What it is
Medication delivered where it works — not everywhere else.
When you take a pain medication by mouth, it travels through your entire body to reach the nerves that matter. That is why side effects happen: the dose needed to reach the spinal cord is far higher than the spinal cord itself requires, and every other organ receives that dose too.
An intrathecal pump changes the delivery route. A small catheter places medication directly into the intrathecal space — the fluid surrounding the spinal cord — where the pain signals are travelling. Because the medication arrives at its target directly, the dose can be a small fraction of what an oral equivalent would require.
The pump itself is a programmable device implanted under the skin, usually in the abdomen. It releases medication continuously at a rate we set, and is refilled in the office periodically through a small needle.
Who it's for
Severe pain where oral medication has run out of room.
This is a late-line treatment, considered when pain is severe and the medication required to control it causes side effects that are no longer acceptable — sedation, confusion, constipation, or effects that make daily life smaller rather than larger.
Cancer-related pain
One of the most established uses, particularly where pain is severe and oral opioids at effective doses cause unacceptable sedation.
Pain after spine surgery
Sometimes called failed back surgery syndrome — pain that continued after the operation and has not responded to other approaches.
Severe spasticity
Certain neurological conditions cause muscle spasticity that responds to medication delivered intrathecally.
Intolerable side effects
When the medication works but the dose required to make it work is doing more harm than the relief is worth.
Pump or stimulator?
Two implantable options, two different problems.
Patients often hear about both and assume they are alternatives to each other. They are not — they treat different kinds of pain by entirely different mechanisms.
Spinal cord stimulation
Changes how pain signals are transmitted, using electrical pulses. Best suited to neuropathic pain — burning, electrical, radiating pain from the nerves themselves. No medication involved.
Intrathecal pump
Delivers medication directly to the spinal fluid. Better suited to severe nociceptive or mixed pain — including cancer pain — where medication genuinely helps but the systemic dose is the problem.
Deciding between them starts with identifying what kind of pain you actually have. That is the same question that begins every treatment conversation here.
What the process looks like
Nothing is implanted without testing it first.
Evaluation
A full review of your pain, what has been tried, current medications, and whether the pattern fits what an intrathecal pump treats well. If a less invasive option has not been properly explored, we will say so.
Psychological evaluation
Standard for implantable therapies and required by nearly all insurers. It is not a test of whether your pain is real — it identifies factors known to affect outcomes so they can be addressed first.
A trial dose
Before any implant, medication is delivered intrathecally on a trial basis to see whether it produces meaningful relief and whether you tolerate it. Same principle as the SCS trial: find out before committing.
Implant
If the trial works, the catheter and pump are implanted in an outpatient procedure with sedation. You go home the same day with a driver, and with activity restrictions while everything heals.
Refills and adjustment
The pump is refilled in the office on a schedule — the interval depends on your dose and reservoir size. Doses are adjusted by programming the device, without another procedure.
Honest limits
What a pump will not do.
It doesn't cure the cause
It delivers medication more efficiently. The underlying condition is unchanged.
It requires ongoing care
Refills are not optional. Missing them can cause withdrawal and a return of pain. This is a long-term commitment to regular visits.
It carries real risks
Infection, catheter problems, device malfunction, medication-related side effects, and the possibility of further procedures. Your consent conversation will cover these specifically.
It's not a first step
This is considered after other approaches have genuinely been tried. If you have not had a thorough evaluation of where the pain is coming from, that comes first.
Common questions
What patients ask about pain pumps
If medication is controlling your pain but costing you your days, there may be another way to deliver it.
An evaluation starts with understanding what kind of pain you have and what has already been tried. Call and we will tell you honestly whether this is worth considering.
Intrathecal pump therapy is a surgical treatment carrying risks including infection, bleeding, catheter or device malfunction, medication-related side effects, and the possible need for revision or removal. Results vary between patients. This page is general education, not medical advice. You are entitled to a clear explanation of the risks, the alternatives, and what happens if you choose to do nothing.