I have been a patient of Dr. Manuel Ramirez for the last 18 years. I have a disease called RSD/CRPS or Reflex Sympathetic Dystrophy/Chronic Regional Pain Syndrome. It is a nerve problem which causes deteriorating bone problems and is very painful. He initially diagnosed me and has been treating my pain with success all these years and I claim him as “family.” He is professional, but also very caring, intelligent and kind and is a great listener.
I have been under the care of Dr Ramirez for the past 8 years and can honestly say that if it wasn’t for him and his staff, my life wouldn’t be worth living. After many years of a pain filled existence, I was fortunate enough to be referred to Dr Ramirez who took a sincere interest in my back, leg, spinal and emotional problems (due to an injury sustained while I was in the Army back in 1969) and his treatment has allowed me to live a much improved quality of life than I had previously experienced for the past 30+ years. It’s so refreshing to have a healthcare professional who actually listens to my concerns and problems and in turn treats these issues in a calm, professional and reassuring manner. Should you have issues with constant pain that interferes with your everyday quality of life, don’t give up. Go see Dr. Ramirez, you’ll be glad that you did.
Intrathecal (Intraspinal) Pain Pump Therapy
I consider this modality of treatment as the last resort in the spectrum of pain therapy. This therapy works by delivering relatively small amounts of medication, usually narcotic medication into the spinal canal, directly to the pain receptors in the spinal cord, thereby blocking the pain sensation from being interpreted as such by the brain. The medication that is required to relieve pain is typically 1-10% of the medication required to give similar relief if it had been given by mouth. Thus a dose of 100 mg of morphine given by mouth to relieve pain may only require 1 mg given in the spinal canal to effectively have the same or better effect. The result of this is that there will be fewer side effects such as sedation, grogginess, confusion, forgetfulness, and thus a better quality of life.
The medication is delivered by an implanted programmable pump which can be instructed by a computer to deliver a continuous dose or a variety of infusion modalities.
Prior to implantation, a trial is usually done which requires an overnight hospital stay. The trial is usually done to see if the intrathecal (intraspinal) narcotic is effective in reducing the patient’s pain, as well as to determine what side effects the patient might have such as itchiness, sedation, nausea, urinary retention etc.
The risks of the surgery include the usual risks of anesthesia and surgery including infection, bleeding, headache, allergic reaction, spinal cord injury , paralysis, inability to relieve pain, urinary retention, pruritus, nausea and vomiting, spinal fluid leak, new pain, accumulation of fluid/blood in the pump pocket site, problems with the catheter including kinks, obstruction, leak, as well as device component failure requiring revision and replacement.
The procedure can be done under IV anesthesia or general anesthesia, with fluoroscopic guidance. Therefore, you are instructed not to eat after midnight, the day prior to surgery. You are also instructed to take a shower and soap your skin well the night before and if possible the day of your surgery. You may take your usual medications with a small sip of water except blood thinners and insulin. You will be kept in the hospital overnight.
The pump is refilled periodically via a small port in the center of the pump and is easily done in the doctor’s office using a small needle and local anesthetic. The pump is then reprogrammed after each refill. Occasionally, the pump may need to be reprogrammed in between refills to reduce or increase the dose of medication using a small computer.