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Intrathecal Drug Therapy

If your physician suggests a procedure called intrathecal drug therapy as a means of treating your pain, some commonly asked questions are listed and answered below.


What is intrathecal drug delivery?

Intrathecal drug delivery is a pain management therapy that delivers medication directly to the intrathecal space the fluid filled area surrounding the spinal cord).

Benefits

The spinal canal is like a highway for pain signals traveling to the brain, where pain sensation is experienced by the body.
 
Because the pain medication is delivered directly to the “site of action” (the area surrounding the spinal cord ) instead of circulating throughout the body, intrathecal drug delivery offers significant pain control using a small fraction of the dose  that oral medication requires.

This drug delivery method has been shown to increase pain relief and comfort for people with severe pain. It may also cause fewer side effects than oral medications.

Studies have shown that for people who did not experience enough pain relief with high doses of oral medication, most achieved significant pain control with intrathecal  drug delivery and  were able to improve their  activities of daily living (ADL)

Setting Your Goal

Realistic goals are key to satisfaction with intrathecal therapy.
Depending on your physical ability, you may be able to accomplish certain goals with the help of intrathecal therapy (ITT).

It’s important to understand that this therapy will not eliminate primary source of your pain and will not cure any underlying disease.  However, it may help manage your pain and improve your ability to do daily activities.

Your Test Options

Injection:

For determining if you are a candidate for ITT a trial with your medication is performed.
 A single injection or multiple injections of a small amount of medication into your spinal canal. The injection is delivered with a needle and syringe.  A medication injection will be followed by several hours of monitoring in a hospital or a physical therapy setting. You can usually can return home after the test.

Continuous Infusion:

This screening test takes place over a few days and closely resembles the therapy delivered by fully implantable infusion system.

With this procedure, a continuous  flow of medication is delivered to the spinal area  through a temporary  catheter ( a soft, flexible tube).  One end of the catheter is  placed in your back  and the other end is attached to an external pump.  There are two types of external pumps which can be used, depending on the placement of the catheter .  One is  for epidural infusion; the other is for intrathecal  infusions. Either of these catheter placements allow for you  to resume most normal daily activities of living.

Log or notes are kept with regards to your pain , function vital signs; if your pain  symptoms are  decreased after your infusion or increased and by what percent.

Reason for Screening:

The purpose for screening is to see if the medication works for you.
The screening whether your pain can be turned off with ITT .

Possible Side Effects:

During  the screening test , these temporary  effects are possible:
Sleepiness, nausea or vomiting, headache, dizziness itching, urinary retension, depressed breathing or respirations.

Drug Delivery System Options:

There are two types of fully implantable systems that treat chronic pain through continuous delivery of medication into the intrathecal space.

SynchroMed System:

Consists of an implantable pump and catheter, and an external programmer used by your physician. Programmability allows for different doses of medication to be given throughout the day, and your doctor can make dose changes using the external programmer.

Some patients may also have an option of a Personal Therapy Manager (PTM).  The PTM allows you to deliver  medication when you need it, within your physicians prescribed guidelines.

IsoMed System:

Consists of an implantable pump and catheter.  The system dispenses medication at a constant flow rate (meaning it gives one dose all the time at the same rate).  The IsoMed pump is used for someone who does not need a variable-dosing pump.

How long does the screening test take?

With a single injection test, the procedure will be performed in a surgery suite, this will take up to one hour to complete then you will be monitored in another room .
Depending on the medication used you can be monitored from 2-3 hours up to eight hours.

 If you receive a temporary catheter and an external pump your hospital stay can be up to 23 hours or your may return home after this and the trial may last up to four days, this depends on your doctors preference.

Will It Hurt?

The goal of the procedure is to make you feel less anxious and comfortable as possible.
Before you are given the injection or the catheter is placed, your doctor will numb a small area of your lower back with a local anesthetic. Some patients may receive medication prior to this procedure, this  needs to be discussed between you and your doctor.

Setting Your Course:

If your trial with intrathecal testing is successful, you may  be a candidate for an implanted drug delivery system.
You and your doctor will then discuss your results and the necessary steps for successful implantation and management of your intrathecal therapy.

If your pain goals are not met with the trail of intrathecal therapy, you and your doctor will discuss other ways to help manage your pain.

Is the Pump a New Device?

The pump has been tested and approved by the FDA, and it has been used successfully by more than 80,000 people world wide.

Will Intrathecal Drug Delivery Eliminate Other Sources of Pain?

The intrathecal drug delivery will not provide relief from other types of acute pain, such as headaches, stomachaches, fractures, etc.

If The Implanted Pump Doesn’t Work, Can It Be Removed?

The screening test is designed to determine whether or not the pump will help to manage your pain.  If the screening test is not successful, you will not go onto receive the implanted infusion system.  If you do receive a drug delivery system, it is removable if you no longer require it for pain relief or if you change your mind after it has been implanted.