Outcomes of Low Back Placement of Intrathecal Pumps for Patients with Chronic Pain

Pain Ther. 2026 Mar 28. doi: 10.1007/s40122-026-00832-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic pain poses a significant challenge to quality of life throughout the USA. It is estimated that as much as 21% of the US population experiences chronic pain, and the incidence of new chronic pain cases is shockingly high, at 52.4 cases per 1000 persons per year. An intrathecal pump (ITP) consists of a small pump surgically implanted under the skin, along with a catheter inserted into the intrathecal space in the spine. Medication, usually in the form of opioids, local anesthetics, or muscle relaxants, is then delivered through the catheter into the spinal fluid, where it can act directly on nerves to provide pain relief or reduce spasticity. The use of intrathecal drug delivery has been established for decades and is used for various conditions, including chronic noncancer pain and cancer-related pain. ITPs are also employed for managing severe spasticity in conditions such as multiple sclerosis or spinal cord injury. Over the years, there has been a gradual increase in the use of ITPs, particularly as awareness of their benefits and technological advancements has increased. ITPs have been historically placed in the abdomen. However, more recently, some ITPs have begun to be placed in the lower back. Placing ITPs in the lower back has the potential to lower operative time and complication rates, but more research in this area is warranted. This study analyzes the outcomes of posterior ITP placement to evaluate their suitability and potential benefits.

METHODS: This study consisted of a retrospective review including data from 115 procedures completed between 2015 and 2025. Data collection included patient demographics, preoperative and postoperative pain scores, surgical time, needle and catheter locations, and adverse events. Pain scores were collected using the visual analog scale (VAS), and data were analyzed using SPSS 29. Two-tailed paired t-tests were used to determine the significance of the difference between preoperative and postoperative pain scores.

RESULTS: A total of 115 procedures from 103 patients were included in the statistical analysis. The average preoperative pain was 6.54 (6.54 ± 2.00, n = 114), and the average postoperative pain score in the first year following the procedure was 4.45 (4.45 ± 2.30, n = 114), with a p value of < 0.001. The average surgical time for the procedure was 49.00 ± 19.53 min (n = 113).

CONCLUSIONS: In this study, ITPs implanted in the lower back were associated with greater pain relief, shorter surgical times, and fewer complications than those placed in the abdomen. These findings, while indirect, provide evidence for promoting ITP placement in the lower back as a safe and effective option for patients experiencing chronic pain.

PMID:41896406 | DOI:10.1007/s40122-026-00832-z