Intrathecal Pump|Morphine Pump|Baclofen Pump
Intrathecal pump is one of the most advanced pain management procedures.
The details: There is a small device which is implanted under skin by a minor surgery, done under local anaesthesia. From this device small amount of medicine is continually delivered directly into the spinal cord at subarachnoid space. Normally 0.5ml of medicine is delivered perday. The standard reservoir space in the device is 40 ml. That means when the device is completely filled, it will deliver medicine for 80 days and then the pump need to be refilled again.
The varieties: There are two variety of pumps, one is battery operated where this flow of medicine can be changed from external device. Other one is fixed dose pump where flow rate is fixed.
Uses: It is most useful in cancer pain. But it can be used in other types of noncancer pain too. It is also used to treat spasticity.
Benefits: The most important advantage of this pump is that the medicine is delivered directly at spinal cord which the site of action of these medicines. For example, the dose of morphine becomes 300 times less when it is delivered at spinal cord at subaracnoid space. Thus the side effects of morphine becomes 300 times less and the required dose is reduced by 300 times than oral morphine dose. Thus it gives very strong analgesia without significant side effects.
Medicines inside: Apart from morphine, few other medicines are also used in these intrathecal pumps like bupivacaine, ropivacaine, midazolam, baclofen, clonidine etc.
Frequently asked questions:
How many days hospitalization is needed? 5-7 days hospitalization is need.
Is it a major surgical procedure? It is done under local anesthesia.
Is the procedure painful? Not at all. It takes about 2 hours, but done under local anesthesia and patient talks while we do procedure.
How much is the pain relief? There is nearly complete pain relief.
How long the pain relief continues? When the medicines inside the pump is finished, the pump need to be refilled with medicines. Once refilled, it continues for 80 days.
What is the cost? It varies depending on the divice used and hospital where it is done. At Dardia the total cost is 4.5 lakhs INR (about 7000 USD), but it may go upto to 8 lakhs (12000 USD) in other hospitals.
Cost of this procedure is much less in Kolkata, India compared to any other countries, and many patients from outside India comes in Kolkata for this procedure.
A Case Report:
Here is example of one patient. This patient was having lung cancer (advanced stage) with metastasis/spread at spine and pelvic bones. Patient was having terrible pain not relieved at all by strongest oral or injectable pain-killer/analgesics. Morphine was giving some pain relief but patient was having bad side effects of morphine. Nerve block which at times become beneficial to cancer patients was not possible here as patient had pain from multiple areas due to spread of cancer.
Patient was admitted at hospital and a test dose of intrathecal morphine was given with a single intrathecal injection at subarachnoid space. Patient enjoyed significant pain relief for next 24 hours which determined this patient to be an ideal patient for intrathecal pump.
Next day under local anaesthesia, the device was implanted with a small surgery and a very fine catheter is introduced at subarachnoid space connected to the device. The device was then filled with morphine at desired concentration which was delivered at a rate of 0.5 ml per day.
Within 2 days patient started enjoying excellent pain relief (Nearly 100% pain relief).
One year has passed in Nov 2015, patient is still alive and living a completely pain free quality life. In a single line we can say that this advanced pain management procedure has changed her life.