Damage to the facet joint is a common cause of back and neck pain. Both areas are highly susceptible to degeneration and injury, such as whiplash. The only way to diagnose whether the facet joints are the source of pain is to numb the joint and see if the pain goes away. Once we know the source of the facet joint pain, we can recommend various treatment options. This process of injecting the facet joints can be done either by injecting into the joint itself or by injecting the nerves, which supply the joint.
The idea behind a pump is that the spinal cord is involved in sorting out all of the information, which we get from the outside world, particularly with regards to such sensations as hot or cold, pressure or cutting. The function of this sorting process is to present important information to the brain and not to present information that is not important, such as the fact that we have pressure on our feet while we walk.
As a part of processing all of this information, the spinal cord has receptors on it for multiple medications, such as narcotics. By selectively applying small amounts of narcotics (or other medications) to the spinal cord, it is possible to get the desired effect, such as pain relief, without the undesired side effects, such as nausea, vomiting, or sedation.
Prior to placing a pump, you are given a trial of medications. These trials can be inpatient or at home, done overnight or last several days. During the trial, we will usually give you just a narcotic, although we may occasionally add other medications.
If you have good relief of your pain with minimal side effects, then we can proceed with the permanent placement of a pump. This placement is a surgical procedure and involves making a pocket under the skin, usually in your abdomen, for the pump and then making a small incision in your back for the placement and tunneling of the subarachnoid catheter. You can expect to be sore for up to two weeks, just as you would after any surgery. You will be provided pain medication and antibiotics.
Pumps do require some maintenance. The reservoir does need to be refilled; we like to do so about every three months, but sometimes, it must be refilled sooner. Pumps can have problems. Although we follow a technique to minimize the incidence of catheter fracture, kinking, or dislodgement, all of these things can occur. Accordingly, it may be necessary to repair the pump. Since we are refilling the pump, it is possible for an infection to occur, whether because of a refill or simply because the pump is there and presents a site for infection. Finally, the battery for the pump, like the battery for a stimulator, will not last forever and the device will need to be changed. Usually, the battery lasts about 5 years.
Pumps and stimulators are very powerful and very important parts of our treatment armamentarium. They allow us to treat problems that otherwise we would be unable to treat. Call the Helm Center today to schedule your consultation with one of our specialists.