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The treatment option that will work best for you depends on your type of pain, how severe it is, and how you respond to pain treatment.
A drug pump might be right for you if:
Your pain persists even though you are taking medication as directed
Your medication is causing side effects that are reducing the quality of life for you and your family
You have had a successful screening test
Screening Test
After your doctor confirms that you are a candidate for a drug pump, he or she may decide to perform a screening test that will allow you to temporarily experience the therapy.
During this test, your doctor may choose one of two procedures:
Single injection – a single injection of a small amount of medication into your spinal column, similar to an epidural injection
Continuous infusion – a continuous infusion of medication is delivered to the area around the spinal cord through a temporary, implanted catheter (this test takes place over several days)
Several medical professionals often work together to design your care plan and deliver your pain treatments. Your healthcare team may include:
Pain specialists
Clinical psychologists
Physiotherapists
Spine surgeons
Neurosurgeons
Oncologists
Rehabilitation specialists
Clinical nurse specialists
Consultants from general surgery or internal medicine
You Are on the Team
Because no one knows your pain like you do, you play an important role in the cancer pain management process. Understanding your pain, communicating your needs, and knowing your options will empower you to take action with the help of your doctors, nurses, and other caregivers.
Surgery: What to Expect – Implanting the Drug Pump
If you and your doctor decide to use a drug pump for cancer pain relief, you will need surgery to implant the system. Before the surgery, you and your doctor will decide where to position the pump for your comfort.
On the day of the surgery, you will receive local or general anaesthesia. Once you are "under" the anaesthetic, your surgeon will:
Make an incision and form a pocket under your skin that is large enough to hold the pump (usually in the abdomen)
Create a second incision on your back for the catheter
Create a small tunnel just beneath the skin for the catheter to pass through
Position the pump and catheter
Once the pump and catheter are in place, the incisions are closed and the surgery is complete. The length of your hospital stay will vary depending on your doctor's preference and hospital procedures.
A screening test is a way for you and your doctor to evaluate your response to medication delivered into your spinal region to see if you are a candidate for a drug pump. If the pain caused by your cancer is measurably reduced, it means that the drug pump may work effectively for you.
How long does the screening test take? Do I have to stay in the hospital?
This will vary depending upon the type of screening test your doctor feels would be best for you. The tests could take as little as a half day or as long as 4 days. Depending upon the type of screening test, you may undergo a procedure that takes approximately 1 to 2 hours and then need to stay in the hospital to be monitored after the procedure. Consult your doctor to understand the details for the type of screening test that your doctor thinks would be best for you.
Will I receive the same relief that I get during the screening test when I receive my permanent drug pump?
If the screening test has been successful and you go on to receive the implanted system, your pain relief may differ. Be sure to tell your doctor about the way you feel so that changes can be made that will give you the best pain relief possible.
Times vary depending on individual doctor technique. On average, the procedure takes approximately 1 to 3 hours from start to finish. Talk with your doctor about the specifics and duration of your procedure.
There are two incisions. One is for the pump and is located in your abdomen. The size of the incision depends on the size of the device and could be up to 15 centimetres long. The other incision, made on your back, is 5 to 10 centimetres long.
How long will it take before I start receiving benefit from my pump?
You will begin receiving pain treatment as soon as your pump is filled with medication and the medication is delivered through the catheter to the specific site. However, depending on your medication, it may take several days before you experience benefits from your medication. You should discuss the use of your usual medication during this period with your doctor.
The medication in your pump needs to be refilled every 6 to 12 weeks, depending on your dosage. It is refilled by a needle injection in your doctor's office. During these appointments your doctor can adjust your dose of medication to address your pain relief needs.
Because your pump is placed near the surface of your skin for easy refill access, on occasion someone might notice a slight bump if you are wearing fitted clothes. However, depending on your size and shape, where the pump is implanted, and the size of your pump, it may not show under your clothes at all.
What if my pain changes? Can my doctor increase or decrease my dosage?
Yes. If your pump is programmable, your doctor can reprogram your dose. If your pump is not programmable, your doctor can change the concentration of drug in your pump, which then changes your dose.
What if it doesn't work – can the pump be removed?
Yes. The screening test is designed to determine whether the pump will help manage your pain. However, if you no longer need the pump or change your mind about the treatment, your doctor can turn off or remove the system.
