If the this a programmable pump and there was a replacement that took place of the pump reservoirbattery than cpt 62362 implantation or replacement of device for intrathecal or epidural drug infusion. The use of intrathecal therapy is associated with increase quality of analgesia and a decrease in side. Background intrathecal it drug delivery can be an invaluable adjunct in the management of severe and refractory pain. The pacc has developed an algorithmic process for several aspects of intrathecal drug delivery to promote safe and efficacious evidence.
Intrathecal permanent pain pump discharge instructions. Intrathecal drug therapy for pain palliative care network. Often it can take 3 to 6 months before you can get the best pain control with your pump. Information guide to intrathecal baclofen pump program. Baclofen is a white to offwhite, odorless or practically odorless crystalline powder, with a molecular weight of. Delivery of the drug by the intrathecal spinal route. Lioresal intrathecal is a sterile, pyrogenfree, isotonic solution free of antioxidants, preservatives or other potentially neurotoxic additives indicated only for intrathecal administration. Implementing and managing intrathecal pumps osu center for. This table gives some examples of how intrathecal pumps and epidural catheters are different. Intrathecal baclofen therapy itb therapy sm is delivered by the medtronic synchromed drug infusion system, which consists of an implantable, programmable pump and an intrathecal catheter. Subcutaneous solid implants, conversely, provide longterm. If the patient had a successful trial, one may proceed to implant an intrathecal system.
Individuals anticipated to live longer than 3 to 6 months are considered for intrathecal analgesia with implantable pump. Intrathecal drug delivery for the management of pain and spasticity. The intrathecal route of administration should no longer be thought of as an exotic way of treating diseases of the nervous system. The technique of intrathecal drug delivery itdd is based on the principle that effective analgesia can be achieved by the action of some drugs at the dorsal horn where adequate concentrations cannot be achieved by systemic administration, or only by high systemic doses. The intrathecal baclofen pump is a surgically implanted device which allows delivery of a small amount of antispasticity medicine lioresal or baclofen to be. Implantation of an intrathecal pump and catheter is a surgical procedure requiring a surgical environment and techniques as described in the previous section on spinal cord stimulator implant. Dec 18, 2017 implantable drug pumps are used to deliver insulin in the treatment of diabetics and to administer pain medications directly to the spine intrathecal pumps. A trial of intrathecal drug therapy often precedes implant of the intrathecal drug delivery system. Medications such as baclofen, bupivacaine, clonidine, morphine, or ziconotide may be delivered in this manner to minimize the side effects often associated with the higher doses used in oral or. Intrathecal drug delivery itdd systems for cancer pain. Consensus opinion, based on expertise, was used to fill gaps in evidence. The pump delivers the drug into an area of the spinal cord called the intrathecal space. Fluid mechanics of intrathecal drug delivery infoscience epfl.
Jul 28, 2014 intrathecal drug delivery is an effective pain management option for patients with chronic and cancer pain. Medications such as baclofen, bupivacaine, clonidine, morphine, or ziconotide may be delivered in this manner to minimize the side effects often. It is the policy of health plans affiliated with centene corporation that implantation of a permanent epidural or intrathecal pain pump to administer an opioid drug, singly or in. Analgesia using intrathecal drug delivery systems idds has been poorly studied specifically in this population.
The current intrathecal drug delivery systems idds are approved by the food and drug administration fda for administration of a single agent and there are only 3 fda approved agents. Lioresal intrathecal baclofen injection is administered directly to the intrathecal space surrounding the spinal cord. Indications for intrathecal therapy in cancer patients. This type of drug delivery is called intrathecal or intraspinal baclofen. An essential component of cancer treatment and management. Information guide to intrathecal baclofen pump program introduction. An implantable intrathecal drug delivery system pain pump or baclofen pump is a device used for the continuous infusion of a drug directly into the cerebrospinal fluid via a catheter placed in the intrathecal or epidural space. Illicit substance abuse via an implanted intrathecal pump is a previously unreported complication. For prometrao programmable pump and intrathecal catheter. An intrathecal catheter may be placed for repeated injection or continuous infusion to allow significant prolongation of the block. About your intrathecal pump memorial sloan kettering. Complications after intrathecal drug delivery due to the. Definitions an implantable intrathecal drug delivery system pain pump or baclofen pump is a device used for the continuous infusion of a drug directly into the cerebrospinal fluid via a catheter placed in the intrathecal or epidural space. While most of the evidence supporting the use of it pain pumps in palliative care settings has been largely based on case series and consensus statements, one prospective randomized clinical trial of cancer.
Intrathecal drug delivery systems for treating pain and spasms information for patients your hospital specialist team thinks that you might benefit from having an intrathecal drug delivery itdd system. Chronic intractable pain of malignant origin and the. Implantable drug pumps are used to deliver insulin in the treatment of diabetics and to administer pain medications directly to the spine intrathecal pumps. Intrathecal pain pumps intrathecal drug delivery chronic pain intractable spasticity.
Your spine is made up of a number of bony supports at the front and. Best practices, chronic pain, intrathecal drug delivery, intrathecal catheter, intrathecal pump, morphine, opioid. Synchromed ii pumps can be managed using the control workflow sm approach, which is designed to help eliminate systemic opioids and provide effective pain relief. The intrathecal space contains the cerebrospinal fluid csf the fluid that surrounds the spinal cord and nerve roots. One developed respiratory depression coinciding with application of fundal pressure during cesarean delivery 211 c. Intrathecal opioids patient selection low dose clinical studies csf flow optimal dosing strategy for intrathecal drug delivery, in general optimal dosing strategy for microdosing intrathecal drug delivery oih case study in cancer microdosing case study. Jul 31, 2006 intrathecal pumps deliver small doses of medication directly to the spinal fluid. Clinical policy implantable intrathecal pain pump page 2 of 9 ii. Definitions an implantable intrathecal drug delivery system pain pump or baclofen pump is a device used for the continuous infusion of a drug directly into the cerebrospinal fluid via a catheter placed in. Intrathecal analgesia an overview sciencedirect topics. Knowledge of intrathecal dose labeling for each drug placed in the. Great care must be taken in selecting dosing regimens for idd.
The screening trial employs lioresal intrathecal at a concentration of 50 mcgml. The drug is stable in solution at 37 c and compatible with csf. An intrathecal pump works to relieve chronic pain by inserting small amounts of medicine directly into the intrathecal space area surrounding the spinal cord to prevent pain signals from being perceived by the brain. The synchromed ii programmable, implantable pump delivers drug to the intrathecal space via an implanted catheter. There are two steps in the process of authorizing an implantable intrathecal drug delivery. Some people have side effects such as drowsiness or seizures from oral baclofen. While both pumps give pain medication directly to the nerves in your spine, there are some differences. Intrathecal drug delivery systems for treating pain and. This video gives a clear picture of an intrathecal pump implant.
Most individuals have significant reductions in pain severity and improved pain relief 60%80% reduction in vas, 60% improvement by relief scales. The implanted infusion system consists of a model 8637 synchromed ii pump and a catheter. The intrathecal pump system consists of a pump reservoir implanted between the muscle and skin of your abdomen and a catheter that carries medication blue area from the pump to the spinal cord and nerves. Implementing and managing intrathecal pumps oscar a. At the centre of these arches lies the spinal cord. Cmm210 implantable intrathecal drug delivery systems. Intrathecal drug delivery systems bja education oxford. Intrathecal permanent pain pump discharge instructions now that you have an intrathecal pain pump, we will rely on your feedback to assist us in managing your pain. Conversely, those patients with survival expectancy less than 3 months will require epidural therapy with an implanted system. Intrathecal pumps are different from epidural catheters, which is what women get during childbirth. It consists of a small batterypowered, programmable pump figure 1 that is. It consists of a small batterypowered, programmable pump figure 1 that is implanted under the subcutaneous tissue of the abdomen and connected to a small catheter tunneled to the site of spinal entry figure 2. Therefore, 2 weeks after initial evaluation, she underwent an intrathecal trial with ziconotide 0.
Sophisticated drug dose regimens can be instituted. Intrathecal dosing and medication selection american. Prior to administration, remove 5 ml of cerebrospinal fluid. Although it has not been reported in the literature, medtronic has seen other cases in which pump tampering has been suspected personal communication, andrea huttonlau, march 3, 1998. Moreover, the pharmacokinetics of drugs delivered intrathecally can be as predictable as with any other route of. An intrathecal pump is a medical device used to deliver via an intrathecal catheter medications directly into the space between the spinal cord and the protective sheath surrounding the spinal cord. It is the policy of health plans affiliated with centene corporation that implantation of a permanent epidural or intrathecal pain pump to administer an opioid drug, singly or in combination with other nonopioid drugs, is medically necessary for either of the following. Conflict of interest declarations prof sam eldabe has received departmental funding from medtronic to conduct studies on intrathecal therapy. Intrathecal baclofen therapy, given via an implanted pump in the abdominal wall either as a continuous infusion or bolus dosing, has. Intrathecal opioid therapy for management of chronic pain. It is presumed that this is the result of drug being delivered at a higher level than with the midline approach, and with the flow of local anaesthetic solution being more cephalad. Targeted drug delivery is a safe, proven, and effective way to.
Lioresal intrathecal 50 micrograms1ml is intended for administration in single. Illicit substance abuse via an implanted intrathecal pump. Consider ultrasound or other imaging techniques to guide intrathecal administration of spinraza, particularly in younger patients. Pain pump, intrathecal drug pump cincinnati, ohio mayfield. Implantable intrathecal drug delivery system cmm210. Idds has demonstrated improved cancer pain management compared to conventional medical management cmm and placebo 1012 and in retrospective and observational studies. Prior to pump implantation and initiation of chronic infusion of lioresal intrathecal baclofen injection, patients must demonstrate a positive clinical response to a lioresal intrathecal bolus dose administered intrathecally in a screening trial. Best practices for intrathecal drug delivery for pain. Pdf best practices for intrathecal drug delivery for pain. Cmm210implantable intrathecal drug delivery systems. Intrathecal drug delivery systems iddss administer food and drug administration fdaapproved preservativefree morphine sulfate or ziconotide directly to the spinal cord. Objective intrathecal it drug delivery has shown its efficiency in treating refractory cancer pain, but switching opioids from the systemic to the intrathecal route is a challenging phase. A pump see figure 1 delivers medication directly to the intrathecal space in your spine.
Before considering you for implantation of the pump we need to check if your spasticity responds to baclofen delivered around your spinal cord. An intrathecal drug pump works more efficiently than oral medication because it delivers medicine directly into the csf, bypassing the path that oral medication takes through your body. Subsequent animal studies demonstrated that intrathecal opioids produce powerful and highly selective analgesia 2. A pain pump is a method of giving medication directly to your spinal cord. Your pain pump incision site watch for signs and symptoms of infection and. The catheter runs from the point of entry in the spinal canal typically in. However, it is not unusual for intrathecal medication and dosing to evolve with time after implant. With current implantable technology, access to the lumbar subarachnoid space is clinically acceptable and carries a low risk of infection. To find out you will receive a test dose of intrathecal baclofen. Intrathecal pumps and microdosing texas pain society. Errors in pump programming have also been reported and resulted in incorrect flow rates. While most of the evidence supporting the use of it pain pumps in palliative care settings has been largely based on case series and consensus statements, one prospective randomized clinical trial of cancer patients with refractory pain, suggested that it drug delivery may. The pump delivers medication through a catheter to the area around your spinal cord.
Indications for intrathecal therapy in cancer patients jacqueline lozano,a oscar a. These are typically programmable active devices which require regular resupply of the medication through an access port. Updated guidelines on intrathecal therapy for pain. Each milliliter of lioresal intrathecal contains baclofen. The intrathecal baclofen pump is a surgically implanted device which allows delivery of a small amount of antispasticity medicine lioresal or baclofen to be delivered around the spinal cord. Rodney jones md, in pain procedures in clinical practice third edition, 2011. Intrathecal pumps deliver small doses of medication directly to the spinal fluid. The system uses a small pump that is surgically placed under the skin of your abdomen. Jan 19, 2017 educational requirements for implanting andor managing intrathecal drug delivery system therapy. Your spine is made up of a number of bony supports at the front and arches at the back.
Pain pump replacement medical billing and coding forum. Lioresal intrathecal baclofen injection description lioresal intrathecal baclofen injection is a muscle relaxant and antispastic. Its chemical name is 4amino34chlorophenyl butanoic acid, and its structural formula is. The saol drug preparation kit is intended for use with medtronic synchromed implantable programmable infusion pumps. Intrathecal drug delivery systems for treating pain and spasms. In fact, you generally need about 0 the amount of medication morphine or baclofen with a pump. Administer spinraza as an intrathecal bolus injection over 1 to 3 minutes using a spinal anesthesia needle see dosage and administration 2.
The pacc recommends that physicians in training, nurses, and allied. The system uses a small pump that is surgically placed. Pdf complications of intrathecal drug delivery systems. Intrathecal pumps for giving opioids in chronic pain. Intrathecal drug delivery is an effective pain management option for patients with chronic and cancer pain. Intrathecal drug delivery itdd systems comprise an it catheter connected to a drug reservoir, which may be externalized and connected to a pump, or fully implanted. The delivery of drugs into the intrathecal space provides superior analgesia with smaller doses of analgesics to minimize side effects while significantly improving quality of life. Baclofen pump therapy for the treatment of spasticity. About your intrathecal pump memorial sloan kettering cancer. Pdf current perspectives on intrathecal drug delivery. Educational requirements for implanting andor managing intrathecal drug delivery system therapy. Intrathecal drug delivery, or pain pump, is a method of giving medication directly to your spinal cord.