# Troubleshooting intrathecal pumps in pain management: A clinical review

## TL;DR

This paper reviews how to troubleshoot intrathecal pumps used for chronic pain management, focusing on non-baclofen medications.

## Contribution

The paper introduces a stepwise framework for troubleshooting intrathecal pumps when non-baclofen medications are used.

## Key findings

- IDDS complications can lead to significant clinical consequences like overdose or neurologic injury.
- Existing guidelines for intrathecal baclofen therapy differ from those for opioids and local anesthetics.
- A structured approach is needed for troubleshooting pumps with non-baclofen medications.

## Abstract

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.