Introduction to Pain
Two Types of Pain
Chronic Pain Treatment Alternatives
What is Neurostimulation?
What is Intrathecal Drug Delivery?

A multidisciplinary plan of care is needed to offer a full range of solutions to patients with chronic pain and to efficiently control the delivery of appropriate health care.

The continuum of care ranges from the most conservative to the more advanced treatments. However, some therapies will be used in combination, depending on a patient's pain diagnosis or response to treatment.

Early treatment options focus on conservative, non-invasive treatments such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDS, i.e. ibuprofen), physical therapy, and oral opioids. Most patients are managed effectively using these approaches or corrective surgery, but a subset of patients don't respond adequately.

This subset of patients may benefit from Medtronic Pain Therapies: neurostimulation or intrathecal drug delivery.

Neurostimulation is a pain treatment that delivers low voltage electrical stimulation to the spinal cord or peripheral nerve to inhibit or block the sensation of pain.

The neurostimulation system consists of stimulating lead(s), which deliver(s) electrical stimulation to the spinal cord or peripheral nerve; an extension wire, which conducts electrical pulses from the power source to the lead; and a power source, which generates the electrical pulses.

Two types of neurostimulation systems are available -- a totally implantable system and a radiofrequency (RF) system, in which the power source is worn externally.

Neurostimulation is a reversible therapy which can be tested before the patient receives a permanent implant.

Please see Important Safety Information and Risks for more information about the risks of neurostimulation.

Intrathecal drug delivery blocks pain by directing small doses of medication (i.e., morphine) directly into the cerebrospinal fluid. (See Important Safety Information and Risks for specific indications.)

The intrathecal drug delivery system consists of an intrathecal drug infusion pump and an intraspinal catheter, which are both fully implanted. The catheter is placed in the intrathecal space of the spine and connected to the implanted pump that releases prescribed amounts of medication to the cerebrospinal fluid.

The pump can be refilled by inserting a needle percutaneously into the septum in the center of the pump. Refill intervals are typically one to three months.

Because intrathecal infusion is directed to the spinal cord (the "site of action"), smaller doses are required than with oral or intravenous methods. Typically, the intrathecal to oral morphine dose conversion is 1:300¹ with the lower dose resulting in reduced systemic effects from the drug.^2,3

The risks of intrathecal drug delivery include surgery-related risks such as infection, catheter and pump complications and drug overdose or other adverse events. Please see Important Safety Information and Risks for more information.

¹Krames, E. Intraspinal Opioid Therapy for Chronic Nonmalignant Pain: Current Practice and Clinical Guidelines. Journal of Pain and Symptom Management. 1996,11(6):333-352.

²Lamer TJ. Treatment of cancer-related pain: When orally administered medications fail. Mayo Clinical Proc 1994;69:473-80.

³Levy, R. Implanted Drug Delivery Systems for Control of Chronic Pain. Chapter 19 of Neurosurgical Managment of Pain.New York, NY: Springer-Verlag; 1997.

Introduction to Pain
Two Types of Pain
Chronic Pain Treatment Alternatives
What is Neurostimulation?
What is Intrathecal Drug Delivery?