Intrathecal pump · Metro East
An intrathecal pump implant takes an afternoon. The refill calendar lasts for years, and that calendar is the decision you are actually making.
An intrathecal pump places a small reservoir under the skin and a catheter (a thin tube) in the fluid around the spinal cord. That way a tiny dose reaches the receptors directly. It is a long relationship with a refill schedule, not a single procedure.
What is an intrathecal pain pump?
A programmable reservoir the size of a hockey puck sits under the skin of the belly. A thin catheter runs from it into the spinal canal. It ends in the fluid that bathes the cord. There the pump pushes a steady, adjustable trickle of medicine. The drug reaches the spinal receptors without passing through the gut, the liver or most of the bloodstream. So the dose is a small fraction of what a pill would need.
Nearly all pumps go to three groups. The first is cancer pain that pills by mouth can no longer control. The second is severe spasticity (stiff, tight muscles) from spinal cord injury, multiple sclerosis or cerebral palsy. The third is a selected group with non-cancer pain, most often after failed back surgery or with complex regional pain syndrome, when less invasive steps have not held.
How often does a pain pump need to be refilled?
Every reservoir runs down. It is refilled in the office by a needle through the skin into the pump’s port. How often depends on the reservoir size and the dose. For most patients it is every one to three months, for as long as the pump is in. Each one is a drive. From Highland it is about 55 minutes each way with no traffic. From Godfrey or Belleville it is about 40 minutes when traffic flows freely, and a January morning on the Poplar Street Bridge does not flow freely.
Before we trial anything we ask who drives you and what happens when a refill lands on a storm. A pump that runs dry does not simply bring back the old pain. Depending on the drug, it causes withdrawal. Baclofen withdrawal can be an emergency within a day or two. Your access to the building decides whether this therapy is safe for you, not only whether it works.
No implant without a trial. The trial is a single intrathecal dose, or a short infusion through a temporary catheter. We track pain, function and side effects against your starting point. A trial can prove the drug reaches the right place and your nervous system responds. It cannot prove you will keep every refill for five years, or that an unknown pain source will stay quiet.
What goes in the reservoir, and where the operation happens
BACLOFEN, FOR SPASTICITY
The best-supported use. In a 2025 meta-analysis of eleven studies, intrathecal baclofen reduced spasticity on the modified Ashworth scale by about 1.5 points in adults, more in the legs than the arms, at doses that would sedate a person into uselessness by mouth.
ANALGESIC MIXTURES, FOR REFRACTORY PAIN
Some patients arrive on a high systemic opioid dose (one that reaches the whole body). For them, the pump moves the site of action to the cord. It cuts the whole-body exposure that has been lowering testosterone, breaking up sleep and worsening insulin resistance. It is a tool inside the practice’s opioid stewardship plan, not a way around it. Non-opioid drugs are combined per the consensus algorithms.
THE HOSPITAL SETTING
The implant is an operation. It is done in an operating room with the catheter placed under fluoroscopy (live X-ray). For an Illinois patient it can be done at Anderson Hospital in Maryville, where Dr. Gurpreet Singh Padda, MD, MBA, MHP holds full privileges. The trial, programming and refills are handled at the clinic. The one day that needs a hospital stays on your side of the river.
WHO IS NOT A CANDIDATE
Some things rule the device out: active infection, a bleeding disorder that cannot be corrected, or a spine that will not accept a catheter. So does a failed trial, or pain that has not been traced to a source. And bluntly: a patient with no reliable way to reach the office every few months for years is not a safe candidate, however well the trial went.
The terrain the pump does not change
Moving a drug from the bloodstream to the spinal fluid changes the dose. It does not change the body the cord lives in. Opioids in the bloodstream leave a hormone and inflammatory mark that a lower dose does not erase. The metabolic inflammation that sensitized the cord keeps running unless the insulin, sleep and food driving it are addressed. The third driver is isolation. Pain this severe has usually cost a job and a circle of people. A nervous system with nothing else to do turns up the volume on what it hears. So a pump here comes with the protocol. Roughly 40 to 50 percent of it is behavior and lifestyle. The Acceptance and Commitment Therapy piece is run in-house by a licensed, pain-trained behavioral clinician. Across the established patient population fewer than 1 percent remain above 90 morphine milligram equivalents a day: practice-reported figures from our own population, not trial outcomes, and individual results vary.
What is the success rate of an intrathecal pain pump?
The one randomized trial that anchors this therapy enrolled 202 patients with refractory cancer pain (pain that has not responded to other treatment). It compared a pump plus medical management against medical management alone. At four weeks, 84.5 percent of the pump group met the trial’s definition of success, against 70.8 percent. Toxicity scores fell by half, against 17 percent. And 53.9 percent were alive at six months against 37.2 percent, a difference that did not quite reach statistical significance. It is the best trial the field has, and its patients are not most people reading this page.
For non-cancer pain the evidence is observational. A systematic review of long-term intrathecal therapy found reasonable rates of satisfactory relief. It said plainly that the shortage of randomized trials leaves real doubt about who to choose and about safety. That gap is why the polyanalgesic consensus process exists. It is a panel that publishes graded algorithms for drug choice, dosing, trials and risk. Our position: a strong cancer-pain trial plus two decades of structured consensus is a legitimate basis for a late-stage, trialed, reversible therapy. The honest way to offer it is to say so.
What happens during a pain pump trial and implant?
- Trial day: baseline recorded, then a single intrathecal dose or a temporary catheter placed under fluoroscopy.
- Monitored response over the next hours, a diary at home, and a review by telehealth when it is clinically appropriate.
- Implant day, if the trial passed: an operating-room procedure. The catheter is threaded into the spinal canal under X-ray, and the pump is seated in its pocket.
- Programmed at a conservative starting rate, then titrated (adjusted step by step) to effect over the first weeks.
- Refills on a fixed calendar that the practice tracks. The device is checked at every visit, and the next date is set before you leave.
Risks, plainly: infection of the pocket or catheter track; bleeding; a spinal-fluid leak that causes a headache worse when upright. A catheter can kink, move or block, which shows up as returning symptoms or as withdrawal. With long-term opioid infusion there is a small risk of an inflammatory mass at the catheter tip.
Common questions
What happens if a storm closes the bridge on my refill day?
Refill dates carry a buffer before the reservoir’s low point, so a missed day is a phone call. If a refill is overdue and you notice returning spasticity, sweating, agitation or a racing heart, treat it as urgent. when it is an emergency lists the signs.
Is a pump a way to get a higher dose?
It is a way to get a much smaller dose to the place it acts. For someone arriving on a large dose in the bloodstream, the whole-body exposure usually falls. The goal of the lowest dose that keeps function is set out in opioid stewardship.
Can it be taken out later?
The pump and catheter can be removed in a procedure about the size of the implant. The drug is tapered first so there is no withdrawal. The drug-free device it is usually weighed against first is on spinal cord stimulation.
Does prior authorization mean the pump is paid for?
An authorization is not a promise of payment; it is the plan agreeing the request is reasonable to submit, and we tell you where things stand before the trial. How the paperwork works for a patient driving in from Illinois is on for Illinois patients.
What medications go in a pain pump?
Two main kinds. Baclofen goes in for severe spasticity from spinal cord injury, multiple sclerosis or cerebral palsy, and it is the best-supported use. For refractory pain, the reservoir holds a pain-relief mix, with non-opioid drugs combined according to the published consensus algorithms. Because the drug reaches the spinal receptors directly, the dose is a small fraction of what a pill would need.
What are the disadvantages of a pain pump?
The biggest is the calendar. A refill by needle comes, for most patients, every one to three months, for as long as the pump is in. A pump that runs dry can cause withdrawal, which with baclofen can become an emergency within a day or two. The operation carries risks of infection, bleeding and a spinal-fluid leak headache. A catheter can kink, move or block.
Is a pain pump better than pills?
For the right patient, it can be. The drug reaches the spinal receptors without passing through the gut, the liver or most of the bloodstream, so the dose is much smaller. Some people arrive on a high opioid dose by mouth. For them, that cuts the whole-body exposure that lowers testosterone, breaks up sleep and worsens insulin resistance. It does not fix the metabolic terrain, which is why the pump comes with the full protocol.
Related reading
We will walk you through the refill calendar before we walk you through the implant
If the drive, the driver and the winter cannot be made to work, we will say so and look at what can. If they can, you will know what the trial has to show, what the operation involves and where it happens, before anything is scheduled.
505 Buckeye Dr, Suite 200
Troy, IL 62294
Procedure clinic: 4499 Woodson Rd, St. Louis, MO 63134, off I-70 next to St. Louis Lambert International Airport. One bridge from the Metro East.
Sources
- Smith TJ et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. Journal of Clinical Oncology, 2002. PubMed 12351602
- Deer TR et al. The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation, 2017. PubMed 28042904
- Deer TR et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy. Neuromodulation, 2017. PubMed 28042906
- Hayek SM et al. Intrathecal therapy for cancer and non-cancer pain. Pain Physician, 2011. PubMed 21587327
- Otero-Luis I et al. Effectiveness of the intrathecal baclofen pump in the treatment of spasticity of different aetiologies: A systematic review and meta-analysis. Neurologia, 2025. PubMed 40769606