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.