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Spinal Pain Pumps Could Develop Tip Granuloma

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Indianapolis, INMuch has been written about the shoulder pain pump and its role in shoulder injury occurring after shoulder surgery. However there are other kinds of pain pumps—including the kind that feed pain medication directly to the spinal cord for back pain.

Spinal PumpUnlike the shoulder pain pump, which was approved by the US Food and Drug Administration (FDA) for use in conjunction with tissue surrounding the shoulder but not directly into the shoulder joint, the spinal pump does carry FDA approval.

With one caveat: morphine is the only opioid approved by the FDA for use in the spinal pump, according to Dr. Edward J. Kowlowitz writing in Doctors, however will often "compound an assortment of a half dozen other narcotics and local anesthetics safely in the pump." That's in keeping with a physician's freedom to prescribe medications for off-label, or unapproved use. That freedom applies for the spinal pump, although morphine is the only opioid that carries the actual FDA seal of approval.

For sufferers of chronic back pain, the spinal pump could be the answer—and a successful individual trial (to test an individual's tolerances) could pave the way for successful spinal pump therapy.

But—and there's always a 'but.' Dr. Kowlowitz stresses the potential for tip granuloma, which is a collection of drug discharge or precipitation at the tip of the spinal pump catheter. This granuloma eventually begins to harden, akin to rock candy and can grow to a point where compression occurs of the nerves and spinal cord itself. The result can be stenosis and paralysis.

Dr. Kowlowitz, Medical Director for the Center for Pain Management located at Indianapolis, Indiana notes that morphine—the approved FDA opioid—is particularly susceptible to the formation of tip granuloma. It's for this reason that his spinal pump patients have an annual MRI scan (18 months is recommended) to check the condition of the catheter tip.

Dr. Kowlowitz also notes that a successful trial of a spinal pain pump is no guarantee as to how the pump will work over the long term, given the body's propensity for building up tolerances for medication over time. What might work well in the beginning may not be quite so effective months, or years down the road.

As for any potential effect that pain medication has on the spine itself, given the fact it is fed directly into the spinal fluid, there so far appear to be no reports of adverse reaction. The shoulder pain pump, of course—often used after shoulder repair surgery—is an entirely different story.

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