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Intrathecal Pumps Thomas Yeargin Biomedical Engineering BME 281 Section 1 What is an Intrathecal Pump? • Method of giving medication directly to the spine to cure intolerable pains • Small pump surgically placed under skin of abdomen • Delivers medication, usually morphine, through a catheter to intrathecal space of spine • Can release medication slowly over period of time or can be programmed to release different amounts periodically Reasons for Intrathecal Pumps • If one is dependent on pain medication • If one could not benefit from additional surgeries • Cancer pains • Lessen spasticity from cerebral palsy or multiple sclerosis http://www.swarminteractive.com/images/thumbs/pumpimplant_300.jpg Is it for you? • Must go through complex trial to see if treatment decreases pain/spasticity • Single injection through lumbar puncture • Multiple injections over the course of days • Continuous trial- catheter placed in correct area of the spine connected to external pump • Dose is increased every two hours until patient feels pain relief Types of Intrathecal Pumps • Two major types of intrathecal pumps: • Implanted pump with a constant flow rate -dosage cannot be changed • Fully implanted pump with programmable pump -Programmed by computer so doctors can change dosages to meet patients needs http://www.medgadget.com/2012/09/ascenda-a-stronger-catheter-formedtronics-baclofen-synchromed-ii-pump.html Medications • First line of medication is morphine, provides good analgesia in patients • Second line of medication is morphine with the addition of bupivacaine or clonidine -better for patients with neuropathic symptoms • Third line is the combination of both bupivacaine and clonidine with morphine -Third line only used if line one and two fail Surgery • Takes about 3-4 hours • Catheter is placed in intrathecal space of spine • Pump is placed in between skin and muscle layers of the abdomen • An extension catheter is passed under the skin from the spine to the abdomen to connect to the pump. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/ Living With the Pump • Must schedule medication refills on a regular basis • Effectiveness of treatment will be assessed at the checkups • Tell doctor if feeling unusual symptoms or drug overdose • Withdrawal symptoms could happen and can possibly be very dangerous Risks/Side Effects • Infection or bleeding from the surgery • It is very rare but the catheter could move out of place or the pump could stop working • Accumulation of cerebrospinal fluid around the pump causes a watery discharge from incisions or headaches • Side effects could include respiratory depression, twitching, muscle spasms and nausea Results of Pump • Depends on the severity of the condition of the patient • Chronic patients experience a reduction of pain as well as overall improvement in everyday activities • Spasticity patients experience a reduction in rigidity and muscle spasms • Oral medications are reduced because of the direct delivery of medication to the spinal cord from the pump Conclusion • It has already surpassed oral medication and is proven more efficient • Most patients find that this type of medication works well for them and there are not many risks or side effects that come with it • If researchers can find a better design for the catheters then the future for this pump is very bright Questions?? References • [1] Mayfield Clinic and Spine Institute. " intrathecal Drug Pump." Pain Pump, Intrathecal Drug Delivery, Drug Pump. N.p., Mar. 2013. Web. 16 Oct. 2015. <http://www.mayfieldclinic.com/PEPUMP.htm#.ViBO27RViko>. • [2] Knight, Karen H. et al. “Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates.” Croatian medical journal 48.1 (2007): 22–34. Print. • [3] Lee, Kung-Shing, Kowng-Shing Chu, Chia-Li Chung, Chiuh-Lung Lin, Shiuh-Ling Hwang, and Shen-Long Howng. "Review Article Intrathecal Drug Delivery System with Programmable Morphine Pump for Pain of Terminally Ill Cancer Patients." CiteSeerX. N.p., 2009. Web. 17 Oct. 2015. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.537.7707&ra nk=27.
