A pain pump allows patients to self-administer a specific dose of pain medication. Known as ‘patient-controlled analgesia,’ pain and palliative care physicians use the procedure as part of specific therapy.
What is a pain pump?
A pain pump allows patients to self-administer a specific dose of pain medication. A patient-controlled pain pump continuously delivers medication to the body. The small electronic device is used for severe, chronic pain. Medical science has been relying on this form of treatment since the 1980s, especially after serious surgical procedures. In addition to clinical use for pain treatment (analgesia), it helps patients with continuous medication at home. Painkiller application tailored to individual needs using PCA (Patient-Controlled Analgesia) takes place at the touch of a button and without the intervention of nursing staff or a doctor. It regularly delivers a set amount of the analgesic via the vein or directly into the spinal cord. There it reaches the required, high level of effect, also known as a bolus, quickly and immediately. In individual cases, an additional dose, which is technically limited, can be called up if required – controlled by the person concerned. People wear external models attached to their bodies. For therapies over longer periods, a surgeon places the palm-sized pump under the skin with a simple procedure.
Shapes, types, and styles
A distinction must be made between intravenous, intrathecal, and noninvasive transdermal pain pumps. In the majority of cases, the former remain outside the body and transport the medication by means of a tube. It enters the subcutaneous fatty tissue through a needle. Alternatively, the treating physician creates access to the vein directly through a port (intravenous PCA). The size of the devices depends on the volume of the necessary reservoir. Usually, this reservoir to be refilled holds between 20 and 40 milliliters. In the intrathecal pain pump for patient-controlled epidural analgesia (PCEA), a catheter delivers the analgesic to the spinal cord or spinal canal. Patient-controlled regional anesthesia (PCRA) for peripheral nerve block works similarly – only the location varies. One example of use is the baclofen pump, which is used to treat spastic pain associated with spinal cord injuries and multiple sclerosis. Non-invasive transdermal PCA refers to another physical procedure. The glued-on electronic system delivers the active ingredient, an opioid, via a weak direct current through the surface of the skin at the touch of a button.
Structure and mode of operation
The basic design of pain pumps is similar. They consist of different technical components. These include a lockable reservoir for the pharmaceuticals, the infusion line and a power supply unit or battery or accumulator. By pressing the bolus button, the pump injects the analgesic and slowly releases it through a thin tube into the connected system. A programmable microprocessor regulates the delivery volume and blocking intervals – periods during which the electronics do not permit any further boluses. It stores and transfers infusion and usage logs to a PC via a connection. The analysis helps anesthesiologists optimize therapy plans. The painkillers used are mainly opioids such as morphine, fentanyl or sufentanil. In addition, medicine uses ziconotide, originally derived from the venom of the cone snail, and local anesthetics. The patient-controlled pain pumps must be refilled regularly. Depending on the size of the reservoir, the amount to be injected and the frequency, this is done at intervals of a few weeks to a few months. Filling is performed by the physician with an injection in the case of implanted pumps. The implantation of a PCA requires chronic pain that cannot be treated by other measures or only with considerable side effects. The surgeon usually places the pain pump below the costal arch in the upper abdomen after placing a catheter to the spinal cord.
Medical and health benefits
Doctors use a pain pump primarily after surgery and for chronic pain syndromes.Other important areas are tumor therapy and palliative medicine. One of the decisive advantages of pain therapy with the aid of PCA is the high degree of effectiveness. The amount of analgesic is determined by the specialist by testing the bolus. At the same time, a blocking interval prevents unconscious or intentional overdosing. The administration of opioids leads to a short-term decrease in consciousness (vigilance). Self-administration of further drugs is not possible during this phase. In many cases, patient-controlled analgesia provides self-determined, rapid relief from acute pain. Care is provided reliably and side effects remain limited. The procedure also relieves the gastrointestinal tract. For patients, it means fewer restrictions and discomfort and, as a result, a higher quality of life. It makes everyday life easier, particularly in the case of cancer-related clinical pictures. Intensive examinations under inpatient conditions are required before PCA is indicated. A decisive factor for success and complication-free use is the patient’s understanding of the treatment method. Psychologists and pain therapists check whether the pain pump is suitable or alternative methods can be considered. Excluded are, for example, allergies and intolerance to opioids, depression, severe sleep disorders or cognitive deficits. Other contraindications include spinal adhesions, blood clotting disorders and impaired consciousness. For the safety and protection of the patient, continuous medical checks are carried out. Patient-controlled analgesia is among the most efficient options for pain management.
