General idea
The intrathecal treatment consists of administering pain-killing medication directly into the cerebrospinal fluid which surrounds the spinal cord. Those nerves transmit pain signals to the brain, where they are integrated into the sensation of pain.
When medication is taken orally, trans-cutaneously, or by the blood, it is spread in the entire body and only a small proportion can fix pain receptors.
When the medication is directly administered in the cerebrospinal fluid however, only a little dose is necessary to bring relief, thus allowing for a reduction of the painkiller’s undesirable side-effects. As such, where 300 milligrams of morphine are needed when used orally, 100 milligrams intra-venously, or 10 milligrams epidurally, only one milligram of morphine is necessary intrathecally.
Instructions
Rebellious cancerous pain makes up the majority of uses of intrathecal pumps. Patients are generally referred to us by the oncology center.
In order to benefit from an intrathecal pump, one must adhere to some precise criteria:
- A lack of improvement of the pain despite an optimal medication treatment and/or its responsibility for notable secondary effects;
- A high dose of morphine-like analgesics (> 200 milligrams/per day);
- The possibility of an implantation surgery;
- An understanding of the therapy and complying to the follow-up;
- An improvement in the quality of life (research protocol, HAD – At-home Hospitalization).
You will have to go through a pre-operation assessment, in order to clear those different eligibility criteria. It includes:
- A consult with the doctor that will do the implantation;
- A consult with a nurse dealing in Pain Management (Research Institute for Development – IRD);
- An anesthesia consultation;
- A consult with a psychologist.
An internal pump will be offered to you, if your life expectancy is estimated to be over 3 months. If it is under 3 months, we will instead opt for the installation of a hooked-up catheter to an implantation spot – a typical port-a-cath –, with an additional external pump PCEA (Patient Controlled Epidural Analgesia). The implantation of an external pump might then be considered, if you get better after getting that treatment.
Contraindication
- Chronic sepsis ;
- An impossibility of using anesthesia;
- The psychological profile;
- A social and environmental context which isn’t conductive to follow-ups.