By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD
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 in League City
- Frequently Asked Questions
Living with chronic pain that no longer responds to oral medications is exhausting in a way that is hard to describe. For NASA engineers, refinery shift workers, Houston Ship Channel commuters, healthcare clinicians at UTMB and Methodist Clear Lake, CCISD educators, and active retirees across Bay Area Houston who have already tried physical therapy, multiple medications, injections, and sometimes prior surgery without lasting relief, an intrathecal pain pump offers a fundamentally 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 than oral opioids. International guidelines recognize intrathecal drug delivery as an evidence-based treatment for refractory chronic pain (Deer et al., Neuromodulation, 2024).
At the League City office of Performance Pain and Sports Medicine, located on East Main Street just minutes from I-45, Dr. Suzanne Manzi leads the intrathecal pain pump program. The Bay Area office offers comprehensive evaluations, in-office trials, and long-term pump management without the long drive into the Texas Medical Center.
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 in League City?
Intrathecal pump therapy is reserved for patients whose pain has not responded adequately to conservative treatment. 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). Many of the patients we evaluate at the League City office have already worked through years of physical therapy, injections, oral regimens, and in some cases prior surgery without finding lasting relief.
Conditions that may respond to intrathecal drug delivery include:
- Failed back surgery syndrome, chronic lower back pain, or persistent sciatica — common in NASA console operators, refinery shift workers, Ship Channel laborers, and active-adult retirees across the Bay Area
- Cancer-related pain
- Complex regional pain syndrome (CRPS) and other neuropathic pain conditions 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 at the League City office helps determine whether a pain pump is the right next step.
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, epidural steroid injections, or radiofrequency ablation — all of which are also offered locally in League City.
The Pain Pump Trial
Before a permanent pump is implanted, every Bay Area patient undergoes a trial to evaluate how well intrathecal medication controls their pain. During the trial, Dr. Manzi injects a small dose of medication into the spinal fluid in the East Main Street office. Patients then track their pain levels in a diary over the next one to three days, often during a normal Bay Area work or shift cycle so the result reflects real life.
A pain reduction of 50% or greater is generally considered a successful trial (Deer et al., Neuromodulation, 2017). If the trial meets that threshold, the patient may move forward with permanent implantation at an affiliated Bay Area surgery center without the long drive into the Texas Medical Center. If the trial does not produce meaningful relief, the team discusses other treatment options without pressure to proceed.
Patients often ask whether they are put to sleep for the trial. The trial 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 practical advantages over oral pain medication for the Bay Area patients we treat at the League City office:
- Lower medication doses. A fraction of the oral amount can produce comparable or improved relief, often with fewer systemic side effects — an important consideration for NASA contractors and refinery operators in safety-sensitive roles.
- Adjustable dosing through wireless programming during routine refill visits at the League City office, with no additional surgery required.
- Reversibility. The pump can be removed if it is no longer needed.
- Continuous delivery, which provides steadier pain relief than the peaks and valleys of oral medications — important for patients on rotating shifts or trying to maintain a normal sleep schedule on the boat.
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 Bay Area patients who have already tried epidural steroid injections or radiofrequency ablation 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 helps reduce these risks.
Long-Term Pump Care and Refills
Once a pump is implanted, Bay Area patients return to the League City office for routine 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 and typically take less than 30 minutes. There is no need to drive into the Texas Medical Center for routine pump care — everything happens locally on East Main Street.
Dose adjustments are 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 League City
When patients across the Clear Lake and Bay Area Houston community choose intrathecal pain pump therapy at the League City office, they benefit from a physician-led care team with deep 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 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.
What sets the League City office apart for pain pump patients:
- Physician-led care with NANS-member expertise in intrathecal drug delivery
- Honest candidacy conversations — we will tell you if a pump is unlikely to help your specific pain pattern
- In-office trials in League City before any permanent implant decision
- TMC-caliber care without the I-45 drive into the Texas Medical Center
- Local refills, reprogramming, and long-term management on East Main Street
- Workers’ compensation accepted for NASA contractor, refinery, petrochemical, maritime, and healthcare cases
- Convenient League City location accessible from Friendswood, Webster, Dickinson, Kemah, Seabrook, Nassau Bay, Texas City, La Porte, Pearland, Pasadena, Alvin, and Santa Fe
For Bay Area patients who want to compare a pump against an electrical neuromodulation alternative, the practice also offers spinal cord stimulation in League City.
Our League City Location
Performance Pain and Sports Medicine — League City:
Address: 1216 East Main Street, Suite A, League City, TX 77573
Major Cross Streets: East Main Street (FM 518) at I-45
Nearby Landmarks: South Shore Harbour, UTMB Health League City Campus, Big League Dreams, Kemah Boardwalk
Parking: Free on-site parking
Phone: 346-217-1111
Conveniently located in the heart of Bay Area Houston, the League City office serves patients from Friendswood, Webster, Dickinson, Kemah, Seabrook, Nassau Bay, El Lago, Texas City, La Porte, Pearland, Pasadena, Alvin, Santa Fe, and the wider Clear Lake / Galveston Bay communities, with quick access from I-45, FM 518, FM 646, and NASA Road 1.
Frequently Asked Questions
Are intrathecal pain pumps available in League City, TX?
Yes. Pain pump candidacy evaluations, in-office trials, and ongoing pump management are coordinated through the League City office of Performance Pain and Sports Medicine, located at 1216 East Main Street, Suite A. Dr. Suzanne Manzi, MD — a NANS member and fellowship-trained interventional pain specialist — leads the program. Permanent pump implantation is performed at an affiliated Bay Area surgery center. Most insurance plans, Medicare, and workers’ compensation cases cover medically necessary intrathecal therapy. Call 346-217-1111 or request an appointment online.
Do you accept workers' compensation for NASA, refinery, and Ship Channel injury claims?
Yes. The League City office regularly treats workers’ compensation patients from NASA Johnson Space Center contractors (Boeing, Lockheed Martin, Jacobs, Barrios), Houston Ship Channel and Bayport refinery and chemical-plant operators, longshoremen and maritime workers on Galveston Bay, UTMB and Methodist Clear Lake healthcare staff, and Clear Creek ISD educators. Pain pump candidacy in workers’ comp cases requires careful documentation of failed conservative therapy — the League City team handles that documentation as part of the evaluation. Call 346-217-1111 to discuss your case.
Do you accept referrals from Bay Area neurosurgeons, oncologists, and primary care?
Yes. Dr. Manzi routinely accepts referrals from UTMB Health, Houston Methodist Clear Lake, HCA Houston Healthcare Clear Lake, NASA contractor health programs, and independent primary care, oncology, neurosurgery, and palliative care practices throughout the Clear Lake / Bay Area. Most patients are seen within one to two weeks for an initial pain pump candidacy evaluation.
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. The medication is selected during the candidacy evaluation and trial.
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 in League City 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. Many Bay Area patients use a pump alongside ongoing physical therapy and other interventional treatments.
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. Replacement is generally simpler than the initial implant.
Are you put to sleep for a pain pump trial?
The trial is performed under local anesthesia in the League City office, so patients stay awake and can give real-time feedback about pain relief. 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 the League City staff verifies benefits before scheduling. Call 346-217-1111 for a benefits check.
Schedule Your Pain Pump Consultation in League City
If chronic pain has not responded to oral medications, injections, or prior surgeries, an intrathecal pain pump may be worth discussing. The League City pain management team at Performance Pain and Sports Medicine offers comprehensive candidacy evaluations, in-office trials, and long-term pump management. Request an appointment to learn whether intrathecal therapy could help your specific pain pattern.
Performance Pain and Sports Medicine — League City
1216 East Main Street, Suite A, League City, TX 77573
Phone: 346-217-1111
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
Quadruple Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. Member, North American Neuromodulation Society. Teaching Faculty, UT Health Houston McGovern Medical School
Last reviewed: April 2026
