Hamza, M. et al. "Prospective Study of 3-Year Follow-Up of Low-Dose Intrathecal Opioids in the Management of Chronic Nonmalignant Pain." *Pain Medicine* (United States) 13, 1304–1313 (2012).
Mercadante, S., et al. (2015). "Intrathecal Treatment for Cancer Pain Not Responsive to Systemic Opioids: A Randomized Controlled Study." *Journal of Pain and Symptom Management*, 49(5), 968-974. Deer, T. et al. "Pain Medicine." doi: 10.1111/j.1526-4637.2004.04011.x. *Pain Medicine* (United States) 13, 1304–1313 (2012).
Rushton, D. N. "Upper Motor Neurone Syndrome and Spasticity: Chapter 10." In *Neurorehabilitation*, ed. Barnes, M. P. and Johnson, G. R., 181–192. Cambridge University Press, 2008. doi:10.1017/cbo9780511544866.011.
Bennett, G., et al. (2000). "Consensus Panel on the Appropriate Use of Intrathecal Opioids for Chronic Noncancer Pain: Guidelines and Recommendations." *Pain*, 85(1-2), 271-281.Grider, J. S., Etscheidt, M. A., Harned, M. E., et al. (2016). "Neuromodulation." *Neuromodulation*, 19(2): 206-219. doi:10.1111/ner.12352.
Deer, T. R., et al. (2007). "A Review of Programmable Intrathecal Drug Delivery Systems in the Management of Pain and Spasticity." *Pain Medicine*, 8(5), 451-466.Sindt, J. H., et al. (2020). "Neuromodulation." *Neuromodulation*, 23(7): 978-983. doi: 10.1111/ner.13175.
Zhao, J., et al. (2011). "Long-Term Intrathecal Baclofen Therapy for Refractory Spasticity in Children: Outcomes and Complications." *Pediatric Neurosurgery*, 47(3), 151-157.
Duarte, R. V., et al. (2020). "Intrathecal Drug Delivery Systems for the Management of Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." *Neuromodulation*, 23(7): 996-1002. doi:10.1111/ner.13097.
Krach, L. E., Nettleton, A., & Klempka, B. (2006). "Pediatric Rehabilitation." *Pediatr Rehabil*, 9(3): 210-218. doi: 10.1080/13638490500138678.Meythaler, J. M., McCary, A., & Hadley, M. N. (1997). "J Neurosurgery." *J Neurosurg*, 87(3): 415-419. doi: 10.3171/jns.1997.87.3.0415.
Krames, E. S., et al. (2009). "The Appropriate Use of Intrathecal Opioid Therapy for Chronic Pain: The POLARIS Expert Panel Consensus." *Neuromodulation: Technology at the Neural Interface*, 12(3), 202-228.
Gomes, L., et al. (2021). "Management of Spasticity with Intrathecal Baclofen Therapy in Children and Adults." *Cureus*, 13(4), e14321.
Deer, T. R., et al. (2012). "Intrathecal Drug Delivery for the Management of Pain and Spasticity in Chronic Pain: A Review of Clinical Evidence." *Pain Medicine*, 13(5), 795-807.
Prager, J., et al. (2014). "Best Practices for Intrathecal Drug Delivery for Pain." *Neuromodulation: Technology at the Neural Interface*, 17(4), 354-372.
Stearns, L. J., et al. (2005). "Intrathecal Drug Delivery for Severe Chronic Pain: Patient Selection and Patient Outcomes." *Pain Physician*, 8(3), 359-364.
Smith, T. J., et al. (2005). "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*, 23(19), 4040-4049.
Lema, M. J., et al. (2005). "Practical Considerations in Using Intrathecal Drug Delivery for the Relief of Cancer Pain." *Journal of Pain and Symptom Management*, 29(5), 118-139. *(United States) 13, 1304–1313 (2012).*
Narayanan, V., et al. (2022). "Intrathecal Drug Delivery for Cancer Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." *Pain Practice*, 22(6), 678-688.
Intrathecal Pump Therapy
Learn more about intrathecal long-term medication with an implanted medication pump, its benefits, the implantation process, and aftercare.
Learn more
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How does intrathecal pump therapy work?
Intrathecal pump therapy is a specialized, minimally invasive method in which medications are delivered directly into the intrathecal space of the spinal cord via an implanted pump system. The intrathecal space contains cerebrospinal fluid (CSF), which surrounds the central nervous system (CNS). This targeted drug delivery to the nerve pathways in the spinal cord allows for a high therapeutic efficacy while significantly reducing the systemic distribution of the active ingredient, which greatly decreases the risk of side effects caused by high systemic drug levels.
In contrast to systemic therapy, where the medication passes through the bloodstream and reaches various organs and tissues, intrathecal therapy works directly on the pain receptors and spasticity centers of the central nervous system (CNS), enabling a highly selective and efficient treatment.
What different systems are available?
Two main types of pump systems are used: electronic and gas pressure-operated pumps: Electronic Pumps, such as the SynchroMed® system, are programmable and allow for flexible adjustment of medication delivery to meet the individual needs of the patient. They offer the capability to precisely control and titrate the medication dose as needed. This is particularly beneficial for patients whose symptoms vary throughout the day or who experience pain spikes that require a temporary increase in dosage. The programmability of these pumps enables personalized therapy, thereby enhancing the efficiency of treatment.
Gas pressure-operated pumps, on the other hand, function mechanically by continuously delivering the medication using a constant pressure. These pumps are not programmable and are particularly suitable for patients who require a steady medication flow. They are robust, low-maintenance, and do not require an external power source, making them less susceptible to technical failures.
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For which indications is an intrathecal pump suitable?
Intrathecal pump therapy is used for a variety of conditions where other treatment options are not sufficiently effective.
Severe spasticity
Intrathecal pump therapy is particularly indicated for therapy-resistant spasticity caused by damage to the central nervous system, such as in multiple sclerosis, cerebral palsy, or after strokes. In this case, baclofen, a GABA-B receptor agonist, is administered directly into the cerebrospinal fluid, significantly reducing spasticity by inhibiting spinal reflex arcs. This targeted effect leads to a reduction in muscle tone and significantly improves mobility and the quality of life for patients, especially when oral baclofen doses are not sufficiently effective or are associated with excessive side effects.
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Chronic pain
In cases of therapy-resistant chronic pain syndromes, such as Failed Back Surgery Syndrome, complex regional pain syndromes (CRPS), or neuropathic pain due to spinal cord injuries, intrathecal administration of analgesics offers effective pain control. Morphine and ziconotide are the primary substances used. Morphine acts as a μ-opioid receptor agonist, directly targeting the pain receptors in the spinal cord, while ziconotide, an N-type calcium channel blocker, inhibits the release of neurotransmitters involved in pain transmission. This form of therapy allows for high efficacy with minimal systemic side effects and a significant reduction in the need for systemic opioids.
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Tumor pain
Intrathecal pump systems are a valuable option for treating severe, opioid-resistant tumor pain, especially in patients with advanced cancer. The intrathecal administration allows for the delivery of high doses of opioids directly to the receptors in the spinal cord, enabling rapid and effective pain relief. This is particularly important for patients with spinal metastases or infiltrating tumors, where peripheral pain therapies are insufficient. The use of combination therapies, such as the simultaneous administration of morphine and a local anesthetic, can further enhance pain control.
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About the implantation process
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Test Phase
Preoperative diagnostics, including imaging procedures (MRI/CT), for precise planning of catheter placement.
Determination of the appropriate medication and individual dosage based on clinical tests (e.g., intrathecal bolus test or port system).
Evaluation of the results and effectiveness of the therapy.
implantation
Implantation of the pump system under sterile conditions and general anesthesia, with the placement of the intrathecal catheter in the lumbar region.
The surgery lasts about one to two hours.
Initial filling (and programming) of the pump immediately after implantation.
Postoperative aftercare
Postoperative monitoring of medication effects and fine-tuning of the dosage through external programming.
Regular follow-up examinations to check the pump, medication reserve, and adjust the dosage as needed.
The regular refilling of the pump takes place on an outpatient basis at scheduled intervals.
Testphase
präoperative Diagnostik inklusive bildgebender Verfahren (MRT/CT) zur genauen Planung der Katheterplatzierung
Bestimmung des geeigneten Medikaments und der individuellen Dosierung basierend auf klinischen Tests (z.B. intrathekaler Bolustest oder Portsysetm)
Evaluierung der Ergebnisse und Effektivität der Therapie
Implantation
Implantation des Pumpensystems unter sterilen Bedingungen und Vollnarkose, mit der Platzierung des intrathekalen Katheters im lumbalen Bereich
Die Operation dauert ca. ein bis Stunden
Erstbefüllung (und Programmierung) der Pumpe unmittelbar nach der Implantation
Postoperative Nachsorge
Postoperative Überwachung der Medikamentenwirkung und Feinjustierung der Dosierung durch externe Programmierung
Regelmäßige Nachsorgeuntersuchungen zur Kontrolle der Pumpe, Medikamentenreserve und Anpassung der Dosierung nach Bedarf
Die regelmäßige Befüllung der Pumpe findet in regelmäßigen Abständen ambulant statt
Universal Refill Kits for Outpatient Aftercare
For safe and smooth filling of the implanted pump, the use of approved refill kits is essential. As the market leader in refill kits, we provide comprehensive support for the care of your pump patients—completely at no cost to you.
Benefits of Intrathecal Pump Therapy
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Targeted and effective pain control.
The direct administration of analgesics into the cerebrospinal fluid allows for high effectiveness in pain reduction, even in severely treatment-resistant pain syndromes.
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Reduction of systemic medication dosage.
Due to the local application in the spinal cord, the required dosage can be significantly reduced compared to oral or transdermal administration, minimizing the risk of systemic side effects.
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Improvement of quality of life.
Effective symptom control leads to a significant improvement in quality of life, particularly through the reduction of chronic pain and the enhancement of mobility in spastic conditions.
Patient satisfaction.
Chronic pain
of patients would recommend the therapy to their family or friends.
Tumor pain
Reduction of systemic opioids.
Spasticity.
would choose this form of therapy again for severe spasticity.
Contact Us
If you are interested in the therapy or our products, or if you need additional informational material, please feel free to contact us. We are here to assist you with your inquiry.
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