| "A thin tube runs under
the skin from the reservoir to the spine. Through
this tube, we can infuse morphine or other pain
killers or anesthetic agents directly into the
central nervous system."
This direct drug delivery system is
extremely effective because it places the pain
medication where the nerves are. "Because we don't
have to use as much medication, patients often
experience fewer medication side effects with
this system," Dr. Tzou noted.
While the technology behind the intrathecal
pump has been around for several years, new advances
are improving the device. At the same time, new
narcotic and non-narcotic agents are being tested
in the hopes that they will provide improved pain
control.
The device itself is typically the
size of a hockey puck, although newer models scheduled
to arrive on the market soon will be smaller and
thinner. The pump works by continuously delivering
a steady dose of medication directly into the
spinal cord. Pump manufacturers are developing
models that will be programmable to deliver medication
on a schedule that varies according to time of
day and patients' individual needs.
The medication in the pump lasts from
one to three months, at which time the device
can be refilled through a simple injection in
the doctor's office. If the medication in the
pump is not effective at controlling pain, the
pump can be infused with a different medication.
"Cancer patients sometimes find that
after awhile, their pain medication may no longer
work, they may not be able to tolerate pain medication
that is taken by mouth," Dr. Tzou explained. "When
that happens, this is one of the alternatives
we can offer to try to give them some sort of
relief so they don't have to be in fear of pain."
Dr. Tzou is currently involved in
a clinical trial of a nonnarcotic pain reliever
that is delivered through an intrathecal pump.
"This is a doubleblind, placebo-controlled
study, so patients who enroll may or may not receive
the actual drug," Dr. Tzou reported. However,
after the three-week trial period, those patients
who have been receiving the placebo and who wish
to try the investigational medication have the
option to do so. Study participants will be asked
to self-report their level of pain control.
"I've seen this device provide very
effective pain control for many patients," Dr.
Tzou concluded. "Advances in the design of the
device itself and the ability to infuse different
medications through the device promise to make
it an even more reliable tool for helping patients
with cancer pain or other types of chronic pain."
November
2003
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