SOMA Orthopedics

This device delivers concentrated amounts of medication into spinal cord area allowing the patient to decrease or eliminate the need for oral medications. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and/or other symptoms. Furthermore, since the medication in being delivered to the site of action, much lower doses can be used and often with less side effects.
 
Before proceeding with the actual implant, a series of steps will have to be taken. First, you will need to be evaluated by a Medical Psychologist with experience in chronic pain management. Assuming that your psychological profile does not contraindicate the implant therapy, you will then have to undergo an "intraspinal medication trial". This trial is design to find out if you have any problems with the medications that may be used in the infusion pump.
 
How Is The Trial Conducted?
The trial is done in an in-patient basis at the hospital. You will have a temporary intrathecal catheter placed under light sedation with the assistance of an x-ray machine. Through this catheter, pain medication will be given. For the next 24 to 48 hours, different doses of medication will be given through the catheter while you are staying in the hospital.

What Is The Purpose Of The Trial?
Provide the patient with the best possible results, by identifying any possible problems, early. The trial is similar to a "Test Drive" prior to purchasing a car. It allows you to see how it feels, before you commit to it.
 
What Do You Look For In A Trial?
We look for two things. The first is to see if the medicines will be effective in providing you with the desired relief of the pain. The second is to find out if you will be able to tolerate the medication well without experiencing any side effects.
 
What Possible Problems Could We Encounter During The Trial?
Just like any other medical procedure, it has its risks and possible complication. Some of these may include bleeding, infection, nerve damage and death. These are rare, but need to be mentioned because they are always possible. The more common side effects are: soreness at the trial site, itching, nausea, vomiting, and rash.

Implantation:
If the trial is deemed a success, then a permanent implant can be considered.

Will The Procedure Hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the larger needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.
 
Will I Be "Put Out" For This Procedure?
No, the placement of the pump is done under regional anesthesia and intravenous sedation. The amount of sedation given generally depends upon the patient tolerance. The procedure is divided in two stages. The first stage (tubing placement) is done with the local anesthesia and sedation, for safety purposes. At the beginning of this stage, the patients will experience a stick and the sting from the local anesthetic. This is the only uncomfortable part of the procedure. Once the tubing is in place, local anesthetic is injected through it to confirm adequate placement and to obtain anesthesia on the entire surgical field. From this point on, the rest of the procedure is completely painless.
 
How Is The Procedure Performed?
It is done with the patient lying on the side. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needle for inserting the tubing.
 
Where Is The Tubing Inserted? Where Is The Pump Placed?
Tubing is inserted in the midline at the lower back. The pump is then placed on the side of the abdomen.
 
What Should I Expect After The Procedure?
If the procedure is successful, you may feel that your pain may be controlled or quite less. The pump is adjusted electronically to deliver adequate amount of medication. As with any other surgical procedure, it will take 8-10 weeks for the wound to heal to the point where the skin strength is back to normal.
 
What Should I Do After The Procedure?
This procedure is normally an outpatient procedure. After a one to two hour recovery period, you will be allowed to go home. You must have a responsible, strong adult drive you home. This person should be able to assist you in moving if you are still weak from the anesthetics. You should plan to rest for the remainder of the week. You will need to take antibiotics to prevent infection.
 
How Long Will The Pumps Last?
The medication contained within the pump will last about 1 to 3 months depending upon the your requirements, concentration, and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the office and it only takes a few minutes. The batteries in the pump may last 3 to 5 years depending upon the usage. Newer devices have been tested and estimated to last 8 years. The batteries can not be replaced or recharged. The entire pump is surgically replaced at that time.