An intrathecal pain pump drug delivery system is made up of two implantable components: an infusion pump and an intraspinal catheter. The pump is surgically placed in a subcutaneous pocket while the catheter is inserted into the intrathecal space of the spine, tunneled under the skin and connected to the pump. Pain medication can be delivered at a constant of variable flow rate. The pump is programed by your TCPC provider. Adjustments in the dose are non-invasive and done in an office visit. At Twin Cities Pain Clinic we only implant the Medtonic Syncromed Pump. A Intrathecal pain pump trial is performed to determine the effectiveness of the treatment prior to implantation.
Prior to the trial, you will be required by your insurance company to complete Physical Therapy with in the last 12 months and a one-time psychological evaluation. A prior authorization is required by your insurance company prior to the trial. We will obtain this prior authorization for you. You will also need to obtain a pre-operative history and physical evaluation from your primary care provider and have a trial education appointment with you TCPC provider.
Our clinic works with a third party to ensure that this procedure will be covered by your insurance. Once you have completed the psychological evaluation and physical therapy, our clinic will send the necessary records to the reimbursement department. The reimbursement department will contact your insurance company or refer to the coverage policies in order to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule a trial. You will also need to schedule a trial education appointment with your TCPC provider.
Patients who are candidates for a pain pump have often tried and failed conservative therapies. A TCPC provider will be able to discuss with you if a pain pump is a good treatment option for you.
For the pain pump trial, you should expect to be at the Twin Cities Surgery Center for 6-8 hours. The procedure to place the catheter is done by a physician under fluoroscopy (xray). You will be receiving sedation through an IV prior to the procedure. You will be brought into the procedure room and lay on your stomach on a special table. Your skin will be cleaned at the injection site and a local anesthetic will be used to numb your skin. A temporary catheter will be placed into the intrathecal space of the spine. The catheter will then be connected to an external temporary pump. You will be placed in an observation area for the rest of the day. During this time a nurse and your physician will slowly increase the amount of pain medication you will receive through the pain pump. Once pain relief is achieved, the catheter is removed by a nurse and you will be asked to lay flat for 1-2 hours in observation. The trial is considered a success if you begin to achieve pain relief and do not have any side effects to the medication. If you decided to pursue an implanted system, we will submit to your insurance company for another prior authorization for the implant.
Prior to the implant surgery you will need to obtain a pre-operative history and physical evaluation. You will also need to have a implant education appointment with your TCPC provider. The surgery is performed by a physician under fluoroscopy (xray) at Twin Cities Surgery Center or Fairview Southdale Hospital. You will be receiving sedation through an IV prior to the procedure. You will be brought into the operating room and lay on your stomach on a special table. Your skin will be prepped and cleaned prior to any incisions being made. The permanent catheter for the pain pump will be placed using a small needle into the intrathecal space of the spine. Once the catheter is placed it will be connected to the pump internally. The surgery is outpatient and you should plan on being at the Twin Cities Surgery Center or Hospital for 3-4 hours.
You will receive an antibiotic to prevent infection. There are certain activities that should be avoided for 6-8 weeks after the surgery to prevent movement of the implanted catheter including bending at the waist, twisting, reaching overhead, and lifting more than 5 pounds. You will return to the clinic for a visit with a nurse who will look at your incision site 3-4 days after the surgery. At this time you will be cleared to shower. Two weeks after the implant you will return to the clinic to have the pain pump filled and programmed. The pump is filled with pain medication through a needle by a nurse using ultrasound to verify proper placement. Your TCPC provider may ask you to come to clinic more often for appointments as they fine tune your medication dose.
Patients who have a pain pump are able to decrease or eliminate the need for oral pain medications. You will be given a personal Therapy monitor (PTM) which will allow you to see the date your pain pump needs to be refilled by and if you provider chooses, gives you the ability to give yourself a bolus dose of medication. You will need to have your pain pump refilled by a nurse at TCPC about once a month.