Intrathecal Pump

An implanted pump sends pain medicine straight to the spinal cord, so you need a much smaller dose. It helps severe pain that other treatments have not eased. We do a trial first at Remix Medical in Houston, TX.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 9, 20262 min read

Key takeaways

An intrathecal pump delivers pain medication directly into the cerebrospinal fluid around the spinal cord, reaching the target receptors at roughly one three-hundredth of the oral dose — which sharply reduces sedation, constipation, and other systemic side effects.
As with spinal cord stimulation, no patient receives a permanent pump without a trial that confirms meaningful relief and tolerability first.
Medications include morphine and hydromorphone (opioids), ziconotide (a non-opioid agent that carries no respiratory-depression risk and is first-line for refractory neuropathic pain), bupivacaine, and baclofen for severe spasticity.
It's reserved for pain refractory to other management — including cancer pain with intolerable oral-opioid side effects, failed back surgery syndrome, and widespread CRPS — and works well for exactly that exhausted-options group.
It's a long-term commitment: refills every 1 to 6 months must not be missed (an empty pump can precipitate withdrawal), catheter granulomas though uncommon are serious, and pumps need replacement roughly every 5 to 7 years.

Intrathecal Pain Pump in Houston, Texas

An oral opioid travels through the stomach, the liver, and the bloodstream, saturating the entire body in order to reach a small population of receptors in the spinal cord. Delivering the drug directly into the spinal fluid reaches those same receptors at roughly one three-hundredth of the oral dose.

Less drug. Less sedation. Less constipation. Less of everything the body did not need in the first place.

What is an Intrathecal Pump?

An intrathecal drug delivery system is a programmable pump implanted beneath the skin of the abdomen, connected to a fine catheter that delivers medication directly into the cerebrospinal fluid surrounding the spinal cord.

The pump is refilled in the office through a port, typically every one to six months, and the dose is adjusted by telemetry without any procedure at all.

Phase	What happens
Trial	A test dose confirms the medication controls your pain
Implant	A small pump is placed under the skin to deliver medication right to the spinal fluid
Refills	The pump is refilled in the office on a schedule

Medications Used

Morphine and hydromorphone — opioids, the most common agents
Ziconotide — a non-opioid calcium channel blocker derived from cone snail venom, useful when opioids are unsuitable
Bupivacaine — a local anesthetic, usually combined with an opioid
Baclofen — for severe spasticity rather than pain

The Trial Comes First

As with spinal cord stimulation, no patient receives a permanent pump without a trial. A single intrathecal injection or a temporary catheter establishes whether the therapy delivers meaningful relief and whether the patient tolerates it.

Who It Helps

Chronic non-cancer pain refractory to all other management
Cancer pain , particularly when oral opioid side effects have become intolerable
Failed back surgery syndrome in patients unsuitable for, or failed by, spinal cord stimulation
CRPS with widespread involvement
Severe spasticity from multiple sclerosis, cerebral palsy, or spinal cord injury

What It Asks of You

This is a long-term commitment. Refills must not be missed — an empty pump can precipitate withdrawal. Catheter granulomas, though uncommon, are serious. Pumps require replacement roughly every five to seven years when the battery expires.

It is reserved for patients for whom other options have genuinely been exhausted, and it works well for exactly that group.

How it's performed

After a successful trial, the patient is positioned laterally under fluoroscopy. A catheter is advanced into the intrathecal space at the desired spinal level and tunneled subcutaneously to a pocket created beneath the skin of the abdomen, where the programmable pump is placed and connected. The pump is filled and programmed by telemetry, and the dose is titrated over subsequent visits. Refills are performed in the office through a septum port.

How to prepare

Complete the required psychological evaluation and a successful intrathecal trial before scheduling. Nothing to eat or drink for 6 hours before the procedure. Arrange a driver and someone to stay with you overnight. Hold anticoagulants as directed. Confirm you can reliably attend refill appointments — this is a condition of candidacy, not a suggestion.

What to expect after

Keep the incision dry for 10 days. Avoid bending, lifting over 10 pounds, and twisting for 6 weeks. Carry the device identification card at all times. Never miss a refill appointment. Report fever, wound drainage, severe headache, new weakness, escalating pain, or any symptom of opioid withdrawal immediately. Sudden severe back pain or progressive weakness may indicate a catheter granuloma and requires urgent evaluation.

Outcome

In patients with refractory pain who pass a trial, intrathecal drug delivery typically produces substantial pain reduction with markedly lower systemic drug exposure, reduced sedation and constipation, and improved function. It is a long-term therapy requiring ongoing refills and periodic pump replacement.

Frequently asked

Intrathecal Pump questions, answered

What is an intrathecal pain pump?

It's a small implanted pump that delivers pain medication directly to the fluid around the spinal cord. Because the medicine goes right where it's needed, far smaller doses work.

Why use a pump instead of pills?

Delivering medication directly to the spine means much smaller doses and fewer body-wide side effects than pills. It's reserved for severe pain that hasn't responded to other options.

Is there a trial before the pump is implanted?

Yes. A test dose confirms the medication controls your pain before the pump is permanently placed, so you know it will work for you.

How is the pump refilled?

It's refilled in the office with a simple needle through the skin on a set schedule. The procedure is quick.

Who is a candidate for a pain pump?

It's considered for severe cancer or non-cancer pain, or spasticity, that hasn't responded to other treatments. Your doctor evaluates whether it fits.

Sources

References

Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations on Intrathecal Drug Infusion Systems Best Practices and Guidelines. Neuromodulation 2017;20(2):96–132 — https://onlinelibrary.wiley.com/doi/abs/10.1111/ner.12538
Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain. J Clin Oncol 2002;20(19):4040–4049 — https://pubmed.ncbi.nlm.nih.gov/12351602/
Staats PS, Yearwood T, Charapata SG, et al. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 2004;291(1):63–70 — https://pubmed.ncbi.nlm.nih.gov/14709577/
Bottros MM, Christo PJ. Current perspectives on intrathecal drug delivery. J Pain Res 2014;7:615–626 — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207581/
Deer TR, Pope JE, Hayek SM, et al. The Polyanalgesic Consensus Conference (PACC): Recommendations for Trialing of Intrathecal Drug Delivery Infusion Therapy. Neuromodulation 2017;20(2):133–154 — https://onlinelibrary.wiley.com/doi/abs/10.1111/ner.12543
National Institute of Neurological Disorders and Stroke: Pain — https://www.ninds.nih.gov/health-information/disorders/pain

SpecialtyPain ManagementTypeProcedureBody locationIntrathecal space, cerebrospinal fluid, lumbar spine, spinal cord dorsal horn, abdominal wall (pump pocket)CPT code62362 (implantation or replacement of programmable pump); 62350/62351 (implantation of intrathecal catheter); 62361 (non-programmable pump); 95990/95991 (refilling and maintenance of implantable pump); 62367-62370 (electronic analysis and reprogramming)

Also called Pain Pump, Intrathecal Drug Delivery System, IDDS, Morphine Pump, Targeted Drug Delivery, Baclofen Pump

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026. Medically reviewed by Raju Mantena, DO.