Curious to hear what experts have to say about pain pumps? Below, you’ll find answers to common questions about targeted drug delivery, as answered by pain management specialists with more than 5 years of experience with Medtronic Chronic Pain Therapies.

The doctors listed on this page are paid by Medtronic as consultants. Medtronic asked for their statements regarding their experience with targeted drug delivery.

Dr. Grigsby
Dr. Grigsby
Dr. Hesseltine
Dr. Hesseltine
Dr. Provenzano
Dr. Provenzano
Dr. Wellington
Dr. Wellington

Pain Doctors Answer Questions About Targeted Drug Delivery

Dr. Provenzano says:
Patients may have a fear of having a foreign object inside of them. And I think that’s a legitimate question that should be answered. The reality is that in this country, and also worldwide, there are millions of people with implantable devices—whether it’s pacemakers, total hips, total knees. We know that in a majority of people, this is very suitable and it works out well.

There are responsibilities and there are risks with implanted devices. And it’s important that patients understand those risks. And it’s also important that healthcare providers and patients do everything to responsibly manage an implantable device.

Dr. Grigsby says:
I remind people that there are millions of implantable devices in use. Medtronic performs routine testing to ensure devices are safe to be implanted in your body and most people tolerate them well. There are always risks, but Medtronic and your physician do all they can to reduce those risks.

Dr. Grigsby says:
This is more of a concern with drug delivery therapy because the pump is larger than the neurostimulator. There have been great advances in technology and the devices have gotten much smaller than they originally were. In many individuals, it is not very obvious that they have a device because it is so small. We typically place the device below the beltline where it is covered by clothing, making it much less noticeable.

Dr. Hesseltine says:
These devices are designed for patients who have failed the more conservative treatment options. They are not last resort therapies, but they’re also not first line therapies. They are intended for long-term use. You should first try things like massage, physical therapy, chiropractic, acupuncture, medication, and other treatments that are non-invasive and inexpensive. If those approaches don’t work, then consider neurostimulation or drug delivery therapy.

To determine whether to try neurostimulation or drug delivery therapy, we first evaluate the type of pain. Neurostimulation is indicated for nerve-related pain in the trunk and/or limbs. For example, this could be an option for a patient who has failed back surgery and has continuing back and/or leg pain. Drug delivery therapy is better for widespread pain. If there is a question as to which therapy to try, I try neurostimulation therapy first.

Dr. Wellington says:
In an appropriately selected individual, the success rates can be very high. At my practice, the success rates are at least 75 percent for spinal cord stimulation. Drug delivery therapy success rates are also very high. In fact, my experience with drug delivery therapy isn’t a question of “Will it work?” It’s a matter of when it works and at what dosage.

The improvement in pain and quality of life with neurostimulation or drug delivery therapy has been dramatic in many people. There have been significant improvements in terms of quality of life and function, ability to work, and participation in family life. With the improved pain control of these advanced therapies, patients are often able to reduce or eliminate their oral pain medications. I will have patients return to the office describing that they have “come out of a fog” when weaned off of their previous oral pain medications. Patients have gone from being homebound to going out to the grocery, mall, or church. Basically, people return to living much fuller lives. It’s very exciting.

Dr. Hesseltine says:
I explain they can test the therapy out and experience it without an incision – just a spinal injection – which is something they have likely already experienced. Patients often hope that another surgery or therapy will come along that will be even better than this option. And so they like the fact that it does not have to be a permanent procedure. The neurostimulator or drug delivery pump can be surgically removed if patients do not like it or if they decide to pursue a different treatment.

I also remind patients that they can talk to someone who is living with neurostimulation or drug delivery therapy before making a decision. The Medtronic Ambassador Program puts people in touch with a volunteer who is living with the therapy and is interested in sharing their experience.

Dr. Grigsby says:
Targeted drug delivery therapy delivers pain medications directly to the spine. We place a very small tube in the spinal fluid sac, and attach it to a device under the skin that constantly drips pain relief medicine around the spinal cord. By placing the pain medication right at the site of action, you can use discreetly small doses to achieve a large effect on pain relief. Delivering the drug via the spinal cord has fewer side effects than the equally effective dose of opiate administered by mouth, with a patch or IV. That’s because the pain medication just stays in the spinal canal so you don’t get the constipation or short-term memory loss that may come with systemic medication.

DR. PROVENZANO ANSWERS THE QUESTION

Dr. Wellington says:
Targeted drug delivery therapy requires significantly lower doses of medication. These comparatively low doses of pain medication can yield large effects to improve pain because the medication goes straight to the pain receptors on the spinal cord. Oral opioids often cause many bothersome side effects, but with targeted drug delivery’s lower dosages, you can often avoid those side effects. Another benefit is that the pump is programmable. This allows customizing the pump to treat pain, even if it changes. Additionally, the pump can be programmed by a pain physician to allow administration of extra doses of pain medicine for different times of the day when activities may increase your pain. This allows patients to have control for when the pain gets worse. Also, SynchroMed® infusion pumps are MRI compatible for body scans, under specific conditions.

Dr. Provenzano says:
During the screening test, we watch for side effects of the medication, in case the patient is underdosed or overdosed with the medication. We monitor oxygen levels and heart rates for signs or symptoms suggestive of a possible complication. Under- and over-dosing can also occur during long-term therapy. Other risks associated with the screening test and long-term procedure include bleeding, infection, and nerve damage. There is always the risk of spinal headache because we’ve entered the spinal canal with a needle. In addition, with the long-term procedure, pump or catheter problems can occur and may require corrective surgery.

Dr. Hesseltine says:
There are risks including infection. If the area becomes infected, the system may have to be removed. You may experience pain with the incision or discomfort where the device is placed. The procedure uses a needle around the spine, which could cause spinal cord injury resulting in nerve damage or paralysis. This is rare, but it is a risk. There is the risk of a granuloma or inflammatory mass growing around the tip of the catheter. That mass could push up against the spinal cord leading to emergency surgery or even paralysis. This device is very reliable, but there is also the possibility of hardware failure.

DR. PROVENZANO ANSWERS THE QUESTION

Dr. Provenzano says:
At the end of the screening test we will talk with the patient about their experience. We’ll ask questions such as, Did it help your pain? Did it help you function? Were there side effects that were bothersome to you? And once we have discussed this and answered the patient’s questions, we’ll remove the catheter if the screening test used a continuous catheter system. We will then clean the area where the catheter was inserted and cover it with a bandage. One of the very nice things about a drug delivery trial is that patients don’t have to rush forward right to the implant. We discuss the results and give the patient some time to think about the results. We always give patients the opportunity to ask more questions. If a patient feels that this was an appropriate and helpful treatment, then at that point we will discuss the possibility of progressing forward and doing the implantation procedure.

Dr. Provenzano says:
One of the things that you might be asking is what can I expect with an implantable drug delivery system. Well, our goal is to reduce your pain, reduce side effects, and help you with the activities that you desire. But one of the expectations that you clearly have to have with most chronic pain treatments is that this is not a cure. It’s a way for us to reduce pain and help you function better. Once we have implanted a targeted drug delivery system we will have to work with you to find out what is the correct dose of drug that we should be delivering. So, during that time you need to be patient. And, you need to let us help you in finding the appropriate dose for you.

DR. PROVENZANO ANSWERS THE QUESTION