One of the most effective ways to treat chronic pain, when all other attempted treatments including surgery has failed, is to put medications directly into the spinal fluid. Intrathecal therapy precisely directs medications to the nerves carrying the pain signals into the spinal cord.
This method uses medications that will reduce and possibly eliminate the transmission of the pain signals in the spinal cord, reducing the signals that reach the brain (where you are actually feeling the pain).
The beauty of this technique is that it is tested with a temporary trial of intrathecal medications, delivered in a minimally invasive way. If significant pain relief is achieved, the system can be implanted as an outpatient. It can also be removed if it is not needed in the future.
This treatment method has many advantages that make it unique.
- The medications are not being delivered by the bloodstream throughout the body.
- Some of the medications used are only available for intrathecal use and cannot be delivered by any other route of administration.
- It is possible that no opioid (narcotic) medication needs to be used for successful pain relief.
Often combinations of medications with different mechanisms of action are used to successfully treat intractable chronic pain. None of the medications are systemic (throughout the body) since they are placed directly into the spinal fluid that bathes the spinal cord and the nerves transmitting the pain signals toward the brain. (Use of some of these medications intrathecally represents an off-label use, but has been used this way for years as best-practice).
Courtesy of Medtronic
Medtronic's Intrathecal Rx Delivery System
This is the Medtronic Intrathecal Delivery System showing the pump attached to the catheter (which is surgically implanted as an outpatient), the Physician’s programmer, and the Patient’s Therapy Manager (PTM).
Medtronic Sychromed II Intrathecal Pump Implant
This is the Synchromed II programmable intrathecal pump by Medtronic. It holds either 20 mL or 40 mL of medications. This can provide pain relief for up to six months between refills but this depends on each individual patient’s response.
Intrathecal pump with Ascenda Intrathecal Catheter
The Medtronic delivery system can also be used to treat intractable spasm due to neurologic conditions including spinal cord injury and cerebral palsy. Intrathecal Baclofen (Lioresal) is very effective and can also be mixed with other medications to treat pain in addition to spascity.
The Flowonix Prometra Intrathecal delivery system is also used to treat intractable pain and spascity. This system is used when medication delivery has to be in the upper thoracic or cervical spinal cord region.
The Flowonix pump only holds 20 mL but also has a Patient Therapy Controller that allows the patient to interact with the system to deliver additional medications when pain intensity increases. Dr. Boyajian and Dr. Rogers have been highly successful treating chronic intractable pain with intrathecal therapy for nearly thirty years. The doctors perform all aspects of this therapy including temporary testing for pain relief (trialing), implantation of the pump and catheter, as well as managing the treatment after implantation. We believe performing all aspects of patient care significantly improves the success for our patients, as compared to doctors that only trial, or only only implant, or personally manage or don’t personally manage the technique.