| Intrathecal Micro Dosing |
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Intrathecal Drug Delivery systems, also known as pain pumps are designed to deliver pain medication directly into the fluid around the spinal cordin an area called the intrathecal space. This form of therapy generally requires smaller doses – potentially 1/300 of what a typical oral opioid dose would be. Unlike oral medications, this form of drug therapy does not travel through your body in your bloodstream. As a result, you may not experience adverse side effects common with oral opioids such as nausea, constipation, drowsiness, and mood alteration.
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WHO IS A CANDIDATE FOR AN INTRATHECAL DRUG DELIVERY SYSTEM?
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| Drug delivery therapy may be right for you if: |
- Other treatment options haven’t provided pain relief or have produced uncomfortable side effects.
- Further surgeries are not recommended.
- You don’t have a serious, untreated dependence on pain medication.
- You don’t have medical issues that would make surgery difficult.
- You have a successful drug delivery trial.
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WHY IS THE TRIAL SO IMPORTANT? |
The trial is important for a number of reasons.
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| During the trial you can: |
- Assess how well drug delivery therapy relieves your pain.
- Feel what it is like to receive pain medications intrathecally.
- Determine which size drug pump would be most effective for you if you decide to proceed with long-term therapy.
- Decide if you want to go on to have the drug delivery system implanted.
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Space City Pain Specialists is at the forefront of an emerging concept in pain management called microdosing that may provide pain relief with markedly lower doses of intrathecal morphine. There are a number of benefits that are associated with microdosing:
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- Microdosing may reduce potential for drug interaction or accidental overdose because opioids are delivered in much smaller increments.
- Microdosing may decrease the risk of respiratory depression due to the low opioid dosage.
- Microdosing may reduce the potential for dose-related side effects including lower extremity edema, hypogonadism, and fibrous catheter tip mass.
- Microdosing may reduce opioid-induced hyperalgesia (a greater than normal sensitivity to pain that may result from a painful or non-painful stimulus) so there is little or no need for repeated escalation of dosages.
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In order for this form of intrathecal drug therapy to be successfully implemented our patients must go through a three step process that includes:
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Step 1: Detoxification: Our practice team will detoxify the patient of all opioids over a 6 week period so that there are no opioids in their system. The patient will receive adjuvant therapies based on their needs during this process.
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Step 2: Trialing – After you have not used opioids for 6 weeks, you are now ready for the trial. A temporary catheter is inserted into the epidural space and you are given a single shot intrathecal injection. Your response to this injection is monitored in the hospital overnight to determine effectiveness and assess any resulting side effects. Based upon the results of this trial, your physician will determine whether you are a good candidate for implantation. There are some cases where microdosing is not an appropriate therapy and a traditional intrathecal pain pump is a better treatment protocol. In these cases, the trial typically requires 2-3 days in the hospital to determine the most effective dosage.
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Step 3: Implantation: The intrathecal pump system consisting of the pum pand the catheter are implanted under the skin. The permanent catheter is placed in the intrathecal space. The pump delivery dose is carefully adjusted with the goal of eliminating or markedly reducing oral opioids.
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FREQUENTLY ASKED QUESTIONS
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GENERAL QUESTIONS
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| Is it dangerous to have a foreign object in my body? |
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The Intrathecal Drug Delivery Pumps has been tested, is shipped sterile, and is FDA approved. Millions of people around the world have implanted medical devices such as pacemakers and implanted cardioverter defibrillators (ICDs)
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| What about infection? |
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As with any surgical procedure there is risk of infection. To reduce the risk of infection, follow the directions given by your doctor. If you notice any unusual swelling, pain, or redness near the incisions, notify your doctor.
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| Is the drug pump a new devise? |
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No. The Food and Drug Administration approved these pumps as safe and effective for the treatment of chronic intractable pain in the early nineties.
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SCREENING TEST
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| During the trialing, can I take other pain medications? |
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Prior to the test trial, you are weaned off all oral opioids – this is the detoxification phase. Your physician will discuss this process with you.
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| If the trialing is successful, will an implantable drug delivery system provide the same pain relief? |
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Your pain relief may differ slightly. During the recovery period your doctor will slowly adjust the medication dose so you receive the best pain relief possible. This is because the medication dose may be different than the dose used during the screening test. Be sure to tell your doctor about the way you feel, so changes can be made to optimize your therapy. It may take some time to find the dose that works well to manage your pain – this is called “titrating” the dose.
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THE IMPLANT PROCEDURE
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| Can a previous abdominal incision be used to implant the pump? |
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Usually not. The incision needs to be made where the pump will be implanted to help properly anchor the pump. Proper anchoring helps keep the pump in place. This may help minimize your discomfort and speed recovery.
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| Where in my back is the catheter placed? |
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That depends on your specific condition(s) and the results you received from the screening test. Your doctor will advise you of the recommended catheter location.
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Are there possible side effects associated with placing the catheter in the intrathecal space?
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In some cases, you may experience a spinal headache as a result of a needle or catheter being placed in the intrathecal space. The spinal headache is caused when cerebrospinal fluid (the fluid that surrounds the spinal cord) leaks out of the intrathecal space. This headache may correct itself, or the doctor may treat it.
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THE THERAPY
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| What if I have no improvements after the pump is implanted? |
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Let your doctor know if you are not receiving adequate relief from your symptoms. The doctor may be able to reprogram the pump to adjust the amount of medication it delivers.
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