In Search of the Best Pain Clinic in Los Angeles: Failed Back Syndrome – The Role of Intrathecal Pump Therapy

By | May 1, 2012

Older patients with primarily axial back pain often do very well with intrathecal drug delivery systems.

While the standard treatment for failed back syndrome is spinal cord stimulation, the best pain clinic in Los Angeles would know that for selected patients the implantation of an intrathecal drug delivery system is a viable and at times a superior option.  Patients with primarily axial back pains are often difficult to capture with standard spinal cord stimulation systems.  The substitution of two subcutaneous improves back coverage, but at the expense of decreased efficacy in treating leg pain.  Intrathecal drug delivery systems (IDDS, Pain Pumps) on the other hand usually give excellent back coverage, but are less satisfactory in the treatment of leg pain even with the addition of Prialt.  The other main point in choosing between intrathecal pumps and spinal cord stimulators is age.  Younger patients (less than 70) tend to do well initially with intrathecal drug delivery systems, but tend to suffer with dose escalation over time that can be difficult to manage.  Older patients on the other hand rarely have problems with dose escalation, even with solutions of plain morphine.  In addition the best pain clinic in LA would know that older patients tend to do less well with spinal cord stimulation for any indication.  Even when allowances are made for cognitive function the difference remains and is probably due to differences that develop in spinal cord receptors and pain pathways with age.  In summary, at Schlesinger Pain Centers older patients with post-laminectomy syndrome and primarily axial back pain are usually treated with intrathecal drug delivery systems and younger patients with primarily radicular pain are clearly better off with spinal cord stimulation.  Unfortunately younger patients with primarily axial back pain and older patients with primarily radicular back pain remain therapeutic challenges.


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