1. Intrathecal Pumps Thomas Yeargin Biomedical Engineering BME 281 Section 1

2. What is an Intrathecal Pump? Method of giving medication directly to the spine to cure intolerable pains Small pump surgically placed under skin of abdomen Delivers medication, usually morphine, through a catheter to intrathecal space of spine Can release medication slowly over period of time or can be programmed to release different amounts periodically

3. Reasons for Intrathecal Pumps If one is dependent on pain medication If one could not benefit from additional surgeries Cancer pains Lessen spasticity from cerebral palsy or multiple sclerosis http://www.swarminteractive.com/images/thumbs/pumpimplant_300.jpg

4. Is it for you? Must go through complex trial to see if treatment decreases pain/spasticity Single injection through lumbar puncture Multiple injections over the course of days Continuous trial- catheter placed in correct area of the spine connected to external pump Dose is increased every two hours until patient feels pain relief

5. Types of Intrathecal Pumps Two major types of intrathecal pumps: Implanted pump with a constant flow rate -dosage cannot be changed Fully implanted pump with programmable pump -Programmed by computer so doctors can change dosages to meet patients needs http://www.medgadget.com/2012/09/ascenda-a-stronger-catheter-for- medtronics-baclofen-synchromed-ii-pump.html

6. Medications First line of medication is morphine, provides good analgesia in patients Second line of medication is morphine with the addition of bupivacaine or clonidine -better for patients with neuropathic symptoms Third line is the combination of both bupivacaine and clonidine with morphine -Third line only used if line one and two fail

7. Surgery Takes about 3-4 hours Catheter is placed in intrathecal space of spine Pump is placed in between skin and muscle layers of the abdomen An extension catheter is passed under the skin from the spine to the abdomen to connect to the pump. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/

8. Living With the Pump Must schedule medication refills on a regular basis Effectiveness of treatment will be assessed at the checkups Tell doctor if feeling unusual symptoms or drug overdose Withdrawal symptoms could happen and can possibly be very dangerous

9. Risks/Side Effects Infection or bleeding from the surgery It is very rare but the catheter could move out of place or the pump could stop working Accumulation of cerebrospinal fluid around the pump causes a watery discharge from incisions or headaches Side effects could include respiratory depression, twitching, muscle spasms and nausea

10. Results of Pump Depends on the severity of the condition of the patient Chronic patients experience a reduction of pain as well as overall improvement in everyday activities Spasticity patients experience a reduction in rigidity and muscle spasms Oral medications are reduced because of the direct delivery of medication to the spinal cord from the pump

11. Conclusion It has already surpassed oral medication and is proven more efficient Most patients find that this type of medication works well for them and there are not many risks or side effects that come with it If researchers can find a better design for the catheters then the future for this pump is very bright

12. Questions??

13. References [1] Mayfield Clinic and Spine Institute. " intrathecal Drug Pump." Pain Pump, Intrathecal Drug Delivery, Drug Pump. N.p., Mar. 2013. Web. 16 Oct. 2015.. [2] Knight, Karen H. et al. “Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates.” Croatian medical journal 48.1 (2007): 22–34. Print. [3] Lee, Kung-Shing, Kowng-Shing Chu, Chia-Li Chung, Chiuh-Lung Lin, Shiuh-Ling Hwang, and Shen-Long Howng. "Review Article Intrathecal Drug Delivery System with Programmable Morphine Pump for Pain of Terminally Ill Cancer Patients." CiteSeerX. N.p., 2009. Web. 17 Oct. 2015. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.537.7707&ra nk=27. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.537.7707&ra nk=27