Implanting an intrathecal catheter and subcutaneous infusion pump is a method now being used to provide pain relief when other treatments have failed. The process involves delivering of medication directly into the cerebrospinal fluid that surrounds the spinal cord. The name "intrathecal" refers to the space beneath the arachnoid membrane of the brain or spinal cord.

The process

A catheter made of a fine synthetic material is threaded into the spinal fluid in the lumbar region. Then a heavier catheter is used to connect the intrathecal catheter to a hockey-puck sized pump implanted beneath the skin of the abdomen. The pump delivers drugs at a rate that is programmed by a computer and tailored to the patient's needs. The pump runs on a built-in battery that lasts five years and is then replaced. The pump is refilled by placing a needle through the skin into the pump and refilling the tank.

Logistics for Procedure

The patient comes into the hospital on a Wednesday, and the catheter is placed in his or her spine under general anesthesia. A temporary extension comes through the skin, and different drugs are tested over the next five days.

On the following Monday, the patient goes back to the operating room and again under general anesthesia, either the pump is implanted or, if adequate response to the drugs did not occur during the trial, the entire catheter system is removed.

The patient is expected to go home on Tuesday; sutures are removed from the back incision and abdominal incision 7-10 days later.

In cases where the pump is implanted, the patient will need to return to clinic to have the pump refilled at intervals of two to six months, depending upon the drug infusion rate.

Medications play a key role in this treatment. The type of medication or narcotic will depend on the degree of pain and supply pain relief when infused directly into the cerebrospinal fluid that surrounds the spinal cord.

Those who have failed all other attempts at pain management should consider this treatment. The patient must not have active infections or be taking anticoagulants, and must be able to undergo general anesthesia.

About half of patients get good long-term pain relief and can stop all other narcotics. Others may get partial relief.

There are some risks, such as infections, headaches, spinal fluid leakage or failure to relieve pain. However, patients who consider this type of treatment, do so because they are unable to find pain relief through conventional measures, and will most likely continue to experience that pain, which often is severe enough to substantially limit the person's ability to enjoy a quality life.

There is no urgency associated with this type of procedure. It can be scheduled at a time that is convenient for the patient.