What to expect BEFORE your Pain Pump Implant

You have had a successful trial of targeted drug delivery and have decided to pursue the permanent implantation.

What happens next?

Insurance

Intrathecal pump implantation is a surgery which requires special authorization. Our clinic works with a third party called Medtronic Reimbursement Department to ensure that this surgery will be covered by your insurance. Once you have completed a successful trial, our clinic will send the necessary records to the reimbursement department. The reimbursement department will contact your insurance company or refer to the coverage policies in order to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule the surgery. Keep in mind, even though they have approved the pump implant, there still may be out of pocket expenses that you will be responsible for

** It may take 4-6 weeks to get this approval. **

 

Pre-operative History and Physical Evaluation

Once we receive approval from your insurance company, you will be contacted by our clinic. You will need to obtain a pre-operative history and physical evaluation. This is an examination to evaluate your health status and “clear” you for surgery. This can be done at TCPC, or your primary care provider if you prefer. Do not schedule this until you have been contacted by our clinic about the approval. Please have this evaluation faxed to 952-841-2346.

 

Scheduling

A scheduling coordinator will be in touch with you after we receive the approval from your insurance company. They will remind you to schedule your pre-op physical, mail you a packet of information and go over all of the necessary appointments. Be prepared to schedule the following appointments:

  1. Med Check Appointment: If you are in need of a medication refill you will need to be seen by your provider prior to the pain pump implant.
  2. Pump Implant Education Appointment: We will review the procedure in detail. Please bring in the signed pump consent form that you received in the mail. This appointment is done at TCPC with your provider. No medications are refilled at this appointment and it cannot be combined with your med check appointment.
  3. Intrathecal Pump Implantation: The implant surgery is performed at either Twin Cities Surgery Center or Fairview Southdale Hospital, depending on your insurance coverage.
  4. Wound Check: 2-3 days after surgery.
  5. Follow Up Appointment: You will meet with your primary TCPC provider 2 weeks after the surgery.

 

Pain Pump Implantation

An intrathecal pump implantation is a surgery involving placing a catheter within the epidural space and then connecting it to an internal pump. The surgery is performed at Twin Cities Surgery Cneter or Fairview Southdale Hospital, depending on your insurance coverage.

  • You will receive general anesthesia during the surgery and will need a driver. Do not have anything to eat or drink for 8 hours prior to the procedure.
  • The Surgery is outpatient and you should plan on being there for 3-5 hours.

You will continue taking your regular pain medication, as instructed by your provider.

 

Post-operative Care

  • You will receive an antibiotic to prevent infection. Let your TCPC provider know if you have any allergies to antibiotics. Start this the day after the surgery and take it for 10 days.
  • There are certain activities that should be avoided for 6-8 weeks after surgery to prevent movement of the pain pump catheter, including bending at the waist, twisting, reaching overhead, and lifting more than 5 pounds.
  • Do not shower, bathe, or get the incisions wet until you are cleared to shower at your nurse visit (3-4 days post op). Then showers only until you are cleared by your provider to bathe/soak/swim (2-3 weeks post op).
  • Notify the clinic for: excessive sleepiness, headache that lasts longer than 2 days, signs of an infection, changes in your bowel or bladder function, or weakness of the legs.

 

If you have additional questions regarding the Pump Implant, or other treatment options please call Twin Cities Pain Clinic 952-841-2345.

 

What to expect BEFORE your Pain Pump Trial

Your provider has recommended targeted drug delivery via intrathecal pump as a treatment option for your chronic pain. It is important that you understand the possible risks and benefits associated with intrathecal drug therapy.

 

Benefits may include:

  • At least a fifty percent reduction in pain
  • Improved ability to function in daily living
  • Potentially reduced side effects compared with oral medications
  • No oral pain medication

 

Risks may include:

  • Surgical complications, including infection, pain, bleeding, spinal fluid leak, and headache.
  • Device complications, including drug overdose or under dose, movement of the catheter or pump, damage to the catheter, and inflammatory masses at the tip of the catheter.

 

What happens next?

You will need to complete a one-day trial of targeted drug delivery to ensure this therapy works for your pain. Intrathecal pain pump information will be given to you in the form of an informational packet and DVD. This will give a brief explanation of targeted drug delivery and may help to answer any questions you have initially.

 

Psychological Evaluation

A psychological evaluation is required by all insurance companies prior to going forward with the trial. In your office visit you will be given a list of psychologists who are experienced in doing this evaluation, as well as a letter to be given to the psychologist. If you choose a psychologist from outside of the list, you will need to make sure that they are comfortable doing this evaluation. Please have the psychological evaluation faxed to TCPC at 952-841-2346.

 

Physical Therapy

Physical therapy within the last 12 months is required by insurance companies prior to going forward with the trial. If you have completed a course of physical therapy in this time frame, please have these records faxed to TCPC. IF you need to update your physical therapy, your TCPC provider can write an order for this.

 

Insurance

A trial of targeted drug delivery is a procedure which requires special authorization. Our clinic works with a third party called Medtronic Reimbursement Department to ensure that this procedure will be covered by your insurance. Once you have completed the psychological evaluation our clinic can send the necessary records to the reimbursement department. The reimbursement department will contact the insurance company or refer to the coverage policies in order to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule a trial. Keep in mind even if approved, there may still be out of pocket expenses that you will be responsible for.

** It may take 4-6 weeks to get this approval. **

** We cannot submit your records to the reimbursement department for approval of the trial without the psychological evaluation and physical therapy records. **

 

Pre-operative History and Physical

Once re receive approval from your insurance company, you will be contacted by our clinic. You will need to obtain a pre-op history and physical evaluation. This is an examination to evaluate your health status and “clear” you for the procedure. His can be done at TCPC, or your primary care provider if you prefer. Do not schedule this until you have been contacted by our clinic about this approval. Please have this evaluation faxed to 952-841-2346.

 

Scheduling

Once we receive the pre-op, we will mail you an informational packet and call you to schedule the remaining appointments:

  1. Pre-Trial Education Appointment: We will review the procedure in detail. This appointment is required to move forward with the trial. Please bring in the intrathecal pump consent form you received in the mail. This appointment is done at TCPC with your provider. No medications are refilled at this appointment, that would need to be done in a separate office visit.
  2. Pump Trial: The trial procedure itself is performed at Twin Cities Surgery Center. You can expect to be at the Surgery Center from 4-8 hours. You will need a driver for this procedure.

 

Intrathecal Pain Pump Trial

A pump trial involves placing a catheter within the epidural space and then connecting it to an external pump. This is NOT a surgery. No incisions are made during the trial. The catheter is placed using a small needle. During the trial, the pain medication will be adjusted to reach the desired comfort level. You will be monitored closely for your response to the intrathecal drug therapy, as well as for any potential side effects (itching, urinary retention, GI upset). At the end of the trial, the catheter will be removed and you will be discharged. The trial is done at the Twin Cities Surgery Center in Edina.

  • You will receive IV sedation during the procedure. Do not have anything to eat or drink for 6 hours prior to the procedure. You will need a driver to pick you up after the trial is completed.
  • You may bring snacks, water, a book, tablet, anything to keep you occupied while you stay in observation at the Surgery Center on your trial day.
  • The trial is outpatient and you should plan to be there for 4-8 hours.

** Bring your prescribed pain medications to the trial with you. **

 

If you decide to pursue a permanent system, we will submit another prior authorization request to your insurance company for the implant.

If you have additional questions regarding the Pump Trial, or other treatment options please call Twin Cities Pain Clinic 952-841-2345.

What to expect BEFORE your Spinal Cord Stimulator Implant

You have had a successful Spinal Cord Stimulator Trial and have decided to pursue the permanent implant.

What happens next?

 

Insurance

This is a procedure which requires special authorization. Our clinic works with a third party to ensure that this procedure will be covered by your insurance. Once you have completed the trial, our clinic can send the necessary records to the reimbursement department. The reimbursement department will contact your insurance company or refer to the coverage policies in order to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule the implant. Keep in mind, even if approved, there may still be out of pocket expenses that you will be responsible for.

** It may take 4-6 weeks to get this approval. **

 

Pre-Operative History and Physical Evaluation

Once we receive approval from your insurance company, you will be contacted by our clinic. You will need to obtain a pre-operative history and physical evaluation. This is an examination to evaluate your health status and “clear” you for surgery. This can be done at TCPC, or your primary care provider if you prefer. Do not schedule this until you have been contacted by our clinic about the approval. Please have this evaluation faxed to 952-841-2346.

 

Scheduling

Once we have received the pre-op, we will mail you an informational packet and call you to schedule the remaining appointments:

  1. SCS Implant Education Appointment: about 1 week before surgery. We will review the procedure in detail. This appointment is required, it will be done at TCPC with your provider, no medications are refilled at this appointment.
  2. SCS Implant: The implant surgery is performed at either Twin Cities Surgery Center or Fairview Southdale Hospital, depending on your insurance coverage. Please bring in the signed Spinal Cord Stimulation consent form that you received in the mail.
  3. SCS Programming/Wound Check: about 3 days after surgery
  4. Follow-up appointment: about 2 weeks after surgery.

 

SCS Implantation

A SCS implantation is a surgery involving placing the leads and battery internally (under the skin). The surgery is performed at Twin Cities Surgery Center or Fairview Southdale Hospital depending on your insurance coverage.

  • You will receive IV sedation during the procedure and will need a driver. Do not have anything to eat or drink for 6 hours beforehand.
  • The surgery is outpatient and you should plan on being at the Surgery Center or Hospital for 6 hours.
  • There are certain activities that should be avoided for 6-8 weeks after the surgery to prevent movement of the implanted leads. These restrictions include bending at the waist, twisting, reaching overhead, and lifting more than 5 pounds.
  • Do not shower, bathe, or get the incisions wet until you are cleared by the nurse to do so at your programming visit (3-4 days post op). Then shower only until you cleared by your TCPC provider to bathe/soak/swim (about 2-3 weeks post op).
  • Notify the clinic for: headache that lasts longer than 2 days signs of an infection, changes in your bowel or bladder function, or weakness of the legs.

 

Device Programming

You will return to the clinic 3-4 days after your surgery to meet with a nurse and the device representative. At this time, your device will be turned on and programmed.

 

Follow-up Appointment

You will follow-up 2 weeks after the surgery to meet with your TCPC provider.

** In the future, if you are not receiving adequate coverage/pain relief with your SCS, please contact the clinic to schedule a separate appointment with the device representative for reprogramming. **

 

If you have additional questions regarding your Spinal Cord Stimulator Implant, or other treatment options please call Twin Cities Pain Clinic 952-841-2345.

What to expect during your Spinal Cord Stimulator Trial

You have been selected as an appropriate candidate for spinal cord stimulation therapy. Insurance authorization has been obtained and you are scheduled for the trial.

What Happens next?

SCS Trial

A SCS Trial involves placing temporary leads into your back and connecting them to an external battery. No incisions are made during the trial. This is NOT a surgery. The leads are placed using a small needle. The leads are then attached to the external battery. The trial is done at Twin Cities Surgery Center or Fairview Southdale Hospital, depending on your insurance.

  • You will receive IV sedation during the procedure and will need a driver. Do not have anything to eat or drink for 6 hours prior to your scheduled trial.
  • The trial is outpatient and you should plan on being there for 3-4 hours.
  • You will receive an antibiotic to prevent infection. Let your TCPC provider know if you have any allergies to antibiotics. Start this the day after the temporary leads are placed and take it for 10 days.
  • Do not shower or take a bath during the length of the trial. You may sponge-bathe only.
  • There are certain activities that should be avoided during the trial to prevent movement of the temporary leads, including bending at the waist, twisting, reaching overhead, and lifting more than 5 pounds.

Mid Trial Appointment

You will return to the clinic 2-3 days after your temporary leads have been placed. The purpose of this appointment is: 1) to check your leads insertion site and 2) to fine tune your stimulation. This appointment is necessary in order to adjust the settings on your device if needed for better pain control. There is often some swelling right after the leads have been placed which can interfere with stimulation coverage. The representative from the device manufacturer and the nurse will be present for this appointment.

Lead Pull Appointment

You will return to the clinic 1 week following your lead placement. The trial leads will be pulled by a nurse at TCPC. At this time, you will discuss the amount of pain relief you received during the trial. If you decide to pursue a permanent system, we will submit another prior authorization request to your insurance company for the implant.

If you have additional questions regarding your Spinal Cord Stimulator Trial, or other treatment options please call Twin Cities Pain Clinic 952-841-2345.

What to expect BEFORE your Spinal Cord Stimulator Trial

Your provider has recommended spinal cord stimulation as a treatment option for your chronic pain.

What happens next?

You will need to complete a spinal cord stimulator trial to ensure this therapy works for your pain. Spinal cord stimulation information will be given to you in the form of an informational packet and DVD. This will give a brief explanation of spinal cord stimulation therapy and may help to answer any questions you have initially. We hope you find this information helpful as you decide if a spinal cord stimulator trial is right for you!

Psychological Evaluation
A psychological evaluation is required by all insurance companies prior to going forward with the trial. In your office visit with your provider they will give you an informational packet, you will find a list of psychologists who are experienced in doing this evaluation, as well as a letter to be given to the psychologist. If you choose a psychologist from outside of this list, you will need to make sure that they are comfortable doing this evaluation. Please have your psychological evaluation faxed to TCPC at 952-841-2346.

Physical Therapy
Physical therapy within the last 12 months is required by insurance companies prior to going forward with the trial. If you have completed a course of physical therapy in this time frame, please have these records faxed to TCPC at 952-841-2346. If you need to update our physical therapy, your TCPC provider can write an order for this.

Insurance
Spinal cord stimulation is a procedure which requires special authorization from your insurance company. Our clinic works with a third party to ensure that this procedure will be covered by your insurance. Once you have completed the psychological evaluation and physical therapy, our clinic will send the necessary records to the reimbursement department. The reimbursement department will contact your insurance company or refer to the coverage policies to reach a decision on coverage. Our clinic requires an approval from the reimbursement department before we can schedule the trial. Keep in mind, even if approved, there may still be out of pocket expenses that you will be responsible for.
** It may take 4-6 weeks to get this approval. **
** We cannot submit your records to the reimbursement department for approval of the spinal cord stimulator trial without the psychological evaluation and physical therapy records. **

Pre-operative History and Physical
Once we receive approval from your insurance company, you will be contacted by our clinic. You will need to obtain a pre-operative history and physical evaluation. This is an examination to evaluate your health status and “clear” you for the procedure. This can be done at TCPC, or your primary care provider if you prefer. Do not schedule this until you have been contacted by our clinic or surgery center about the approval. Please have this evaluation faxed to 952-856-2644.

Scheduling
A scheduling coordinator will be in touch with you as soon as possible after receiving your approval. We will mail you an informational packet and call you to schedule the remaining appointments:
1. SCS Trial Education Appointment: about 1 week prior to the trial. We will review the procedure in detail. This appointment is at TCPC with your provider. No medications are refilled at this appointment.
2. SCS Trial: The trial procedure itself is performed at Twin Cities Surgery Center or Fairview Southdale Hospital, depending on your insurance coverage. Please bring in the signed spinal cord stimulation consent form you received in the mail.
3. Mid Trial Appointment: about 2-3 days after the temporary lead placement
4. Lead Pull Appointment: about 1 week after the temporary lead placement

 

Spinal Cord Stimulation helps improve the ability to function in daily life. We want you to get back to the things you love the most, without pain. If you have questions about Spinal Cord Stimulation, or other treatment options please call Twin Cities Pain Clinic at 952-841-2345.