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Before the implantation of the intrathecal pump, the doctor will do several blood tests, conduct a physical examination, and order some standard tests (electrocardiogram and chest x-ray). The doctor will have you undergo a trial to see if the pump will work for your pain. The pain medication will be injected around your spine in one or more test trials.

If the test trial proves effective, you will be informed of the risks and benefits of the pump implantation procedure and sign a consent form. You should not eat or drink after midnight the night before the procedure. In addition, you will need to have someone drive you home after the surgery.

With the intrathecal pain pump implant procedure, you will be given either general or regional anesthesia. A small incision is made in the back so the catheter can be inserted and positioned near the spinal cord. An incision is made on the abdomen to place the small pump, which connects to the catheter. The devices are secure with stitches, and the incisions are closed with stitches.

Once the surgery is done, you will be moved to a recovery area where a nurse will monitor your condition for approximately 30 minutes. There will be certain restrictions to follow when you go home, but you will be gradually allowed to return to usual activities. After returning home, you should avoid:

. Bending, stretching, twisting, or lifting for 6-8 weeks
. Raising your arms above your head for 6-8 weeks
. Climbing stairs for 6-8 weeks
. Sitting for long periods of time for 6-8 weeks
. Driving for 2-4 weeks

. First line medications - These are morphine and hydromorphone, which are opioid narcotics.
. Second line medications - These are chosen when the individual cannot tolerate the first line drugs. Second line drugs include hydromporphone or morphine with the addition of clonidine or bupivacaine.
. Third line agents - These drugs are chosen when the patient fails on first and second line treatments. Third line medications include fentanyl and gamma-aminobutyric acid agonists (midolazam and baclofen).

Problems associated with the implantation of the intrathecal pain pump are rare. However, potential problems do exist, and the risk increases for people with bleeding disorders, psychological problems, and active infection. Possible complications include:

. Infection
. Nerve injury
. Spinal headaches
. Bleeding
. Pump-related problems
. Medication side effects

In a recent clinical study involving the implanted Medtronic SynchroMed system, the perceived success rate was 68%, when reduced pain medication was evaluated. However, 86% of patients reported that they would undergo the procedure again.