By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated April 2026
Medically Reviewed By: Dr. Suzanne Manzi, MD
On This Page:
- What Is an Intrathecal Pain Pump?
- Who Is a Candidate for a Pain Pump?
- The Pain Pump Trial
- How Pain Pump Implantation Works
- Benefits of Intrathecal Drug Delivery
- Risks and Side Effects
- Long-Term Pump Care and Refills
- Pain Pump vs. Spinal Cord Stimulator
- Why Choose Performance Pain and Sports Medicine in Houston
- Our Houston Location
- Frequently Asked Questions
Living with chronic pain that no longer responds to oral medications can feel overwhelming. When pills, physical therapy, and injections have not provided lasting relief, an intrathecal pain pump offers a different approach. This implanted device delivers pain medication directly into the spinal fluid, using a fraction of the oral dose to achieve better symptom control.
An intrathecal pump bypasses the digestive system entirely, which can mean fewer side effects for many patients. International guidelines recognize intrathecal drug delivery as an evidence-based treatment for refractory chronic pain (Deer et al., Neuromodulation, 2024).
At Performance Pain and Sports Medicine in Houston, the pain management team is led by quadruple board-certified physicians Dr. Suzanne Manzi and Dr. Matthias Wiederholz. The practice offers comprehensive pain pump evaluations, trials, and implantation for patients who have not found adequate relief through conventional treatments.
What Is an Intrathecal Pain Pump?
An intrathecal pain pump is a small, programmable device implanted beneath the skin of the abdomen. A thin catheter connects the pump to the intrathecal space surrounding the spinal cord, providing targeted drug delivery directly into the spinal fluid. Because the drug reaches pain receptors without passing through the digestive system, doses as low as 1/300th of an oral amount may provide comparable or improved relief.
Unlike spinal cord stimulators, which use electrical pulses, a pain pump works by releasing precise amounts of medication on a set schedule. The pump can be adjusted wirelessly, allowing physicians to fine-tune dosing without additional surgery.
Types of Intrathecal Pain Pumps
Two programmable pump systems are commonly used:
- Medtronic SynchroMed II, the most widely implanted programmable pain pump
- Flowonix Prometra, which uses valve-gated technology for medication delivery
Both allow dose adjustments through an external programmer.
The FDA has approved morphine and ziconotide as first-line intrathecal agents (Deer et al., Pain Medicine, 2019). Other medications used through pain pumps include baclofen for spasticity, bupivacaine, and hydromorphone (Deer et al., Neuromodulation, 2017). The device is sometimes called a morphine pump when morphine is the primary medication delivered.
Who Is a Candidate for a Pain Pump?
Intrathecal pump therapy is typically considered after conservative treatments have not provided enough relief. Patients who experience significant side effects from oral pain medications or who require escalating doses may also be candidates (Abd-Elsayed et al., Pain Physician, 2020).
Conditions that may respond to intrathecal drug delivery include:
- Failed back surgery syndrome, chronic lower back pain, or persistent sciatica
- Cancer-related pain
- Complex regional pain syndrome (CRPS) and other neuropathic pain conditions, which may be considered for select patients
- Spasticity from neurological conditions
Patients with active infections, certain body habitus concerns, or untreated psychological conditions may not be appropriate candidates. A thorough evaluation helps determine whether a pain pump is the right option.
A pain pump is not a “last resort.” It is reserved for patients who have not responded adequately to less invasive approaches such as back pain treatments or radiofrequency ablation.
The Pain Pump Trial
Before a permanent pump is implanted, patients undergo a trial to evaluate how well intrathecal medication controls their pain. During the trial, a physician injects a small dose of medication into the spinal fluid at the Houston office. Patients then track their pain levels in a diary over the next one to three days.
A pain reduction of 50% or greater is generally considered a successful trial (Deer et al., Neuromodulation, 2017). If the trial meets this threshold, the patient may move forward with permanent implantation. If pain relief is insufficient, the care team discusses other treatment options.
Many patients ask whether they are put to sleep for the trial. The procedure is performed under local anesthesia, though sedation is available for comfort. Patients remain aware enough to provide real-time feedback about their pain relief during the injection.
How Pain Pump Implantation Works
Pain pump implantation follows a structured process completed in a single surgical session.
Step 1: Pre-operative preparation. The care team reviews imaging, confirms medication selection, and provides pre-surgical instructions. Patients may need to adjust blood thinners or other medications beforehand.
Step 2: Surgical implantation. Under general anesthesia, the surgeon places the pump device in the lower abdomen and threads a thin catheter into the intrathecal space near the spinal cord. The procedure typically takes one to two hours.
Step 3: Programming and recovery. The pump is programmed to deliver precise medication doses before the patient leaves the hospital. Most patients can expect a recovery period of four to six weeks with temporary activity restrictions.
Incision discomfort after surgery is typically manageable with prescribed medications. The PROSPER trial, the first randomized controlled study of intrathecal drug delivery, demonstrated statistically significant pain improvement compared to conventional medical management (Pope et al., Expert Review of Medical Devices, 2022).
Benefits of Intrathecal Drug Delivery
Intrathecal drug delivery offers several potential advantages over oral pain medication:
- Lower medication doses, which can reduce systemic side effects
- Adjustable dosing through wireless programming, with no additional surgery
- Reversibility, as the pump can be removed if no longer needed
- Continuous delivery, providing steadier pain relief than the peaks and valleys of oral medications
Data from the PROSPER trial showed early and sustained pain improvement in the intrathecal group, with a cost breakeven point at 4.5 months compared to conventional management (Pope et al., 2022). Additional evidence suggests intrathecal therapy can significantly reduce systemic opioid use (Potocnik et al., Radiology and Oncology, 2025). For patients who have already tried approaches such as epidural steroid injections without lasting success, a pain pump may offer a longer-term solution.
Risks and Side Effects
Like any surgical procedure, intrathecal pump implantation carries risks. Being informed about potential complications helps patients make confident decisions.
Possible risks include:
- Infection at the surgical site (reported in 2 to 5% of cases)
- Catheter complications such as migration, kinking, or disconnection (5 to 25%)
- Medication side effects including nausea, urinary retention, constipation, or itching
- Catheter-tip granuloma, a rare inflammatory mass that requires monitoring
These complication rates are documented in consensus guidelines and practice reviews (Deer et al., Neuromodulation, 2017; Abd-Elsayed et al., Pain Physician, 2020). Working with experienced physicians who follow evidence-based safety protocols can help reduce these risks.
Long-Term Pump Care and Refills
After implantation, patients return for regular pump refills every one to six months, depending on dosage and reservoir size. Refills are quick, in-office procedures performed with a needle through the skin.
Dose adjustments can be made wirelessly using an external programmer, with no surgery required. Pump batteries typically last five to seven years before a replacement procedure is needed. Newer pump models are MRI-conditional, though patients should inform all healthcare providers about the implant before any imaging.
Pain Pump vs. Spinal Cord Stimulator
Both intrathecal pain pumps and spinal cord stimulators are implanted devices used for chronic pain, but they work in fundamentally different ways. A pain pump delivers medication directly into the spinal fluid (a chemical approach), while a spinal cord stimulator sends electrical pulses to the spinal cord to interrupt pain signals.
A pain pump may be preferred when pain is widespread, related to cancer, or best managed through medication delivery. A spinal cord stimulator is often considered for localized neuropathic or radicular pain.
Some patients are candidates for both, and the physician evaluates each case individually. No head-to-head clinical trial currently compares these two approaches directly.
Why Choose Performance Pain and Sports Medicine in Houston
When patients choose intrathecal pain pump therapy at the Houston practice, they benefit from a physician-led care team with advanced training in neuromodulation and targeted drug delivery.
Dr. Suzanne Manzi, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine — is a member of the North American Neuromodulation Society (NANS) and stays current with the latest developments in intrathecal drug delivery, patient selection, and pump programming. Her fellowship training in interventional spine and pain management at Michigan State University, combined with her role as teaching faculty at UT Health Houston McGovern Medical School, provides both the clinical depth and academic perspective to guide complex pain pump decisions. Dr. Manzi is also a founding member of the Society of Women Innovators in Pain Management.
The intrathecal pump program also benefits from the expertise of Dr. Matthias Wiederholz, MD — Quadruple Board-Certified in Physical Medicine & Rehabilitation, Sports Medicine, Pain Medicine, and Anti-Aging, Regenerative & Functional Medicine — who serves on the Medtronic National Advisory Board for targeted drug delivery systems. As the founder of the practice since 2009, Dr. Wiederholz brings extensive experience with implanted pain management devices.
Jade Nemeth, PA-C, supports patients through every stage of the pain pump process, from initial evaluation through trial, post-implant programming, and ongoing refill visits.
What sets the Houston practice apart:
- Physician-led care with board-certified expertise in intrathecal drug delivery
- Dedicated one-on-one consultation time
- Comprehensive trial evaluation before permanent implantation
- Ongoing support for pump refills, dose adjustments, and long-term management
- Convenient Houston office location in the T-Mobile Tower near the Galleria, accessible from River Oaks, West University, and the greater Houston area
At PPSM, the right approach to chronic pain starts with a thorough evaluation and an honest conversation about options. When an intrathecal pain pump is appropriate, the team guides patients through every step — from trial to implantation to long-term management.
Our Houston Location
Performance Pain and Sports Medicine occupies Suite 1700 of the T-Mobile Tower, providing a convenient Houston pain management location for patients from River Oaks, the Galleria, Bellaire, West University, and Montrose. The building offers covered parking with validation.
Performance Pain and Sports Medicine — Houston:
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, 17th Floor
Phone: 346-217-1111
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Nearby Neighborhoods: River Oaks, Galleria, Bellaire, West University, Montrose
Frequently Asked Questions
What medications are used in an intrathecal pain pump?
The FDA has approved morphine and ziconotide as first-line intrathecal medications. Physicians may also use baclofen for spasticity, bupivacaine for localized pain, or hydromorphone based on the patient’s needs.
What are the risks or downsides of a pain pump?
Possible risks include surgical site infection (2 to 5%), catheter complications (5 to 25%), medication side effects such as nausea or constipation, and rare catheter-tip granuloma formation. Regular follow-up visits help manage these risks.
Is a pain pump a last resort?
Not necessarily. A pain pump is considered when less invasive treatments have not provided sufficient relief, but it does not have to be the final option in a patient’s care plan.
How long does an intrathecal pain pump last?
Pump batteries typically last five to seven years. When the battery is depleted, the pump is replaced through an outpatient surgical procedure while the catheter usually remains in place.
Are you put to sleep for a pain pump trial?
The trial is performed under local anesthesia, so patients stay awake. Sedation is available for comfort if needed.
Does insurance or Medicare cover intrathecal pain pumps?
Many insurance plans and Medicare cover intrathecal pain pump therapy when medical necessity criteria are met. Coverage varies by plan, so patients should verify benefits with their insurance provider before scheduling.
What is the success rate of intrathecal pain pumps?
The PROSPER trial showed statistically significant pain improvement in patients receiving intrathecal drug delivery compared to conventional medical management (Pope et al., 2022). Success depends on proper patient selection, accurate diagnosis, and the underlying pain condition.
Schedule Your Pain Pump Consultation in Houston
If chronic pain has not responded to oral medications, injections, or prior surgeries, an intrathecal pain pump may be worth discussing. The Houston pain management team at Performance Pain and Sports Medicine offers comprehensive evaluations, trials, and long-term pump management. Request an appointment to learn whether this therapy could help.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Medically reviewed by Suzanne Manzi, MD
Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine
Last reviewed: April 2026
