This modality is usually offered to patients who have been tried on a variety of medical and minimally invasive treatments (e.g.
epidurals) without significant success, or when patients experience a lot of side effects with their current medical regimen. An
infusion pump has been used in patients with spasmodic conditions, cancer related pain, and in selected patients with non
cancer related chronic pain. Usually patients who are candidates for this modality have been taking higher amounts of
medications. However, patients who have good pain relief from their medicines but are experiencing significant side effects
(e.g. sedation) are also good candidates. The pump is a wireless and programmable reservoir that is placed in the abdomen
underneath the skin. A catheter from this pump is tunneled under the skin to the back where the medicine is delivered to the
fluid the bathes the spinal cord. By doing so, superior pain relief is achieved by far less amount of medication. Many of the
side effects of medications taken by mouth are no longer an issue given the fact that a lot less medicine is required. This
pump is usually filled every month or for some every couple of months or so.
Prior to implantation of the pump, the patient may be asked to have a psychological evaluation ( mandated by some insurance
companies), making sure that the patient is a good candidate for this procedure. Also, every patient must have a trial. During
the trial period, usually the patient will be admitted to the hospital and an epidural catheter will be placed in the back. Through
this catheter, an infusion of medication will be given through an external pump. There is no incision for this part and the
catheter will be removed at the end of the trial period, which can last between 24 to 72 hours. If there is a good response, the
patient will be scheduled for the final phase which is the implantation.
The implantation is done some time after a successful trial. Usually, general anesthesia is used for this phase. In this phase,
the pump will be placed under the skin in the abdominal or gluteal area and gets connected to the catheter that is placed in
the back for medication delivery.
The patient will be provided with more information and some educational packets on this modality if he/she is a candidate for
this procedure.
