Chronic pain and cancer pain can be managed with new advances such as implanted intrathecal morphine pumps and spinal cord stimulators.
Intrathecal Morphine Pump Placement
An intrathecal morphine pump is a special device that delivers continuous small amounts of morphine or other pain medication through a catheter into the fluid surrounding the spinal cord. The pump is used for cancer pain and chronic pain that does not respond to other pain treatment methods. The pump is also effective in reducing spasticity associated with cerebral palsy and multiple sclerosis with a medication call Baclofin.
How is the pump inserted?
In the operating room, a tubing is surgically inserted in the middle of the lower back connecting to the cerebral spinal fluid space the spine. The pump is implanted on the abdominal wall. General anesthesia will be used which means the patient is asleep for the procedure.
How long does the pump last?
The battery-operated pump needs to be refilled at least every three months. This is done by inserting a needle through the abdominal wall. The batteries in the pump last from about three to five years, depending upon usage. At that time, the entire pump is replaced, as the batteries cannot be replaced.
Spinal Cord Stimulators
Spinal cord stimulation is a type of neurostimulation that can be effective in relieving persistent or severe neuropathic pain.
Spinal cord stimulators typically consist of three components designed to work together as a system: two implanted components (a power source and leads) and an external controller. The power source generates electrical pulses, which are carried by the lead to electrodes at the end of the lead. The external controller allows the doctor to program the power source to generate pulses customized for the individual receiving the therapy.
A relatively short noninvasive surgical procedure is required to place the electrodes in the space above the spinal column (epidural space). When the power source is turned on, the electrodes stimulate the nerve fibers associated with the areas of the body affected by pain. For many people, this stimulation of the targeted nerves effectively changes pain messages and replaces the pain with a tingling or massaging sensation called paresthesia. For many patients, paresthesia is much more tolerable than the pain, making spinal cord stimulation a good option. However, for some patients paresthesia is not tolerable. A trial procedure is normally performed to determine a patient's response to spinal cord stimulation.
Spinal cord stimulators are surgically implanted devices designed to provide relief from chronic pain. Prior to placing an implantable spinal cord stimulator, patients typically receive a trial of a temporary stimulator to assess the efficacy of stimulation in providing pain relief for that patient.