Is the Implantable Drug Pump a Good Fit for You?

Question: Is the Implantable Drug Pump a Good Fit for You?

The success of implantable drug pumps for chronic back pain depends on if it is the right treatment for you. This is especially true with infusion pump implantation, since it is an invasive, controversial surgery not guaranteed to relieve your pain.

Answer: It will take a team of specialists to answer this question properly. Your primary surgeon (whether she is a pain management specialist or a neurosurgeon), a pain management nurse, pharmacist, physical therapist and/or a psychologist will all have a hand in evaluating your suitability for an implanted drug pump. As this is a very radical solution, and one that is used only as a last resort, it will be worth knowing in advance that you are entering into a treatment that is a good fit for you. In fact, some pain management specialists refuse to offer implanted drug pump treatment to their patients, viewing the risks and consequences of failure (for both patient and doctor) as far outweighing any potential benefits.

If you have tried all conservative care options, including narcotic medications, and nothing is working (or the side effects from the narcotics are too much to bear), the implantable drug pump may be something you could consider. But the consideration doesn’t stop there. In order to qualify for this therapy you will need to submit to a careful psychiatric evaluation. Your doctor will also thoroughly examine you to try to find a specific, definable cause for your pain. If she cannot identify a cause, and determines that back surgery will not help relieve your pain either, at that point, the drug pump can be considered as an option.

Along with your symptoms, the nature of your disease, and psychological factors, your assessment team will evaluate your risk for complications. For example, they will be looking to see if your health is such that you can handle surgery and anesthesia.

If you have terminal cancer, your doctor will probably be more likely to favor the implantable drug pump treatment. Side effects such as granuloma and catheter problems tend to show up over time. Because of this, pain management specialists are often reluctant to offer the treatment to their non-cancer chronic back pain patients.

During the comprehensive assessment to check your mental health status, the psychologist will attempt to identify any potential barriers to success such as a fear of procedures. You may get some tips or assignments to help you prepare for the implantation. And once the procedure has been done, if you find you need support, cognitive behavioral therapy may help you create and follow through with a plan for enjoying your new reduced pain status.

You have a role to play, too. You will be informed of risks and potential complications of the procedures, and asked to sign an informed consent agreement. The informed consent agreement protects the doctors and hospital in case one or more of the risks they tell you about actually happens. While rare, some of the risks can be fatal, so consider carefully before you sign away your rights.

You also can take a look at the members of your pain management team and assess for yourself their level of competency. Research shows that the most successful implantations are done by surgeons who have taken the time to upgrade their skills, and who have the opportunity to practice them regularly. Is your surgeon a "lone implanter" or truly a specialist? Similar questions can be asked about your pain nurse, physical therapist and psychologist. Do they specialize in pain? How much day-to-day, hands-on experience do they have treating patients with implantable drug pumps for chronic back pain?

You might also evaluate if you feel comfortable with the members of your team. At some point in the process, you may have an unusual question or request to make. Do you feel confident you can get a satisfactory and timely reply from your specialists or their staff?

So while much of the responsibility for patient selection, or determining if an implantable drug pump is a good fit for you as a patient, lies with your pain management team members, you can still be an active participant in the process. Patient selection assessments, including the unofficial ones you do for yourself, are probably the best determinants of a successful outcome when it comes risky procedures such as implantable drug delivery systems. And don’t forget that implantable drug pumps are not only radical and controversial, but a last resort treatment, as well.

_{Sources:
Dr. Sudhir Diwan, Director Pain Medicine Fellowship Program and Director of the Division of Pain Medicine at Weil-Cornell Medical College of Cornell University. Telephone Interview. May 2008.}

Dr. Eugene Lipov. Advanced Pain Management Clinics, Chicago, IL. Personal Interview. April 2008.

Gould, H., III, MD, PhD, Understanding Pain: What it is, Why it Happens and How It's Managed. American Academy of Neurology. 2007. New York.

British Pain Society. Intrathecal drug delivery for the management of pain and spasticity in adults; recommendations for best clinical practice.December 2006.