Pain Pump Trial for Chronic Back Pain Relief

If you and your healthcare provider have determined that a drug pump may be a good option for managing your chronic back pain, you'll likely need to first agree to a trial before the device can be permanently implanted.

The trial for an implantable pain pump — aka an infusion pump — is done to tailor the treatment to you as an individual patient. From the trial, your healthcare provider will be able to answer two important questions necessary for continuing on to permanent implantation.

Hospital personnel operates a drug monitoring system
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Is Implantable Drug Delivery Treatment (I.E. a Pain PUMP) a Good Fit for You?

After looking at your medical, social, financial and psychological history, the trial is the next step in determining if and how well you respond to medication delivered directly to the spinal cord.

Approximately How Much Medication Will You Need? 

At this time, the healthcare provider gets data she or he can use to determine the dosage of the medication the pain pump will deliver. The dosage information gleaned from the trial is only the first step in a process known as titration, or defining the amount needed that will bring maximal pain relief with minimal side effects. Your dosage will probably be further adjusted after the permanent device has been surgically implanted, but the trial gives the healthcare provider some basic information with which to begin.

Length of the Pain Pump Trial 

Depending on your condition, a trial run will last between 2 and 14 days. The length of the trial depends on your condition. If you are otherwise healthy, it will probably last longer. If you have a serious illness, it might be of a shorter duration.

What Happens During the Procedure?

During the trial, a catheter is placed in the spine, often (but not always) in the epidural space. The catheter and the pump are worn outside the body. For the permanent implantation and some types of trials, the catheter is placed deeper into the spinal cord, into an area known as the intrathecal space. The type of trial that inserts the catheter into the intrathecal space has the advantage of more closely simulating the final procedure and thus yielding more accurate data. The use of the external catheter raises the risk of infection. In people with cancer, the risk is even higher. Your healthcare provider will probably wait a few days between the end of the trial and the actual implantation procedure, to monitor for signs of infection.

As mentioned above, during the trial, the healthcare provider begins to establish the medication dosage offering the best possible balance between pain relief and side effects. The healthcare provider then decides if you should be given just one shot, several, or a continuous dosage.

Trials are done as an outpatient procedure, but for the permanent implantation, a hospital setting is needed to control possible infections. As with the permanent procedure, the pain pump trial is generally done by either a pain management specialist or a neurosurgeon.

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  • Berner, B. Dinh, S. (eds)Electronically Controlled Drug Delivery Boca Raton: CRC Press 1998
  • Dr. Sudhir Diwan, Director Pain Medicine Fellowship Program and Director of the Division of Pain Medicine at Weil-Cornell Medical College of Cornell University. Telephone Interview. May 2008.
  • Krames, E., MD. Implantable Technologies: Spinal Cord Stimulation and Implantable Drug Delivery Systems. National Pain Foundation website.
  • Lipov, E., MD. Ch. 34. Intrathecal Drug Therapy in Chronic Low Back Pain. Low Back Pain: Diagnosis and Treatment. ASIPP Publishing. Physicians. Paducah, KY. 2002
  • Markman, J., MD., Philip, A., MD. Interventional Approaches to Pain Management. Anesthesiology Clinics. Dec 2007. Volume 25, Issue 4. Saunders, An Imprint of Elsevier

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.