Chronic Pain

I've had a Medtronic intrathecal morphine implanted for about a year with good results and some initial problems. I'm willing to share my experience and answer any questions for those interested or contemplating this procedure.

I had my first pump put in 2 years ago but had so many problems with it that 3 months ago I had to have it replaced with the larger one. Even though I had the problem with the first one, I as so very glad I did this. I have had chronic back pain for 13 years after a fall at work. But,I would like to ask if any one is having some of the problems that I am having. Some are, my unit sits at an angle and I will hit it on counters or the sink and when that happens it will hurt. My taste is off and I am having trouble sleeping. I still take meds at nite so I fall asleep but can not stay asleep. My pump is set at 13 mgs plus I take morphine for break thru pain. But all in all, this was the best thing I did for myself and my family.

Hi Bob,I have a unit from MedTronic also. Just wondering what was the problems you had in the beginning. I'm glad things are working out well for you now as they are for me also.

Hi Tina,

I've never had problems with the pump itself - just with the catheter slipping out of the spinal cord on three occasions following implant of the pump. This resulted in most unpleasant drug withdrawal symptoms and a dramatic increase in pain level which required me to return to oral morphine and breakthrough medication with all of the bad side effects like constipation, etc.

I finally had the catheter revised by a neurosurgeon who placed it higher up (T6-7 vs. the usual T10-11) and who used a stiffer material along with surgical glue to hold the thing in place. So far, it's held up and I'm doing fine.

Like you, I have the later version that's a larger pump which holds more medication and reduces the frequency of refilling. When you first had your unit implanted, Medtronic only sold a smaller unit but have since replaced it with the larger one as a standard.

My morphine dosage appears to be much less than yours and I don't generally require more than one or two Vicodin a day if I do a lot of physical activity which increases the pain level.

Although I now sleep very well, I do have a lot of pain early in the morning despite the fact that the pump is programmed to put out additional medication between 4 and 6 AM. I take a Vicodin as soon as I awaken and after I get up and eat breakfast, the pain level goes down for the rest of the day most of the time.

The pain management clinic I go to said I would never be totally pain free but, like you, the pump has made a major change in my life and, despite the setbacks, I'm glad I had it implanted.

I'm happy to hear that you, too, are satisfied with the pump. As for the placement problems you're having, a lot depends on where they implanted it and how much body fat surrounds it. Although I'm quite thin, I did develop some fat around the middle of my abdomen so the pump is fairly well insulated from external damage. I can put my fingers around it but it's still pretty well protected by the fat layer. I try to be very careful not to cause any great movement of the pump itself even though its sturdy construction makes it quite impervious to physical damage.

The biggest potential problem from pump movement involves possible breakage or disconnect of the feeder line that runs from the pump to the spinal cord area where it's connected to the intrathecal catheter that's placed in the sub-achronoid space of spinal cord. The instructions accompanying the pump stress avoidance of manual manipulation.

As a man who occasionally wears a belt, I do have to decide whether the belt is above or below the pump. Women may have less of a problem with this.

If you are very thin with minimal abdominal fat, protecting the pump may pose a problem but so long as it doesn't move around a lot, it should be OK. Otherwise, minor out-patient surgery may be necessary to re-anchor the pump deeper and more securely.

Sorry to be so verbose but I'll be happy to answer any other questions from you and others.

Aloha,
Bob

Aloha Bob,
Thank you for all the information. And it is nice to hear that the problems I have are not all in my head. But what I did not know is that the pump could be programed to administer different doseage rate, mine is set at a steady rate. If I could have more pain relief at night that would help me as that is when I have alot of break thru pain. Also I know our weather has alot to do with the increase in my pain. We are having a lot of deep cold temp. right now. This time of year I stay in and wait for spring. You are very lucky to be where you are. Somewhere warm. It is nice talking with someone who shares this unit. Mine is just not right still. Very sore, hurts to touch or even brush against. The first one moved around so much it took 2 people for a fill, one to hold it and one to do the fill.Now this one, I have only had 1 fill with but when they did it, this one rests on a nerve in by back. But still, on a day to day it is just not right yet. I have said something to the doctor's but they just seem to think it is still healing. I don't. The thought of not having the pump and going back on all my meds scares me. Those meds made my life unbearable. Thank you for all you information and have a wonderful warm day
Freezing in Upstate New York-Tina

Hi Tina,

Like you, I greatly fear the possibility of not having the pump in the future should the catheter slip out again and the the doctors refuse to revise it again. It's made such a great change in my life.

On the other hand, both of us must realize that this possibility exists as the pump might fail or some other problem will occur that might prevent us from continuing to enjoy its benefits. I keep some oral morphine around to reduce the withdrawal symptoms should that occur.

From your comments, it sounds like the pump is not properly anchored or may have come loose. I assume it's in your abdomen. There are several anchor points on the pump's case which the surgeon can use to prevent excessive movement. Also, the body tends to create scar tissue around an implanted foreign object which can provide additional support for the device.

Mine also moves around quite a bit but there is no soreness. I would question the soreness you are experiencing so long after the unit was implanted. If it continues and the pump has excessive movement, I would check with a surgeon or pain specialist and request that it be checked and, if necessary, revised. This should be a fairly simple and quick out-patient surgery
using a local anesthetic unless they decide to place the pump in a different location. This depends on how much the movement and soreness causes too much discomfort.

We're glad we live in Hawaii where it's always warm. I'm originally from NY but I lived near NYC. I did spend some time on farms in the upstate area and attended college in Troy so I know something about your cold weather although the past few days seem rather unusual and excessive. One of our daughters lives in Minnesota where the weather is even worse.

Best wishes,
Bob

My mother may be getting a morphine pump. She is on several pain medications including a morphine patch which is completely drugging her. She told us that the pump does not effect the brain. Is this correct? Are you able to function normally on the pump or are you in a drug induced state.

Thank you

Hi Sally,

One of the great advantages of the intrathecal morphine pump is that it places the morphine directly into the spinal cord and at a dose that is a fraction of the amount that must be taken orally or via a patch. For example, a patient taking 125 Mg. of oral morphine per day may realize the same or even greater pain control from the pump which is injecting only 0.8 Mg. per day into the spinal cord. This is because the morphine is being applied directly to the area that's causing the pain vs. metabolizing the medication through the body.

Thus, annoying side effects, such as constipation, sleepiness, and the "drugged out" feeling are mostly eliminated by reducing the dosage of the medication to a fraction of the amount taken orally or via a patch.

In my case, the oral morphine's side effects primarily caused constipation but it also did not result in sufficient pain control. I did not want to increase the oral dosage so my pain specialist agreed to implant the Medtronic pump.

The normal procedure is to first have the patient undergo a trial to be sure that this method of medicating will be successful. An overnight hospital stay is required using an external morphine pump, typically used for post-operative anesthesia, and a temporary catheter in the spinal cord to determine if the pain will be controlled. If the patient experiences pain relief, then he or she is a candidate for a permanent pump implant.

Depending on the age and overall health of the patient, implanting the pump and associated catheter is often an out-patient procedure but does require general anesthesia. The pump is placed in the abdominal area and a supply tube is routed internally to the base of the spine where it connects to a thinner catheter that's placed in the subachronoid space of the spine and pushed up to the T10-ll joint or higher. In addition to the incision to prepare the pocket that holds the pump, two smaller ones are made. One is on the side to facilitate routing the supply tube to the back area and the other is needed for implanting the catheter into the spine. Recovery is generally quick with some soreness around the pump implant area

The pump can hold sufficient medication to last up to three months at which time it's refilled using a hypodermic needle inserted through the skin into a self-closing port on the pump. This is a quick and painless procedure. The pump's battery will last for about six years at which time the pump must be removed and replaced.

The pump is adjusted by the doctor or nurse using a touch-screen programmer that interfaces with the unit via a small device that's held by the patient against his or her abdomen near the pump. The pump can be programmed to provide continuous medication at a particular rate or at different rates during different times of the day. Initially, a minimum dose will be programmed and then increased in subsequent doctor visits if greater pain control is needed.

I suggest that you copy this URL and paste it in your browser for additional information:

http://www.healthcentral.com/tamethepain/painpump.html?ap=408

Please feel free to contact me if you have any questions or need more information

Hello,

I was just wondering what you have your morphine pump for? Have you had spinal surgery, or a problem with your spinal cord that causes you pain?

Hi RuffLife,

My back and neck problems started many years ago. I had a herniated disk that required surgery but the main problem that caused chronic pain is the result of severe degeneration of the disks in the lumbar and cervical areas. I then had neck surgery where they did laminectomies on three joints to relieve the pain caused by stenosis (nerve compression).

My neck pain was mostly eliminated but the back pain remained and more surgery was not indicated because so many joints were damaged. I was referred to a pain management clinic where, for the first year, I was put on various oral narcotic medications and patches that initially worked but then, over time, became less effective along with unpleasant side effects.

The morphine pump provides excellent pain relief fir me with no noticeable side effects. The medication in the pump is fully covered by Medicare in comparison to some of the very expensive oral medications I was taking that were not covered by the Part D drug plans.

In conclusion, I believe the pump is a very effective alternative to oral medications in the treatment of chronic spinal pain although it's commonly considered a "last resort" after more traditional treatments fail.

Please let me know if you have any other questions.

Luckily I have pretty great insurance, and all oral narcotics are covered up to a $10 co-pay. I don't have problems that are usually anticipated with the oral medicines like constipation, but I do get a "brain fog" with most of the ones that are strong enough. Being a student in a demanding major, this is unacceptable. I also have a problem with medications losing effectiveness over time. I end up trying to switch to a different medicine every three months. Glad to see you've found something that work so well!

-Stefany

Hi Stefany,

I don't think your experience with oral narcotics is unusual. In my case, I did experience constipation but no mental side effects that I was aware of. As you say, the effectiveness tends to reduce over time and we either have to take more of a particular medication or switch to another.

With the pump, the doctor or technician can increase the strength of medication as needed and because the dose is a tiny fraction of the amount required when using oral narcotics, side effects will be minimal as the dosage is increased. For example, before the pump, I was taking 120 Mg. of Avinza (slow release morphine) per day. Currently, the pump is giving me just 0.8 Mg. of morphine per day with improved pain control.

What is causing your chronic pain?

I have disc deterioration at L1-L2 and disc bulging with stenosis in my neck at C2-C5. I'm not a good candidate for surgery at this time for my lower spine, which is fine with me because as I'm sure you know the positive results are usually not worth the risks. Unfortunately, I'm still trying to find a pain management doctor who doesn't think I'm after drugs, I'm just trying to get some relief.

I agree with your remark about surgery. It often results in only temporary relief and, if they fuse two vertebra, this often causes stress on the adjacent joints resulting in additional problems in the future.

I know many physicians are fearful of prescribing narcotics because of their abuse by people who have no need for them. This causes suffering for those of us who have chronic pain. Pain management specialists may be more sympathetic and less afraid of prescribing narcotics than other physicians. I hope you can find one in your area.