Intrathecal Pump (Targeted Drug Delivery)

Key facts

Who it is for

How targeted drug delivery works

Medicine taken by mouth has to travel through the gut, liver and bloodstream before a small fraction reaches the spinal cord and brain. An intrathecal pump bypasses all of that. A catheter no wider than a piece of spaghetti sits in the fluid-filled space around the spinal cord (the intrathecal space), and a hockey-puck-sized pump under the skin of the abdomen pushes a programmed amount of drug through it, continuously and in tiny quantities. Intrathecal morphine, for example, is typically dosed at about 1/100 to 1/300 of the oral dose, which is why sedation, constipation and nausea are usually much less. For spasticity, intrathecal baclofen relaxes tight muscles at doses that would be impossible to tolerate by mouth. The pump is programmed with an external tablet and can deliver a steady rate, a rate that changes across the day, or, for some pain patients, a patient-triggered bolus. Refills happen in the office: a nurse or physician locates the port with a template or ultrasound, empties the reservoir with a needle through the skin, and refills it with fresh medication. The practice cares for pump patients in Houston, Webster and Pearland (opening November 2026), including refills and programming.

Evidence and coverage statement: intrathecal drug delivery is FDA-approved and well established for cancer pain and for spasticity, with randomized trial support in cancer pain. For chronic non-cancer pain the evidence is mostly observational, guidelines reserve it for a narrow group, and outcomes are more mixed; coverage exists but requires strict documentation.

What happens on procedure day

1. Trial visit. For pain: a single intrathecal injection of the planned drug in the office or procedure room, followed by 6–24 hours of observation at home or in a monitored setting depending on the drug and your breathing risk; or a temporary catheter connected to an external pump for 1–3 days, usually in the hospital. For spasticity: a single baclofen injection with tone measured over the next 4–8 hours. You need a driver.
2. Judging the trial: at least 50% pain relief (or a clear drop in spasticity scores) with side effects you can live with. Headache after the spinal needle is possible and usually settles within days.
3. Implant (separate visit, at a surgery center or hospital). After antibiotics and sedation or general anesthesia, the catheter is placed through a needle into the intrathecal space under X-ray and threaded to the level matching your pain, then anchored to the tissue over the spine.
4. A pocket is made in the abdominal wall, the catheter is tunneled under the skin to it, and the pump is placed and filled. Two incisions are closed. The pump is programmed before you leave the recovery area. Most people go home the same day or after one night.
5. First refill and dose adjustment are scheduled within weeks; the interval then settles at 1–6 months depending on dose and drug concentration.

After the procedure

Days 0–3: incision soreness at the abdominal pocket and back; a spinal headache from the catheter entry in a minority of people, treated with fluids, caffeine and lying flat. Doses are started low and raised gradually to avoid over-sedation.

Weeks 1–2: wound check and first programming visit. Oral pain medication is tapered as the pump dose rises; do not stop oral opioids abruptly on your own.

Weeks 1–6: no bending, lifting more than about 10 pounds or twisting, to keep the catheter from moving until scar tissue holds it. Avoid pressure on the pump pocket.

Months 2–3: normal activity. Dose is titrated at each visit until relief and side effects balance. This is when to judge the result.

Ongoing: refills every 1–6 months are not optional. The pump alarms when the reservoir is low, and every visit ends with the next refill date. Carry the pump ID card, tell every physician and hospital you have a pump, and call immediately for fever, redness over the pump, new severe headache, or any of the withdrawal or overdose signs listed under risks. Pump replacement for battery depletion is scheduled about every 6–7 years.

What the evidence shows

The best-known trial is a 2002 randomized study of 202 people with refractory cancer pain comparing an implanted pump with comprehensive medical management: the pump group had a higher rate of clinical success (85% versus 71%), lower pain scores and markedly fewer drug side effects such as fatigue and sedation, with a trend toward longer survival. Intrathecal baclofen has decades of evidence for reducing spasticity in spinal cord injury, multiple sclerosis and cerebral palsy, with FDA approval since 1992 (spinal origin) and 1996 (cerebral origin). For chronic non-cancer pain, evidence is largely from observational series; the Polyanalgesic Consensus Conference (PACC) guidelines recommend it only after other options, favor low starting doses, and identify ziconotide or low-dose morphine as first-line agents. Long-term data show that dose escalation, catheter problems and, with opioids, hormonal side effects are common, which is why the trial and the candidate selection matter so much.

Alternatives and what comes next

For chronic non-cancer nerve pain, a spinal cord stimulator is usually tried first because it involves no drug, no refills and no withdrawal risk. For cancer pain, a pump is often the better tool because it treats pain from multiple sites and can be adjusted quickly as the disease changes; sympathetic blocks such as a celiac plexus or hypogastric block are alternatives for specific abdominal or pelvic cancers. For spasticity, oral baclofen, tizanidine and botulinum toxin injections come first; the pump is for people who fail or cannot tolerate them. If a pump trial fails, we return to medication management, palliative care coordination for cancer pain, or a stimulator trial where the pain pattern fits. Referring oncologists, neurologists and physiatrists can send records through Refer a Patient.

Safety and preparation

• Blood thinners: held before the trial injection and the implant on a schedule agreed with your prescriber; a bleed around the spinal cord is the reason. Never stop them on your own.
• Infection/fever: any active infection postpones the procedure. Bring diabetes numbers; poor control raises pocket infection risk.
• Breathing risk: tell us about sleep apnea, COPD, heavy sedative use or alcohol use; these change how the opioid trial is monitored and may rule it out.
• Pacemaker/ICD: pumps are compatible with cardiac devices, but tell us so programming and MRI planning can be coordinated.
• MRI: current pumps are MRI-conditional. The magnet stops the pump motor during the scan; afterward the pump must be interrogated to confirm it restarted. For baclofen pumps in particular, arrange every MRI through our office so a pump check follows the scan the same day.
• Refill discipline: you must be able to keep every refill appointment. Missing a baclofen refill can cause life-threatening withdrawal; missing an opioid refill causes withdrawal and loss of pain control.
• Other medications: do not add sedatives, sleeping pills or alcohol without telling us; combined with intrathecal opioids they raise breathing risk.
• Allergies (contrast, local anesthetic, antibiotics, morphine or other opioids, baclofen): tell us in advance.
• Sedation and driving: bring a driver for the trial and the implant; do not drive for at least 24 hours after any dose increase until you know how it affects you.
• Pregnancy: tell us if you are or may become pregnant; intrathecal therapy in pregnancy requires a joint plan with obstetrics.

Risks and side effects

Frequently asked questions

Related care

Related treatments

Related conditions