Medication Options for Pain Pumps

Various medications, including opioids and local anesthetics, are available for use in implantable pain pumps. These medications are injected into a pump’s reservoir and refilled as needed.

Currently, three medications are approved by the U.S. Food and Drug Administration (FDA) for use in pain pumps: morphine, ziconotide and baclofen. Baclofen is used to treat spasticity and is not commonly used for pain relief. Certain other medications — even though they are not currently approved by the FDA for pain pump use — may be used in addition to or instead of morphine and ziconotide.

A physician takes various factors into consideration when prescribing medication(s) to be administered through a pain pump. These factors include the individual’s type and cause of pain and other medications the individual takes. If one medication is not effective or causes intolerable side effects, a different medication or combination of medications may be prescribed.

Physicians can choose to administer one or more of these medications through a pain pump:

• Morphine
  Morphine is one of the most common medications used in pain pumps. It is an opioid medication that works by affecting the way the brain and nervous system respond to pain.
• Ziconotide
  Ziconotide is a non-opioid pain medication that works by blocking certain calcium channels in the spinal cord.
• Hydromorphone
  Hydromorphone is an opioid medication that is sometimes prescribed as an alternative to morphine, especially if morphine is not effective or causes side effects.
• Bupivacaine
  Bupivacaine is an anesthetic that may be prescribed in combination with either morphine or hydromorphone. This combination may be particularly beneficial for neuropathic pain.
• Clonidine
  Similar to bupivacaine, clonidine is primarily used in combination with morphine or hydromorphone. It can improve the pain-relieving effects of opioids. It is less commonly used than bupivacaine due to its potential side effects, such as low blood pressure.
• Fentanyl or sufentanil
  The opioid fentanyl or sufentanil can be administered through a pain pump if other opioids are not viable options or are not effective.