It uses a pressure-driven, valve-gated delivery mechanism to deliver boluses of medication with broad, rapid spinal cord coverage. Peristaltic action then moves the drug to the infusion site via implanted catheter.įlowonix’s Prometra II programmable pump system with intrathecal baclofen, Medtronic’s only pain pump competitor, received FDA approval in February 2020. At normal body temperature, pressurized gas stored below the reservoir expands and exerts pressure to advance the drug into pump tubing. The drug enters the pump via reservoir fill port and travels through the reservoir valve and into the pump reservoir. The current model has been in use for over 13 years. Medtronic’s SynchroMed II implantable drug infusion pump is FDA approved for both pain and spasticity treatment. Spinal cord stimulation is most effective at easing pain arising from nerve-related conditions that cause pain in the legs or arms, and conditions where oxygen-rich blood flow is limited. It’s rarely used today because of more modern designs, but like rechargeable IPGs can be better for lower back and leg pain. They’re more powerful than conventional IPGs.Ī radiofrequency (RF) stimulator is an older design that uses a battery outside the body. These can put out more electricity so can be a better choice for lower back pain or pain in one or both legs. It can be a good choice for those with pain in just one body part as less energy is needed to manage pain.Ī rechargeable IPG, where a battery is still placed in the spine but can be recharged without another operation. They come in three main types:Īn implantable pulse generator (IPG), where a battery is placed in the spine, which must be replaced in another surgery. They consist of leads placed in the epidural space around the spinal cord and are connected to and powered by a pulse generator or batteries. Patients with chronic pain, pain related to cancer or its treatments, or pain with spasticity can be candidates for pain pump therapy.Ī spinal cord stimulator (SCS) is an implanted device that transmits low levels of electricity directly to the spinal cord. Extra doses can be given as needed via a controller. Generally, doctors set a continuous rate similar to a long-acting pain pill and bolus dose equivalent to a short-acting pain pill. They can be programmed using a tablet and Bluetooth connection. It bypasses barriers of oral medications like the gastrointestinal track, bloodstream, and blood-brain barrier. Refilling the pump is relatively painless and takes approximately five minutes.Ī pain pump lets the patient use a significantly smaller, targeted medication dose to help lessen side effects and improve pain control. A pump usually houses one to three months of medication and is refilled using a small needle accessing the reservoir. The pump is about the size of a hockey puck and the catheter equivalent to angel hair pasta. Medication is stored in a reservoir in the pump and delivered continuous through a catheter into the fluid around the spinal cord (intrathecal space). It’s usually surgically implanted in the lower abdomen and catheter inserted into the lower back. This article will compare two common long-term implantable pain management devices: intrathecal drug pain pumps and spinal cord stimulators.Īn intrathecal drug pain pump (also known as a pain pump, intrathecal pump, or targeted drug delivery/TDD) is fully implanted into the body and delivers medication. Implantable pain management doesn’t work for all patients, but when it’s successful can yield significant boosts in daily function. Both therapies are given on a trial basis first, then the patient decides whether to use either therapy over the long term. Two main therapies-pain pumps and spinal cord stimulation (SCS) can help to reduce pain without the need for an extensive surgery. If oral medications and other conservative strategies have not sufficiently relieved a patient’s chronic pain, implantable pain management systems can be an option.
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