the spinal cord or the nerve network.  The therapy is reversible and easily testable and can be adjusted according to your needs

Risks of the Intrathecal pump therapy

Since the Intrathecal pump therapy is surgically implanted under the skin, there might be complications  that may include; infection, cerebro spinal fluid leakage and headaches. In case of any active infections or allergic reactions it is strictly advised to avoid the Intrathecal pump therapy

The implantation of the drug pump can create several complications that sometimes require surgery to settle, the complications can also be caused by inadequate dosage of the drug an can bring life threatening consequences

The most observed complications include;

The displacement of the drug pump, the leakage from the catheter, tearing or loosen contact of the catheter with the device. The device stops working or in some cases growth of inflamed tissues at the end of the catheter that may result in paralysis

Intrathecal Pump therapy and other chronic pain treatments

Intrathecal pump therapy enjoys priority over other treatments offered for chronic pain due to its uncommon benefits

Prior to implanting the drug pump for permanent bases, a temporary testing period is considered to check if the pain is relieved. The therapy is not permanent such as back pain surgery and can be easily adjustable and reversed, if not needed by the patient, Intrathecal pump therapy dissimilar to oral medication release potentially small amounts of dosage  straight into the spinal cord, reducing pain abruptly. The Intrathecal pump therapy works wonders when all the other medications have failed

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