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