A pain pump implantation may be done in cases of CRPS where pain is chronic, severe, and does not respond to other forms of treatment. Also called intrathecal pumps, pain pumps are implanted in the body and administer steady doses of a prescribed pain medication. This can be helpful for patients for whom pain medications do not work adequately to eliminate pain.
Pain Pump Implantation Surgery
A pain pump must be surgically implanted into the patient’s abdomen. Prior to surgery, the patient will be given antibiotics and the area will be sterilized. The physician will then make a small incision and insert a catheter that will deliver the pain medication into the cerebral spinal fluid. Once the catheter has been placed, the surgeon will make an incision just large enough to accommodate the pain pump, just below the beltline. The pain pump, which is usually about the size of a hockey puck, will then be inserted and the catheter will be connected. Patients are advised to allow six to eight weeks for recovery.
Pain Pump Implantation Medications
Medications administered through a pain pump to treat CRPS may include:
- Local anesthetics
- N-methyl-D-aspartate receptor agonists
- Adrenergic agonists
Pain Pump Implantation Benefits
Once the pain pump has been implanted, the patient will no longer need to steadily take pain medication to reduce pain, although additional pain medication may be helpful for “pain spikes”. The pain pump will directly administer medication into the cerebral spinal fluid that surrounds the spine and brain. This allows for lower doses of medication, and is effective faster than orally administered medication. Lower dosages may reduce side effects of the pain medication.
Quality of Life
In cases where patients were incapacitated, pain pump implantation may restore quality of life. Patients that could not bend, walk, or perform daily tasks due to chronic pain may be able to resume these activities with the help of a pain pump implantation. In some cases, patients may be able to recommence working and regain the quality of life that was present prior to CRPS diagnosis.
Pain Pump Implantation Disadvantages
While pain pump implantation is often beneficial for chronic pain, there has been little evidence that pain pump implantation is a lasting solution for CRPS. CRPS patients that have had pain pumps installed require the medication within the pump to be refilled regularly, approximately every one to three months. In many cases, the tolerance for the medication increases at a steady rate, increasing the amount of medication required to relieve pain. Over time, the pump may become virtually ineffective for pain relief. Removal of a pain pump requires a second surgery and more recovery time.
As with any surgery, complications may occur during pain pump implantation surgery. Since the catheter is positioned to distribute medication into the cerebral spinal fluid, errors may occur that can damage the spinal cord or surrounding nerves. This damage can cause pain, sensory loss, and possibly loss of motor control in affected areas of the body. Cerebral spinal leaks can also be caused by pain pump implantation surgery. Cerebral spinal leaks can cause pain, nausea, vomiting, and severe headaches.
Pain Pump Implantation Assessment
The decision to follow through with pain pump implantation must be made by the CRPS patient and physician. Physicians should attempt to treat CRPS in more conservative ways before recommending pain pump implantation. Patients should discuss all concerns about the surgery and after effects of having a pain pump implanted thoroughly with the treating physician. If the decision is made to have a pain pump implanted to treat CRPS, the patient should be closely monitored following surgery to assess effectiveness and identify any possible complications.
“After Surgery – Drug Pumps.” Medtronic. Medtronic, 18 Feb 2013. Web. 7 Mar 2014. <http://www.medtronic.com/patients/chronic-pain/living-with/drug-pumps/after-surgery/>.
“Complex Regional Pain Syndrome Fact Sheet.” National Institute of Neurological Disorders and Stroke. U.S. Department of Health and Human Services, 12 Jul 2013. Web. 7 Mar 2014. <http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm>.
Knight, Karen, Frances Brand, et al. “Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates.”Croatian Medical Journal. 48(1).February (2007): 22-34. Web. 7 Mar. 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/>.