Intrathecal Drug Delivery Pumps
An intrathecal drug delivery system — commonly called a "pain pump" or IT pump — is a surgically implanted device that delivers pain medication directly into the fluid surrounding the spinal cord. By bypassing the digestive system and bloodstream entirely, intrathecal delivery achieves equivalent or superior pain relief at a fraction of the oral dose — dramatically reducing systemic side effects.
For patients with severe chronic pain or cancer pain who have not achieved adequate relief through other means, IT pump therapy can represent a life-changing solution.
How It Works
The implanted system has two components:
- The pump — A small titanium device (about the size of a hockey puck) implanted under the skin of the abdomen, containing a reservoir of medication
- The catheter — A thin flexible tube that runs from the pump to the intrathecal space (the fluid-filled space around the spinal cord), delivering medication directly to where pain signals travel
The pump is programmed externally by Dr. Rubin using a wireless programmer, allowing precise control over the dose, timing, and rate of medication delivery. The reservoir is refilled every 1–3 months through a simple in-office injection through the skin into the pump's fill port.
Medications Used
The most common medications delivered via IT pump include:
- Morphine (the only FDA-approved intrathecal opioid for chronic pain)
- Ziconotide (Prialt) — a non-opioid, non-addictive medication derived from cone snail venom, FDA-approved for severe chronic pain
- Baclofen — for severe spasticity from spinal cord injury or multiple sclerosis
- Bupivacaine — a local anesthetic added to the opioid for enhanced effect
Who Is a Candidate?
IT pump therapy is appropriate for patients with:
- Severe chronic pain unresponsive to oral medications or other interventional treatments
- Intolerable side effects from systemic opioid therapy
- Cancer pain requiring escalating doses of oral or IV opioids
- Failed back surgery syndrome with severe pain
- CRPS with severe, refractory pain
- Spasticity from spinal cord injury or MS (for baclofen pump)
A psychological evaluation and a trial of intrathecal medication (to confirm response before permanent implant) are standard requirements.
The Implant Procedure
IT pump implantation is a surgical procedure performed at an accredited surgical facility under general or regional anesthesia. The catheter is placed first into the intrathecal space, then tunneled to the pump pocket created in the abdominal wall. The procedure typically takes 1–2 hours, with same-day or next-day discharge.
Dr. Rubin manages patient selection, programming, and ongoing refills and adjustments. Surgical implantation is performed by a surgical colleague.
Benefits Compared to Oral Opioids
| Factor | Oral Opioids | Intrathecal Pump | |---|---|---| | Dose required | 100% | 1/300th (ziconotide) or 1/100th (morphine) | | Constipation | Common | Minimal | | Cognitive fog | Common | Greatly reduced | | Sleep disruption | Common | Less common | | Systemic side effects | Significant | Dramatically reduced |
Frequently Asked Questions
Can the pump be removed if I change my mind? Yes. The system can be surgically removed, though this is rarely needed. The pump can also be reprogrammed to zero dose and essentially deactivated.
How often does the pump need to be refilled? Refills are performed in-office every 1–3 months depending on your dose. The procedure takes about 15 minutes — Dr. Rubin inserts a needle through the skin into the fill port and replenishes the medication reservoir.
Will I be able to feel the pump? The pump is placed under the skin and is typically not visible through clothing. Patients can feel it if they press on the area, but most quickly stop noticing it in daily life.
Does insurance cover this? Medicare and most major commercial insurance plans cover IT pump implants when appropriate criteria are met. Our office will obtain prior authorization.
Contact Our Office
IT pump therapy is appropriate for carefully selected patients with severe pain needs. Call 516-492-3100 to discuss whether this therapy is right for your situation.