Cancer Pump Trialing: The Second Visit, Discussions & Preparation

One of the most common questions we are asked is how pump trialing and the insertion of an intrathecal pump will affect their chemotherapy. We tell them that as long as their white blood cell and platelet counts are acceptable, there is no need to delay either pain therapy or chemotherapy.

The second visit is often scheduled late in the afternoon to facilitate attendance by the largest number of people and to ensure that the discussions, which will take place, are not impacted by the pressures of a busy schedule. Questions are answered and the purposes of the trial are discussed. We emphasize that the purpose of the trial is not to relieve all of their pain in the shortest time possible, rather it is the goal of the trialing process to answer two very simple questions: is it likely that intrathecal therapy will provide significant relief and are there any side effects which would preclude use of this therapy.


Next the specifics of trial catheter location are discussed. While we can control large areas of pain, at the present time, we cannot cover the entire spine from a single point. In order to get the maximum benefit from the therapy the catheter tip must me located next to the portion of the spinal cord, which serves as the relay station from the most painful areas. In patients with widespread metastases or with pain in multiple areas of the body, it is often necessary to prioritize different pain locations, accepting some pain in secondary areas in order to ensure that the primary pain sites are adequately treated.


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