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PAIN PUMP

Intrathecal Pump Therapy

Targeted drug delivery (TDD) via intrathecal pain pump (IT pump), colloquially referred to as the pain pump, is a long-term, safe and effective treatment for chronic pain management. The pain pump is useful for multiple pain conditions and is an excellent solution to many of our real-world problems with chronic pain management today.

This device affords you the ability to bypass long-term deleterious effects and short-term side effects of chronic oral opioid therapy. Since the pump delivers opioid or adjuvant therapy directly to your pain receptors in your spine, our patients experience significantly improved pain control with a fraction of the dose of medication. Our patients also enjoy the freedom of no longer picking up prescriptions from the pharmacy, dealing with supply-chain issues or back-ordered medications.

Depending on your pain condition and your opioid tolerance, many of our patients can go multiple months without having to be refilled or seen in the office. This can provide you with the freedom in your life that chronic pain has taken away.

Please view the video below to explore the benefits of the pain pump
What to expect:
If you are identified as a possible candidate for the pain pump, here are some steps you can expect. **Most insurances will require a psychological assessment prior to the below trial.
Trial
Unlike most other medical therapeutics, you can try the pain pump before deciding if it is right for you. At The New York Pain Pump Institute, we have revolutionized this trial to optimize your experience and give you a true indicator of whether or not this therapy is right for you.

Historically, the trial is what is called a ‘single shot trial.’ During this type of trial, you are sedated with IV anesthesia in a doctor’s office or surgery center, then given a single bolus of opioid medication into your spinal cord. You are then asked to assess your response to this bolus and determine whether or not this therapy is right for you. Alternative methods for a trial include multiple single shot boluses, or even a temporary indwelling intrathecal catheter.

At the New York Pain Pump Institute, we believe these approaches do not provide the ability to assess this therapy in your everyday life.
First, you’re going to feel pain relief, you were just sedated with powerful anesthetics.

Second, at most, that bolus of opioid can provide up to four hours of therapy. During those four hours, you are recovering from anesthesia, traveling back to your home and recovering from your procedure. This is not a clear trial of targeted drug therapy and its benefits on your everyday life.

Third, you are limited to the one medication option that is delivered in that bolus. Humans are not all the same, and your response to one medication is not necessarily representative of your response to targeted drug therapy. You may think that you have failed a trial when truly you just needed a different medication.

Fourth, we do our absolute best to avoid unnecessary dural puncture that can result in post-procedural complications, headaches, and dural leaks, all of which would interfere with your ability to assess the effectiveness of this therapy.

At The New York Pain Pump Institute, Dr. Do Ouro has perfected the home trial. An extended home infusion with an external pump connected to an indwelling epidural catheter. The benefits of this trial are many:
You get the opportunity to assess how this therapy can improve every aspect of your life as you live with the trial for 5-10 days.

Opportunity to optimize medication therapy, rotate to different drugs, and assess for uncommon interactions or side effects.

Reduction of post-procedural complications d/t minimizing dural punctures.

Building tolerance to intra-spinal opioid therapy and establishing a safe and effective starting dose for intrathecal therapy.

Long-Term management

  • After your pump is implanted, you will have to come into the office for pump refills and dose adjustments.

  • The length between refills is different for everybody. This depends on your specific pain and the regimen that is effective for you. On average, patients require refills every eight to twelve weeks. The maximum time in between refills is three months, or sixteen weeks.
    Frequently, brand new pump patients will require shorter intervals between dose adjustments and refills, this is not indicative of your long-term regimen.

  • As your pain changes, so can your pump. Ongoing management includes reassessment of your pain generators and adapting your therapy as needed.

  • The pump is not designed or intended to be a cure for every possible pain condition. Certain types of pain pathologies can still prevail, so interventional procedures may still be available to you as part of your pain plan.
Implantation

Frequently Asked Questions

The SynchroMed™ II pump was designed to be MRI safe under certain conditions. You will be given a Medtronic patient identification card at the time of implantation. You should be prepared to show this card at any MRI appointment so the ordering doctor and radiologist may confirm MRI compatibility.
The pump is implanted in the right or left flank, based on your preference.
Just like a cardiac implantable defibrillator, you will be able to feel the pump if you try. However, the pump is expertly implanted by Dr. Do Ouro, and careful attention is taken to ensure the pump is perfectly implanted in a way where it will be minimally noticeable by you or your loved ones. Everybody is different, and your body habitus may require further pre-operative discussion on how your pump is implanted. This is a discussion we will happily have with you prior to surgery.
There is no cut-off age which is ‘too old’ for a pain pump. However, certain medical conditions, spinal deformities or surgical/anesthesia risks may unfortunately be a barrier to your care.
The pump is designed to be a long-term solution to your chronic pain needs. It is perfectly suited to be an adaptable pain solution throughout the lifetime continuum.
Frequently, patients become very comfortable after years with the pain pump and they think they are ‘cured’, or they don’t need the therapy anymore. If this is the case, we are more than happy to facilitate your requests and titrate down on the pump. Once you are titrated from opioid, we give you a month with just normal saline in your pump so you can truly be sure if this is something you want.
Depending on your pain management regimen, the pump life is five to seven years.
Yes. However, the surgery to replace the pump is only one incision and very routinely does not require the catheter to be changed.
Complications are rare; however, they do exist. The formation of a granuloma at the tip of the intrathecal catheter is a cluster of granulation cells that form in response to a foreign body or medication infusion itself. This is extremely rare, about 0.4% incidence rate, and forms slowly over time. Other complications exist such as surgical hematoma’s, dosing errors, etc. Please speak with a provider at The New York Pain Pump Institute to learn more about the potential complications of therapy and how we manage and prevent these.
No. There has never been any confirmed or documented evidence of a pump electrocuting a patient.
Depending on what surgery you are scheduled for, there may be some special considerations. If you are scheduled for surgery, please discuss this during your appointments and we can help create a plan for your safety and post-operative pain control.
In very rare instances, the catheter can possibly move to a sub-therapeutic position. This is very unlikely and usually occurs after a severe trauma or even another spine surgery. If you start to notice a change in your pain control, we can complete a dye study in the office to confirm the patency and position of the catheter.
The New York Pain Pump Institute provides new world solutions for your individualized chronic pain needs.
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