Chronic Pain

From what I know of the pumps, they can be "installed" even if you have had a spinal surgery. I think it's just a matter of there being space to put the catheter in and everything. I'm sure someone else will have more to add, but I've definitely known people with failed back surgeries who ultimately had the pump put in.

Hope that helps,
Stefany

Hi,

As indicated in a previous post, implanting the pump should be no problem if you've had spinal surgery. The pump itself is placed in your abdominal area and the supply tubing is burrowed around to your spine. They have to make a small incision on your side to allow them to push the tubing towards your back after which it's connected to a thinner catheter that's inserted in the spinal cord and pushed up to the thoracic region around T10-11 or, as in my case, further up.

In other words, it shouldn't get in the way of any metal devices that may be in your spinal area.

I hope you are a good candidate for the pump as it may help your pain control and be superior to patches and oral analgesics that you may be currently taking

Thank you both for your input. I live in NM and have to travel to a VA clinic in Texas to get treatement. I am going to inform the ortho and spine surgeon that I see about this and that I want to give it a try due to the fact that I am tired of being their experiment there at the VA and hopefully this will help get control over my pain. I am dead tired of popping pills for pain being on 5 different medications that are "supposed" to help control pain so we shall see how it goes. Again Thank you both.

Hi!
I haven't posted in awhile. Once you're back from surgery life goes on and the busyness comes back!

I've had 2 fusions and also have 6 rods in right where my pain is and had no problem putting the pump in. I am still adjusting my dose which I hear could take 2 more months but I'm doing pretty good. There are times where I wish I had breakthrough meds (like after grocery shopping today) but it's so great not having to take oral meds anymore. I have had horrible swelling and water retention so I just started taking a prescription diuretic. I'm thinking they might have to change me from morphine to something else.
Bob- I hope you can get the handheld device soon. Is it just because you have an older version?

Hi Jos33:

It does take time to get the correct pump dosage settings to properly control your pain. I'm surprised you don't have any breakthrough oral meds but I guess since you have some control over the pump for extra medication, that takes the place of them.

I have the newer pump and the only reason I don't have the external control is because my pain management clinic hasn't adopted that feature yet. I wish they did as I could probably completely discontinue oral meds for breakthrough if I had that option. They prescribed generic Norco that's equivalent to Vicodin with less opiate to take up to twice a day as needed. I can get along pretty well with that.

My next challenge to have is knee surgery next Friday but it should be quick and simple using laparoscopy to repair what they believe is a torn meniscus. I had the same problem in my other knee several years ago and it was fixed with fast recovery.

Of course, I will be taking Vicodin for pain for a few days after that but maybe the pump will help make the post-operative less severe even though the pain will be in the knee and not the back.

I certainly hope the VA will consider providing you with this great form of pain control and you should certainly pursue it with them. However, keep in mind that this device and the associated surgery to implant it is extremely expensive and, knowing how the government works sometimes, they may balk at the idea. It's cheaper for them just to give you the oral meds. In fact, I doubt I could have afforded it myself if I were not elderly and covered under Medicare. They cover all of the costs including medication refills.

I'm not trying to discourage you but just pointing out the possibilities. I certainly hope I'm wrong and wish you the best. You certainly deserve the best possible pain management solution regardless of the cost.

Hi Bob!

Good luck with your knee surgery! My sister-in-law just had the same thing done and she is feeling great. I hope you have a quick recovery. Let us know how you are doing.

Jos

I just have a question for anyone in a similar situation. I had spinal fusion surgery L-3 through S-1 and still am experiencing leg pain on the left down the leg onto the top of the foot up to the big toe. (this is my second surgery, the first was a decompression of L4/5 in the80's) Would it be possible that the nerves were damaged to the point that this is something that is going to be permanent? This is the reason that I want to give the pain pump a try being that I have been on oral meds (morphine IR30,IR15,SR60 etc) and have become what was described as immune to the meds by an ortho DR. Would anyone think that the pain pump would help address the problem? I have been using a cane ever since the surgery and experince sharp pain on the left after every step taken and can't be standing of walking for more than 10 min at a time. Any suggestions or similarities? I am hoping that the VA will pick up the tab for this pump installation. I talked to a Vietnam Veteran with a pain pump installed and he said that it's the only thing that ever helped address his pain.

Hello Bob, I am scheduled to go into the hospital for a five day trial and hopeful implant this thursday [4-19-07]. I have had four disc operations - 1 in 1972, 1 in 1999, 2 in 2000. I got a staph infection from the last one and I have been in a lot of pain ever since. My main problem is degenerative disc disease according to the doctors although I was not in nearly as much pain before the infection. My worst disc problems [and pain] is in the lumbar area. My question is do they not place the catheter in the problem area? I also have a lot of pain in my legs and feet. Does this procedure sound like it could work well for my problems? I realize everybody is different and you are not a doctor but did you have any similar pain problems before your procedure? Thanks in advance, Tom

Your question is a good one but I think only a pain management specialist could answer it properly. I'm not a physician and can only express what I have learned through research and personal experience.

If you are truly "immune" to oral opiates, it means that your bodily system has adjusted to the medications to the point where they are no longer as effective for the pain control you require. I imagine you are experiencing unpleasant side effects such as constipation and fatigue.

The main purpose of the pump is to continually place a tiny fraction of the opiate directly into the spinal cord, close to the damaged area and upwards towards the brain stem. As compared to taking oral meds, which must be metabolized throughout the body, small amounts opiate applied via the spinal cord should provide equivalent pain relief at much lower doses.

In some cases, the pump will successfully control chronic pain with as little as 1/200th of same medication that would otherwise be taken orally.

Prior to implanting the pump, the standard procedure is to have a hospital type morphine pump apply medication to the spinal cord area using a temporarily inserted catheter in your back. The medication placed in the hospital pump is equivalent to what would be used in the implanted pump. After a day or two in the hospital, the patient can determine if he or she is getting noticeable pain relief. If so, he or she is a good candidate for a permanent pump implant.

Whether your particular condition will respond to intrathecally applied opiate medication won't be known until they do the test.

This is about all I can comment on for your situation and I certainly hope that the pre-implant test will provide profound plain relief for you and that you will be a candidate for the pump implant and which cost will be fully covered by the VA

Hi Tom,

My problems with disk degeneration are similar to yours. Most of my lumbar disks are either gone or very thin and one joint is self-fusing which I think is where most of my pain originates.

The pump catheter is normally placed in the thoracic region at T10-11 which is considerably higher in the spinal cord than the lumbar region where you and I have problems. (Actually, because of repeated catheter slippages, mine is located even higher in the T6-7 region).

The opiate medication provided by the pump does not have to be placed exactly in the area of pain-causing damage. The concept is to have the drug flow up and down in the spinal cord subachronoid region between the damaged area and the part of the brain that causes the pain to be experienced. In other words, the opiate medication is not applied just to the damaged area but the whole spinal cord.

I hope this answers your question.

Thanks Bob, that does answer that question. Maybe I could get some more information from you. I also have a problem with spasticity when trying to walk normally and with weakness in my right leg as well as numbness and urinary problems. How does the pump effect things besides pain. Since my problem began, my balance has not been the same. Does it affect any of these problems that I have mentioned? Is the pain feeling replaced with numbness or is it just gone. I realize that you may not be able to answer these questions but any reliable info is much appreciated. Thanks - Tom

Hi Tom,

I can't answer with any authority or experience because I don't have those conditions you mention. In general, the pump, because if its relatively low dosage of opiate medication, should have fewer side effects such as constipation, fatigue, etc.

I have noticed that, except for the fatigue, most of the side effects from the oral meds are no longer there and I recently found that my fatigue is being caused be thyroid problems for which I'm not taking medication.

How the pump will affect conditions other than chronic pain can't really be determined without doing the trial.

Hi Tom,

We seem to have a lot of the same back problems. I also have DDD with pain and weakness down my right leg, but my doctors are not willing to go in for surgery because -as you know- they don't always work, and can sometimes leave you even worse off. I would like to try this pump implant, but I get the feeling I'm going to need to have a few failed surgeries before they will consider it. I definitely hope that you get this pump, it sounds like it could really help your pain issues.

-Stefany

Hi Stefany,

Yes, many back surgeries, especially fusing deteriorated joints, eventually fail because of the stress it puts on the adjacent joints. I certainly hope you can convince someone to consider the pump instead of waiting for more surgeries. In any case, you should try to find a clinic or physician who specializes in pain management. Your regular doctor or surgeon may have to refer you to one. They are in the best position to determine if your problems can best be handled through better pain control.

Best wishes,
Bob