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On this page you will find information about:

    PAIN MEDICATION
        
Office Policy on Prescription Medications for Pain    
        
Pain Medication Refill Policy

    IMPLANTED PAIN MANAGEMENT DEVICES  
        
Intrathecal Drug Delivery Pump 
        Neurostimulation Systems

PAIN MEDICATION

Pain managment is necessary for people suffering from injuries and chronic pain. Effective pain managment often requires pain medication. An experienced physician should decide whether pain medications are right for the treatment of your pain. Typically, a referral from another physician is required to become a patient. We take a responsible stance against pain medication misuse. Our patients receiving pain medication are screened frequently and randomly for compliance with their prescriptions.

 MEDICATION REFILL POLICY

Pain medication refills are prescribed only during a scheduled office visit.  No prescription medications are refilled or increased over the phone. The medication prescribed during an appointment is intended to last until the next patient appointment. If a patient runs out of or loses their medication or if the medication is stolen, a refill may be provided during the next appointment. All prescriptions must be obtained from the office during regular office hours. 

Note: NO PAIN MEDICATION IS STORED at the office.


IMPLANTED PAIN MANAGEMENT DEVICES

 INTRATHECAL DRUG DELIVERY PUMP

General
Continuous intrathecal drug delivery, often called "pain pump" therapy, is a method of giving medication directly to your spinal cord.  Your spinal cord is located within the intrathecal space in your spine.  After the patient and physicial together decide that intrathecal pain management is appropriate, the patient receives a test does of intrathecal pain medication.  If sufficient pain relief is achieved, then a surgery is planned for the patient to have the pump system implanted under general anesthesia (the patient is totally asleep). During the surgery, a small sophisticated pain pump is implanted beneath the skin of the abdomen and a soft and flexible intrathecal catheter is implanted under the skin between the abdomen and the lower back. In the lower back, the catheter is positioned in the intrathecal space to deliver pain medication directly to the spinal cord. Compared to pain medication taken by mouth, pain medicine delivered directly to the spianl cord is very effective at a much lower dose and side effects such as nausea, confusion, and drowsiness are minimized.  In fact, you generally need about 1/300 the amount of medication with a pump than when taken orally

What is an intrathecal drug pump?
The pump (Figure 1.) is a small round device that stores and delivers pain medication. The pump is typically implanted just under the skin of the abdomen. A reservoir inside the pump holds the pain medication.  Similar to an epidural catheter that is used for pregnant women in labor, the spinal catheter (a thin, flexible tube) is inserted into your
spine. The other end of the catheter is connected to the pump.  The pump is programmed to slowly release medication over a period of time.  It can also be programmed to release different amounts of medication at different times of day, depending on your changing needs.  The pump stores information about your prescription in its memory, and your doctor can easily review this information with a wireless pump programmer.  When the reservoir is empty, the doctor or nurse refills the pump by inserting a needle through your skin and into the fill port on top of the reservoir.  If you no longer need the pump or change your mind, your doctor can turn it off or remove the system. 



Figure 1. Intrathecal pump and intrathecal catheter.



Who can benefit from intrathecal drug therapy?
Intrathecal drug pumps may benefit people who suffer from pain associated with the following conditions:
-  Cancer pain
-  Chronic back and leg pain
-  Complex regional pain syndrome (CRPS)
-  Painful neuropathy
-  Cerebral palsy
-  Multiple sclerosis
-  Stroke
-  Back injury
Spinal cord injury

Are you a candidate for  intrathecal drug therapy?
During your office visit, Dr. Klim and his staff will evaluate your pain history and may suggest intrathecal pain managemtn therapy if you are not dependent on pain medication, do not have psychological problems, have no medical conditions that would keep you from undergoing implantation, and if you are not allergic to any of the drugs used in the pump.
For more information about intrathecal pumps for chronic pain please visit the following websites:

www.medtronic.com/our-therapies/drug-pumps/index.htm
www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/
www.spineuniverse.com/treatments/pain-management/spinal-pumps-spinal-cord-stimulators

 NEUROSTIMULATION SYSTEMS

General
If you've been living with chronic pain, neurostimulation (also called spinal cord stimulation) may be an option for you.  In this therapy, electrical impulses are used to block pain from being perceived by the brain.  Instead of pain, the patient feels a mild tingling sensation.  A thin, soft, flexible catheter called a lead (Figures 2 and 3) is connected to a battery called an impulse generator (Figures 3 and 4). Therapeutic impulses are transmitted through the lead to the spinal cord or to specific nerves to block pain signals from reaching the brain.  Using a wireless remote control, you can turn the stimulating system on and off, or adjust the intensity.  The sensations derived from the stimulator are different for everyone; however, most patients describe it as a pleasant tingling feeling.

 
Figure 2. Spinal cord stimulating leads of various sizes and configurations.

 
Figure 3.  An impulse generator and two spinal cord stimulating leads. 
                                                   Note the compact size of the system
.




Figure 4. Impulse generator (battery) used to power the spinal cord stimulaing system.
Note small size of impulse generator.


What type of pain responds to neurostimulation?
Chronic pain the back, neck, arms, or legs with a strong neuropathic quality (burning, tingling, or numbness) that has lasted at leased 6 months
-  Neuropathic pain often experienced in patients with advanced diabetes
-  Pain that has failed to respond to spine surgery or other treatment options 
  such as pain medications, nerve blocks, or physical therapy



Figure 5. Typical spinal cord stimulating system location in body after implant procedure. The impulse generator (battery), situated in upper buttock area, is connected to spinal cord stimulating catheter positioned in epidural space.


For more information about neurostimulation please visit the following websites:

www.poweroveryourpain.com/sb/
www.medtronic.com/IN/health/pain_treatment_neuro.html
www.nationalpainfoundation.org/cat/14/neuropathic-pain


                                                                                                
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