15 Feb Intrathecal Pain Pump Could Wean Patients Off Opioids
The United States is currently in the grasp of an opioid crisis. In October 2017 President Donald Trump announced that the crisis was a “national emergency” that should be dealt with immediately. Millions of Americans currently have an addiction to illicit opioids. However, these drugs were often first prescribed by a registered legal doctor and for patients with chronic pain. When doctors began to stop renewing patients prescriptions, many turned to the streets to feed their dependence. Even patients who wean themselves off opioids still have to deal with the day to day hardships of a chronic pain condition – which is often unbearable with non-opioid medications. As such new avenues for pain management should be pursued. One technique offered at specialist clinics across the United States could help patients come off oral based opioids, either by controlling the dose of opioids or changing their pain medication altogether. That option is known as an intrathecal pain pump.
What is an intrathecal pain pump?
An intrathecal pain pump is a small implanted device in your abdomen that pumps tiny amounts of medication through a catheter into the space that surrounds your spinal cord. It was first used in 1981 for patients with chronic pain associated with cancer, but it is not used more widely for all sorts of chronic pain conditions. There are a number of different patients that would be candidates for its insertion, including:
- Patients with chronic pain from a terminal illness like cancer (as discussed above)
- Patients in whom conservative treatment like oral painkillers have failed
- Patients with pain from chronic pancreatitis
- Patients with back pain from failed back surgery
- Patients with pain caused by peripheral nerve injury
Once the pump is inserted, a small and measured dose of a given drug baths the spinal cord. The spinal cord receives messages from your peripheral nerves about pain, however, it is not simply a relay station. It can increase or decrease the signals it receives as it relays them to the brain and you become aware of the pain. By using certain medications we can inhibit those pain signals and reduce the pain detected at the level of your spinal cord.
How could it reduce dependence on oral opioids?
As the pump injects the drug directly to the level of the spinal cord, lower doses of an opioid need to be given. The pump is also set to a certain dose and certain frequency, meaning patients cannot take too many opioids and experience a life-threatening overdose. In one study published in Pain Medicine, they found that patients using intrathecal pain pumps had a significant reduction in the number of oral opioids they took and that the dose of intrathecal opioid administered was “virtually unchanged” for patients they followed up for 3 years. This means that the dose of painkiller needed to kill the pain did not increase in the same way it often does when patients take oral opioids.