Pain and spasticity, UK
Intrathecal drug delivery pump, for pain and spasticity.
A small programmable pump, implanted under the skin of the abdomen, delivering morphine, ziconotide or baclofen directly into the CSF. A proper trial first. A named consultant. Refill and reprogramming clinics you can rely on for life.
Why patients choose us
- 01
A specialist pain or spasticity consultant, not a generalist
A named interventional pain physician or neurologist with a high implant volume, in a centre that runs regular refill and reprogramming clinics.
- 02
A proper trial, before you commit
Every candidate has a single-dose or short catheter trial. If the trial does not deliver real functional benefit, no permanent pump goes in.
- 03
Independent, and free to you
We are paid by no clinic, so the recommendation is impartial. Second opinions on existing pump problems are welcome.
Indicative pricing
What a private intrathecal pump costs in the UK.
Indicative ranges across our partner centres. Send the referral and imaging, and we quote firm figures across two or three options.
In short
A permanent IDDS implant in our network: £26,000 to £45,000, refills £850 to £1,600 each.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Second-opinion review of existing pump or trial | £350–£650 | 30–45 min | 48 hours |
| Single-shot intrathecal trial (opioid or ziconotide) | £1,800–£3,200 | Half day | Same day |
| Extended catheter trial (3–7 days, inpatient) | £6,500–£11,000 | 3–7 days | End of trial |
| SynchroMed II or Prometra II implant, all-inclusive | £26,000–£45,000 | 2–3 h GA | 1–2 night stay |
| Routine pump refill and reprogramming | £850–£1,600 | 30–45 min | Same visit |
| Pump replacement at end of battery life (7 years) | £18,000–£28,000 | 90 min GA | Day case |
Prices vary by pump model, reservoir size, drug, and by whether an inpatient catheter trial is needed before implant. The drug itself is charged on top of each refill.
The journey
From referral to refill, what happens, in order.
One team from the first message through the trial, the implant, and the refill and reprogramming clinics for the life of the pump.
- 01
Before
You send the referral and imaging
A short, confidential form. Your pain or spasticity story, drugs tried, previous SCS or surgery, and any recent MRI of the spine.
- 02
Before
We come back with a plan
Within one working day: whether an IDDS trial is appropriate, or whether SCS, a plexus block, or oral optimisation is the better next step.
- 03
Before
MRI, psych review, and consent
MRI checks theca patency and rules out cord tethering. A pain psychology review is standard for chronic non-cancer pain. Full consent on refills for life.
- 04
Trial and implant
The trial
A single intrathecal bolus, or a short percutaneous catheter trial over 3 to 7 days, with objective pain or spasticity scoring by a blinded assessor.
- 05
Trial and implant
The implant
2 to 3 hours under general anaesthetic. Midline lumbar catheter under fluoroscopy, tunnelled to a subcutaneous abdominal wall pocket for the programmable pump.
- 06
Trial and implant
Overnight stay
One or two nights in hospital for wound checks, first programming, and initial dose titration before you go home.
- 07
After
Refills, programming, follow-up
Percutaneous refill every 1 to 6 months depending on drug concentration and daily dose. Telemetry reprogramming as pain or tone changes.
When it helps
When an intrathecal pump is the right step.
The pain and spasticity situations we see most, plus the signs that IDDS is not the right answer.
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Refractory cancer pain, end-of-life
When oral or transdermal opioids no longer control pain, or side effects are intolerable. Intrathecal morphine is around 300 times more potent than oral.
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Chronic non-cancer pain after failed SCS
Failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain where a spinal cord stimulator trial has not delivered lasting benefit.
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Severe spasticity from MS, CP or SCI
Intrathecal baclofen (ITB) for multiple sclerosis, cerebral palsy, or spinal cord injury where oral baclofen is ineffective or causes drowsiness.
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Post-stroke or post-anoxic spasticity
Selected adults and children with disabling spasticity in the legs or all four limbs, where botulinum toxin is not enough on its own.
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Opioid-tolerant patients with side effects
Constipation, sedation, cognitive fog, or hormonal suppression from high-dose oral opioids. Intrathecal delivery uses a tiny fraction of the systemic dose.
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When ziconotide (Prialt) is appropriate
A non-opioid intrathecal calcium channel blocker for severe chronic pain, useful in patients where opioids are not working or not wanted.
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When IDDS is not the right answer
Untreated depression, active substance misuse, uncorrected coagulopathy, active infection, or a spine that will not allow safe catheter placement.
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Red flag: sudden change in pain or tone
A sudden increase in pain, new withdrawal symptoms, or a swollen pump pocket may signal catheter failure or granuloma. Contact the pump team urgently.
Pump and drug options
Which pump, which drug, and how we trial it.
The two programmable pumps used in the UK, the drugs that can go in them, and the two ways we run a trial before any permanent implant.
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Medtronic SynchroMed II
The most widely used programmable pump in the UK. 20 or 40 mL reservoir, MRI-conditional at 1.5T and 3T with a defined protocol. Battery life around 7 years.
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Flowonix Prometra II
A gas-driven programmable pump with a 20 or 40 mL reservoir. MRI-conditional with a specific pre-scan protocol. Often preferred where high accuracy at low flow rates is needed.
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Intrathecal morphine
The workhorse opioid for cancer and non-cancer pain. Typical starting dose 0.5 to 1 mg per day intrathecal. Very small doses because intrathecal morphine is roughly 300 times oral potency.
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Ziconotide (Prialt)
A non-opioid, non-tolerance-forming option for severe chronic pain. Slow titration is essential; side effects include dizziness, nausea and cognitive symptoms.
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Bupivacaine and clonidine
Often added to morphine or ziconotide for neuropathic pain, working synergistically to widen the therapeutic window and reduce individual drug doses.
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Intrathecal baclofen (ITB)
For severe spasticity. Doses are individualised, typically in the range of 100 to 900 micrograms per day, with careful titration to preserve useful tone.
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Single-shot trial
A one-off intrathecal bolus with structured before-and-after scoring. Quick, low-cost, and screens out clear non-responders before a permanent implant.
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Catheter trial (3–7 days)
A tunnelled percutaneous catheter connected to an external pump, giving a realistic dose-titrated preview of what a permanent system will do.
London centres we work with
A small panel of implanting centres, chosen carefully.
Pain and neurology teams with established IDDS and ITB programmes, dedicated refill clinics, and on-call cover for pump problems.
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King’s College Hospital Private Pain
Long-standing interventional pain service with IDDS trial and implant pathway.
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London Pain Clinic, Guy’s
Consultant-led pain medicine team offering intrathecal trials and refill care.
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HCA The Wellington Pain Management
Independent-sector implanting centre with anaesthetist-led pain service.
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Cleveland Clinic London Pain
Multidisciplinary pain and neurology team, with modern implant theatres.
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Great Ormond Street (paediatric ITB)
Specialist paediatric intrathecal baclofen service for children with severe spasticity.
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National Hospital for Neurology, UCLH Private (adult ITB)
Neurology-led adult ITB service for MS, spinal cord injury and post-stroke spasticity.
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Consultant pain physicians or neurologists with a high IDDS implant volume
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Dedicated refill and reprogramming clinics, not ad-hoc appointments
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24/7 on-call cover for pump alarms, withdrawal, and suspected granuloma
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MDT links to neurosurgery, palliative care, physiotherapy and pain psychology
Safety and aftercare
What to expect, honestly.
A pump is a long-term commitment. The things worth planning are the anaesthetic, the mechanical risks, the drug risks, refills for life, and what to do if something changes.
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General anaesthetic for the implant
The pump is placed under GA in the dorsal position. Expect 2 to 3 hours in theatre and one or two nights in hospital for wound checks and first programming.
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Catheter kink, disconnection or migration
The commonest mechanical problem. Presents as loss of effect, breakthrough pain, or, with ITB, sudden increased tone. Usually diagnosed on plain films or contrast study.
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Catheter tip granuloma
An inflammatory mass at the catheter tip, more common with high-concentration morphine at high daily doses. Presents as loss of effect, new neurology, or back pain. MRI diagnoses it.
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Over-dose and under-dose
Programming errors, refill errors, or pump failure can cause life-threatening opioid or baclofen over-dose, or acute withdrawal. Every pump patient carries an alert card.
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Infection at the pocket or along the catheter
Rare but serious. Superficial wound infection is managed with antibiotics. Deep infection or meningitis usually needs the whole system removed.
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CSF leak and post-dural puncture headache
A postural headache in the first two weeks, from CSF leak at the catheter insertion. Most settle with rest and fluids; a small number need a blood patch.
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MRI-conditional per model
Both SynchroMed II and Prometra II are MRI-conditional under a defined protocol at 1.5T and 3T. The pump is interrogated before and after every scan.
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Refills for life
Every 1 to 6 months depending on your drug, concentration and daily dose. Missing a refill risks acute withdrawal. Refills are booked in a rolling calendar.
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Red flags after discharge
Sudden loss of pain control, new weakness, high fever, severe headache, or a hot swollen pump pocket needs same-day contact with the pump team or A&E.
Reading your pump card
Your pump card in four parts. Read the last one first.
Every intrathecal pump patient carries an alert card. It keeps to the same shape whichever model you have.
- 01 Header
Indication, pump model and catheter level
Why the pump was implanted, which device and reservoir size, and the vertebral level of the catheter tip on fluoroscopy.
- 02 Drug
Drug, concentration and daily dose
Which drug or combination, its concentration in mg/mL, and the current 24-hour dose in mg or micrograms.
- 03 Programme
Delivery mode and bolus rules
Simple continuous, flex, or patient-controlled bolus, with any lockout intervals and the maximum daily dose.
- 04 Impression
Refill interval and next appointment
Read this first: the date of the next refill, the alarm date, and the plan for reprogramming or dose titration.
Recognised by major UK insurers
Cover for IDDS and ITB varies by insurer and by indication, and is usually funded when medically indicated. We confirm cover before booking.
Ready to talk?
Send us the referral and imaging. We come back within one working day.
Whether you are exploring a trial, weighing pumps against a spinal cord stimulator, or looking for a second opinion on an existing system, we will match you to the right consultant.
Frequently asked
Everything we get asked about intrathecal pumps.
Quick answers on trials, drugs, refills, costs and MRI safety.
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What is an intrathecal drug delivery pump?
It is a small programmable pump, roughly the size of an ice-hockey puck, implanted under the skin of the abdominal wall. A fine catheter runs from the pump into the intrathecal space around the spinal cord, delivering pain or spasticity medication directly into the cerebrospinal fluid. Because the drug bypasses the bloodstream, the dose is a tiny fraction of the equivalent oral or intravenous dose, with fewer systemic side effects.
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Which patients are considered for an IDDS or ITB pump?
The main groups are: refractory cancer pain, particularly at end of life; chronic non-cancer pain after failed conservative management including a spinal cord stimulator trial; and severe spasticity from multiple sclerosis, cerebral palsy or spinal cord injury where oral baclofen is not enough or causes intolerable drowsiness. Every candidate goes through a trial before a permanent pump is implanted.
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What drugs go in the pump?
For pain, most pumps hold morphine, sometimes with bupivacaine and clonidine added for neuropathic pain. Ziconotide (Prialt) is a non-opioid option for severe chronic pain in selected patients. For spasticity, the drug is baclofen. The mix, concentration and daily dose are individualised, and can be changed by telemetry at refill visits.
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How much does a private IDDS pump cost in the UK?
A full implant, including the pump, catheter, theatre time, first hospital stay and first refill, is roughly £26,000 to £45,000 depending on model, drug and centre. A single-shot trial is £1,800 to £3,200, an inpatient catheter trial £6,500 to £11,000. Routine refills are £850 to £1,600 each, with the drug charged on top. We confirm firm figures within one working day.
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How often do I need refills, and what happens if I miss one?
Refills are usually every 1 to 6 months depending on your drug, its concentration and your 24-hour dose. Missing a refill lets the pump run dry, which risks acute opioid or baclofen withdrawal. Refills are booked in a rolling calendar, with an alarm date set on the pump itself. If you ever cannot reach your clinic in time, go straight to A&E with your pump alert card.
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Can I have an MRI with a pump in place?
Yes. Both the SynchroMed II and the Prometra II are MRI-conditional under a defined protocol at 1.5T and 3T. The pump is interrogated by the pump team before and after every scan to check it is running correctly, and reprogrammed if needed. Always tell any radiology department that you have an intrathecal pump before you are booked in.
Related treatments and conditions
Looking for something else?
-
Spinal cord stimulator
The usual step before an intrathecal pump for chronic non-cancer pain.
Learn more -
Coeliac plexus block
Neurolytic block for upper abdominal cancer pain, an alternative to IDDS.
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Ketamine infusion for chronic pain
Inpatient ketamine infusion for refractory neuropathic pain.
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DBS for spasticity
Deep brain stimulation for selected dystonia and severe spasticity.
Learn more -
Multiple sclerosis
Diagnosis and treatment pathways for MS, including spasticity care.
Learn more -
Chronic pain
Our full guide to chronic pain assessment and treatment options.
Learn more