Chronic pain is very common, affecting people all over the world. A 2023 article on pain pumps explains that chronic pain affects: “13–50% (of the population) worldwide out of which 10–14% is moderate to severe in intensity”.
Medical professionals are always looking for effective ways to treat chronic pain, especially for patients who haven’t had success with standard treatments.
Pain pumps are one way doctors can help patients with severe chronic pain. But what are they and how do they work? We’ll break it down together.
What is a Pain Pump?
Pain pumps are surgically implanted devices that deliver pain medication straight to the nervous system. They can help to reduce chronic pain for many pain patients.
The device consists of the pump itself powered by a battery; a reservoir (where the medication is stored), and a catheter (a small medical tube). The pump and reservoir are implanted in the abdomen, and the catheter runs from there into the spinal cord.
Pain pumps are also called intrathecal pumps or sometimes an ‘implanted intrathecal drug delivery system’.
How Do Pain Pumps Work?
Pain pumps are programmed to regularly deliver small doses of pain medication from the reservoir inside the pump. In some cases, the patient is given a device so they can control when the medication is delivered. This is known as patient-controlled analgesia (PCA).
The medication is delivered through a catheter to the subarachnoid or intrathecal space (they both refer to the same area). This is the area between the spinal cord itself and the membranes around it. There is cerebrospinal fluid in this space (the fluid that surrounds and protects the spine). When the medication reaches this fluid, it can be absorbed and distributed into the nervous system.
Several medicines can be delivered via a pain pump depending on the patient’s needs. These include:
- Anaesthetics (that work to numb your pain)
- Drugs to reduce muscle contractions and spasticity
- Other pain medications including Ziconotide (an analgesic medication)
The most obvious benefit of having a pain pump is reducing pain levels and making chronic pain more manageable. One 2023 study states that pain pumps can be used in a way that: “profoundly relieves a patient’s pain and improves their body functions along with their quality of life.”
A systematic review of intrathecal pumps assessed how effective they were at reducing a patient’s pain using VAS pain scores (this is simply a standard method to measure the severity of chronic pain). Higher numbers of VAS pain scores mean more significant pain. The review found: “a substantial drop in pain score from 7.6 pre-therapy to 3.0 post-therapy.”
The pain medication goes straight to the nervous system so it isn’t diluted as it travels through the body. Therefore, medication can be given in much lower doses with a pain pump than with oral painkillers. Studies show that this can produce fewer and less severe side effects.
A 2023 study stated that when using morphine in a pain pump: “the spinal daily dose can be reduced by a factor 12–300 compared to the oral daily dose, which diminishes the systemic side effects.”
Other potential benefits come from having your pain under control such as:
- The ability to do more
- The ability to exercise more and build strength
- Better sleep
- Improved quality of life
- Lower stress levels
- Improved mood
The pump can be programmed to release a patient’s medication throughout the day. This means you don’t need to think about your medication or remember to take it (this can be especially helpful for patients with brain fog).
However, the pumps which can be controlled by the patient can give them a sense of empowerment. Since chronic pain can leave us feeling that we have lost so much control in our lives, this can help to regain that sense of power.
A detailed study gave 125 patients a device known as a personal therapy manager (PTM) to control the medication release through their pump. The study concluded: “75% of patients with a pre-existing pump were more satisfied with the PTM system than with their pump alone, despite the fact that not all patients experienced significantly greater pain relief as a result of PTM use.” The study goes on to explain that the satisfaction came from the patient’s ability to be active in their treatment and regain some control.
Side Effects and Risks
Having a pain pump involves a surgery, and like any surgery it can carry risks and shouldn’t be taken lightly. However, in general, the procedure is well-tolerated and safe.
Risks of the surgery and the pump itself include:
- Allergic reaction to implanted material
- Leak of cerebrospinal fluid
- Short-term back pain after surgery
- Spinal cord damage
- Numbness and tingling
- Scar tissue forming
- Issues with the pump functioning or moving which will require additional surgeries
- Side effects from anaesthesia (nausea, vomiting, headache, fatigue, etc)
The battery of a pain pump will last for up to 10 years, so patients will need ongoing surgeries to replace it. If the pump or catheter breaks or stops working, you will need a surgery to fix or replace it. You will need to recover from the surgery each time, which is something to take into account.
A 2022 review in the Journal of Pain Research explains that the most common issues relating to the catheter are: “catheter dislocation, disconnection, leakage, occlusion, and granuloma formation at the catheter tip.” A granuloma is a collection of cells and tissue that may block the catheter. The review goes on to explain that the most common issues with the pump itself are: “pump repositioning, infection, and battery exhaustion.”
It’s also important to note that pain pumps aren’t a quick fix – they won’t cure the root problem and may not take away the pain completely (the aim is to reduce pain and improve quality of life). Some people may find the pump doesn’t work for them and will need to have it removed.
Side effects once the incisions are healed come from the medication in the pump. Pain medication side effects may include:
- Building a tolerance (meaning your medication dose will need to be increased over time as your body gets used to it)
- Trouble urinating
- Breathing Issues
- Dry mouth
- Mental ‘fog’ and confusion
- Excess sweating
- Hormone changes
- Issues with sex drive
- Decreased immune function
- Increased risk of falls and fractures
- Dry mouth
- Dental issues
One study found that of 181 complications related to a pain pump: “32% were benign and essentially drug-related side effects such as nausea, sedation, and somnolence.” So although side effects are possible, many come from the medication itself which would likely occur even if the patient was given oral medication.
Who Can Have a Pain Pump?
Pain pumps involve a surgical procedure and ongoing monitoring, so aren’t a first line of treatment. A 2023 study on the topic states: “intrathecal drug-delivery devices (IDDDs) are the last resort for the treatment of intractable chronic pain after conventional treatment options have been exhausted.”
Pain pumps are only offered to chronic pain patients where their conditions are complex, pain is severe, and other treatments have failed. Pumps are usually recommended for patients who take daily pain medication.
Pain pumps typically won’t be offered to patients who have a previous history of addiction or opioid abuse. A 2020 narrative review of intrathecal drug delivery systems (IDDS) explains that these patients: “exhibit maladaptive coping patterns, which are not likely to be corrected with IDDS placement.”
A 2023 study on the topic stated that the: “main indications for intrathecal drug therapy in chronic pain (cancer and non-cancer related) include neuropathic pain, postherpetic neuralgia, peripheral neuropathy, and mixed nociceptive–neuropathic pain syndromes.”
It’s important that patients are mentally able to cope with living with a pain pump. A psychological evaluation will be done before the surgery, and often counselling is offered before and after the procedure.
A pain pump may be used for the following:
- Complex regional pain syndrome
- Neuropathic pain (nerve pain)
- Pain from cancer or cancer treatment
- Pain from a nerve injury
- Spasticity caused by multiple sclerosis, cerebral palsy, stroke, etc
- Severe chronic pain where other treatments have failed
What to Expect: Pain Pump Surgery
Before your surgery, you will be given plenty of information about the procedure and the opportunity to ask questions.
Your pain team may trial different medications with you in hospital before your pump is installed. The goal is to decide which medication will work best in your pump. They sometimes do this via injection, or using an external pump attached to a catheter that goes into your spinal cord.
You will also have some tests before surgery to make sure you can cope with the procedure. You’ll be given a surgery date and told not to eat after a specific time the night before.
You might be given a chance to see and hold the same type of pump that will be installed before the surgery. A 2022 study from the Journal of Pain Research explains that this is an important step because it gives patients an understanding of the size and weight of their pump.
During surgery you will be under general anaesthesia, so you won’t be awake during the procedure.
The surgeon will use a small incision on your lower back to get to the correct area. They will then place the catheter at your spine, and use stitches to keep it in place. The surgeon will then insert an ‘extension catheter’ in a sort of tunnel under your skin around your body to reach your abdomen where the pump will be placed.
The pump is round and fairly small. It’s sometimes described as the size of a hockey puck. The pump will be placed under your skin in your abdomen. This study explains that it’s usually placed in the: “lower quadrant of the abdomen” and shouldn’t come in contact with your bones or cause discomfort when sitting, lying, or standing up.
The surgeon will often use a fluoroscopy to ensure everything is placed correctly (an x-ray in ‘real time’).
The pump and catheters will be connected, and the surgeon will stitch up the incisions so you can heal.
Once the surgery is over, you will be taken to a recovery area until you come round from the aesthetic. They will keep an eye on you there for a while then take you to a ward for further monitoring. When the hospital staff decide you’re ready, you’ll be sent home.
You will be given instructions to take care of your incision sites at home, such as keeping them clean and not lifting anything heavy.
It can take up to six weeks to fully heal, sometimes longer. Your surgeon or a specialist will likely see you after a couple of weeks to check the incisions are healing properly and ensure you are happy with how the pump is working.
Living With a Pain Pump
When you’re living with a pain pump, your pain should be reasonably controlled. Your surgeon will have programmed the pump to deliver your medication when needed. Some patients may be given a small hand-held device to control the pump so they can release the medication at a predetermined dose when they need it. If this is the case for you, your medical team will teach you how to use it.
Talk to your doctor if you feel the pump isn’t working for you the way you thought it would. You should also talk to them if you experience any new symptoms, concerning side effects, or hear the pump beeping (it may need maintenance).
Depending on the dosage of your medication, you will need to have the reservoir of medicine in your pump refilled every one to six months. You will likely need to go to the hospital to see your pain management team for this. Alternatively, in some places, a nurse can do it for you at home.
They will use a needle to take out any leftover medication and refill the reservoir. They will also check the battery and make sure the pain pump is working for you and your lifestyle.
The pump has metal parts. This means that if you need tests like an MRI, or go through a metal detector while travelling, you’ll have to inform the professionals involved about your pump. You will likely get a card that explains you have an implanted device.
If your pain pump stops working or you simply don’t need it anymore, it can be removed with another surgery.
Is a Pain Pump Right for You?
If you have severe, ongoing chronic pain and you’ve tried a wide range of treatments that haven’t helped you, a pain pump may be right for you. It’s important to talk to your pain management team or regular doctor about your thoughts and do plenty of research so you can make an informed decision.
If you feel a pump isn’t the right choice, there are lots of other chronic pain treatments you can explore.
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- Denise Wilkes, (2022), “Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency”. Journal of Pain Research Volume 7, 2014