Long Island NeuroSpine: Pain Pump

Pain Pumps [Medtronic]

Spinal Cord
Stimulator

Pain Pump

Currently the Neurosurgeons at Mid-Suffolk Neurosurgical Associates, PC use the intraspinal drug delivery pumps manufactured by Medtronic, Inc. The SynchroMedIIŽ infusion system produced by Medtronic, Inc. was introduced in the United States in 1988 as the first externally programmed, implantable pump. It became commercially available for chemotherapy in 1988 and for intraspinal morphine for chronic pain in 1991. It is also used for relief of severe spacticity using baclofen as medication.

What is it?
The Medtronic SynchroMedIIŽ Infusion System, sometimes referred to simply as "the pump" is an implantable therapy for drug infusion used in treating chronic pain, severe spasticity of spinal cord origin, and malignancies.

What advantages does implantable drug infusion have over oral methods?

Many patients who are given oral drugs for pain become nauseated or addicted to the drug. The pump delivers the drug continuously and precisely to a specific area of the body; less dosage is needed, and side effects are reduced. Some patients who do not respond, or experience intolerable side effects, to oral medications at recommended dosages do respond to implantable drug infusion. There is simply more drug at the site where it is most effective, near the spinal cord.

The pump is externally programmable and automatically administers the right dosage at the right time, day or night; the patient does not have to worry about forgetting to take medication. Some physicians believe that medications are more effective when timed in accordance with "circadian rhythms," or normal body cycles.

What are the components of the SynchroMedIIŽ system?
The system has three basic parts:

Pump >
	The pump stores and releases prescribed amounts of drug. It is contained in a round metal housing about one inch thick and three inches in diameter; it weighs about six ounces. The ma]or components are a miniature peristaltic pump, drug reservoir, battery, antenna, and microprocessor. The pump is implanted surgically, usually in or near the abdomen, and can be refilled through the skin with a needle and syringe.
Catheter >	Programmer >
	The catheter is a small-diameter silicone rubber tube that is tunneled under the skin from the pump to the drug delivery site.
	The programmer is used by the physician to externally program and reprogram the pump, the device is run by a portable computer with special software. It has a hand-held programming head that transmits instructions by radiotelemetry to the pump.
	How is the SynchroMedIIŽ system implanted? If a patient appears to be an appropriate candidate for drug infusion, the physician will conduct a trial screening to determine how effectively the drug reduces pain or spasticity. If the patient feels significant pain relief (or reduction in spasticity) , physician and patient will consider the option of implantable drug infusion. The pump and catheter are implanted, often with local anesthetic, and the system is programmed. The patient remains in the hospital one to three days after the operation, then returns to a physician every 20 to 90 days, depending on the type of medication and dosage, to have the pump refilled and reprogrammed. And how is the pump programmed? The pump can be programmed from outside the body, and is easily adjusted to the patient's changing needs. A clinician uses a programmer to set and/or adjust the dosage, drug flow rate, and other variables. The pump offers various delivery patterns, including a straight continuous-flow pattern, or a more complex pattern that allows varying the dose at different times of the day to meet the patient's changing requirements. A "on-demand" mode is available. For further information visit the Medtronic Website.