Troubleshooting intrathecal pumps in pain management: A clinical review

Intrathecal drug delivery systems (IDDS), commonly known as pain pumps, have become an increasingly more prevalent method for management of refractory chronic pain, both non-cancer and cancer-related pain. IDDS are generally regarded as safe and reliable, however there is potential for complications leading to clinically significant consequences, such as accidental overdose, withdrawal and neurologic injury. In cases of suspected device malfunction, it is important to have an organized approach to troubleshooting. IDSS are also utilized for intrathecal baclofen therapy, and several prior reviews have focused on algorithms for management of ITB-related pump problems. While there is overlap with existing literature on intrathecal baclofen therapy, the clinical presentation and work-up varies when utilizing opioids and local anesthetics. Therefore, we propose a stepwise framework for troubleshooting intrathecal pump therapy in the setting of non-baclofen medications.