Chronic Pain

Since my pain specialist was the one who did all the other procedures, i.e. injections, discogram, etc. he will also do the implant. My brother is having surgery next week on his lower back and I am trying to talk him out of it and to go for the pump instead.

Hi Cheddar,

Back surgery has a poor success record compared to other surgeries. That doesn't mean he shouldn't have it but it often results in a return of chronic pain within a year or two depending on the type of surgery and the skill of the surgeon performing it.

Bob

Hi Cheddar,
I do know of 1 of my friends that had a fusion done nearly 10 years ago, and she has never had a problem since. Also, my mother had neck surgery (fusion) 17 years ago and she has done fine since, she suffers from arthritis, but the surgery did the trick. The only medicine that she has to take is Mobic daily. And to be quite honest, speaking for your brother, you have to have the diagnosis of Failed Back Syndrome to be eligble for the pump. It is true that a whole lot of people who have had back surgery have had little or no success, or like Bob wrote, the problems come back in 1 to 2 years.
I do know for a fact that you have to meet all of the criteria to even have the pump implanted.
Good luck to you and to your brother both.
Sheila

Fusion surgeries are much more successful the less number of vertebrae fused. The L3-S fusion is not much better than a 50-50 deal. Also, the higher up the spine the fusion is, the better chance of success. Cervical fusions generally very successful, even 3 or 4 levels.

Hi Chet,

I fully agree with your post. I had three cervical laminectomies that were successful in relieving chronic neck pain and one lumbar surgery to to fix a herniated disk that did not relieve the chronic back pain. My pain is the apparently result of one joint self-fusing in a crooked fashion. Joint fusion performed by a surgeon will be clean and in a straight line but the body isn't always that neat when it self-fuses a joint.

Bob

Has anyone had multiple locations connected with the pump? My doctor had said I could have a connection to my neck and one to my lower back, but I am not sure how the programming would work or the effectiveness to stop the pain in 2 locations.

Hi Cheddar,
It sounds to me like you have a very good doctor taking care of you and he is willing to address your pain adequately. I am sure that he/she will know what he/she is doing. The programming to get it to a comfortable level just takes a while. I know that it did with me. I haven't heard of this before, but then again, this surgery isn't performed much at all in the region that I live in. Unfortunately, people suffer horribly from pain and the doctors around here see everyone as a pain med seeker. It is so sad. This is the reason that I chose to travel nearly 2 hours away for my pain needs. I honestly wish that people in my area could have pain managment. A whole lot of people where I live, are extremely poor and can't even afford the gas money to go for the proper treatment of pain, so therefore, they end up in the ER, and that is a red flag to all of the doctors of a pain med seeker. I am praying that someone will open a pain management facility in my area. I am so fortunate and I thank God for that.
I wish you well with the upcoming implant. And keep asking questions, that is what this forum is for and this is the reason that Bob has been such a blessing to all of us.
By the way Bob, Aloha to you. I am considering moving to Hawaii due to the weather where I am from. I live in Pennsylvania and our tricky weather adds to my pain. And thank you for caring enough to even keep this post going. Blessings to you.
God Bless,
Sheila

Thanks, Sheila, for your kind words. I agree with you completely.

Although we have a good pain clinic here, the doctor did not prescribe the strength of oral medication that I once needed when the pump system was not working properly (for reasons which were never determined).

To get any pain relief, I had to take at least 1 1/2 tablets every 6-8 hours instead of the 1 tablet twice a day that he prescribed. Of course, I soon ran out of the medication and when I went back to get more, the doctor literally bawled me out and was very unkind. I felt like being treated as a kid who stole cookies from the cookie jar (although I'm 78 and don't eat a lot of cookies).

I could not convince him that his prescribed dose would not work but just a 1/2 tablet additional amount was effective. He still became belligerent with me and not understanding that I really required a stronger dose. I explained that I hate taking the medication because of the side effects.

He remained unsympathetic and gave me another prescription with the same strength. (5 Mg. oxycodone instead of 7.5 Mg.).

Fortunately, the pump system started to be effective again and I didn't need to take any oral medication since that visit so I have plenty on hand if I need it again in the future.

I've been going to this clinic for many years and they know I'm not a drug seeker and that I have never gotten high on anything they've prescribed even when I was taking large doses of oral opioids before the pump was implanted.

The doctor should have realized that my pain level required a small increase over what he prescribed and he should have been sympathetic instead of belligerent. He's not the one with the pain so how can he tell me what I needed especially when it was such a small increase over the minimum strength he prescribed?

I'm posting all of this to illustrate that even pain clinics can be unsympathetic to people with chronic pain so I really feel sorry for those patients whose physicians refuse to provide any pain medication to ease their suffering.

The current FDA plans to further regulate opioid drugs and make them even more difficult to obtain will result in this situation becoming even worse. It's all because of the many people who obtain these medications illegally and use them for recreational purposes. Unfortunately, we may all have to endure discomfort and debilitating conditions caused by chronic pain because of those illegal users. It seems very unfair!

Hi Cheddar,

The pump continually injects a small amount of opioid medication directly into the spinal cord where it circulates in the spinal fluid between the base of the brain and the lower back. Nerves from the back and neck are contained in the spinal column and the pain mitigating medication bathes these nerves and reduces the pain.

Most of what I've read about the pump relate to chronic back pain and I haven't seen articles about its effect on neck pain. Maybe others in this forum will comment.

Hi Bob,
While reading your post, I became more and more angry for you. Is there any way at all that you can switch Pain Medicine Doctors, yet keep the Physician that you have now for your pump issues? How unfair to you, just how unfair!!!! This is what my Neurosugeon has done for me. I go to him concerning the pump implant (when it is implanted back in), yet he referred me out to an Avanced Pain Medical doctor, which, by the way I am nervous about because I am not sure if he will be one of those kind of doctors that has that underlying prejudicial issues concerning pain meds, so I have been in prayer and, of course, nervous about.
Just thinking about this Doctor having you in tears, really upsets me (I'm a redhead from birth so I do have a temper, which definitely doesn't compliment me referring to myself as a Christian). I am going to begin praying for you again Bob. I hope this doesn't offend you and of course, as a Christian, I have my own beliefs that when we are used to "serve" others, the "enemy", attacks us in some sort of way so that we will give up, lose sympathy for others and shut us down so that we will no longer be that vessel that God uses. I won't apologize for my beliefs, but I have seen it so many times Bob and I am going to pray for protection for you from attack. If anyone out there reading this is offended, then I don't know what to write, but Bob, I am going to begin praying for you again. I apologize that I stopped praying for you, because it seemed that you got better for some time. Whatever you do, don't give up on pain control and don't stop sharing your experience with the Intrathecal Narcotic Pump. No matter how hard that it may become, don't stop, that is exactly why this is PROBABLY happening to you, but of course, it could just be that he (the doctor) is being nasty, but it seems strange to me, that once that you started helping people by researching and giving of your time, that your doctor has lost his sympathy. SHAME ON HIM FOR TRYING TO SHAME A MAN WHO HELPS PEOPLE, AND SCOLDING YOU AS THOUGH YOU WERE A CHILD!!!!! It upsets me so much, that I can not allow it to. If I become bitter, then my prayers will be hindered and Bob, you need them. So, I will be down on my knees for you and that doctor both. I will pray that God will move on his heart, mind and spirit and show compassion upon you.
I received bad news today. My Neurosurgeon's nurse told me that my Neurosurgeon isn't going to do the next implant for at least a whole year. The last time it was only 5 months, but I am just going to have to accept it and rely on Grace because after another doctor has touched you concerning the pump, there aren't other doctors out there who will touch me. It's going to be a long year Bob. I haven't heard of what the FDA is going to do or about their new rules and regulations. It is such a shame that people like you and I have to pay for people who have abused the pain control system. Would you please give me a website to go onto? I will contact the Representatives of our state. As a 40 year old woman (fairly young), the only physical problem that I have that is disabling to me, is just the pain, that is it.
You'll be in my prayers Bob and hang in there and don't give up. I am sure things will change for you in a short time.
Take Care and God Bless,
Sheila

Hi Sheila,

Thanks for your comments and prayers. Actually, my post may have made the situation sound worse than it really was. The doctor is normally pleasant but lacks the warmth I find in other physicians. That was the only incident where there was an actual confrontation between myself and him. Normally, when I go to that clinic, I see his nurse practitioner who is a pleasant woman with whom I can comfortably converse.

There is no other pain clinic here that I'm aware of and, in any case, most physicians will refer the patient back to the doctor who originally implanted the pump and is servicing it.

I'm sorry to hear that you have to wait for a year for your pump. Unless I missed something, I don't recall the reason being explained in your post.

As for the FDA matter, here's a website with information:

http://www.healthcentral.com/c.../medications?ic=6042

You can also send comments to the FDA on their form. Information and instructions can be found here:

http://www.painfoundation.org/

I hope this information will be useful for you. I sent in my comments to the FDA last week.

Aloha,
Bob

Hi Bob,
I guess I don't understand either aobut the amount of time that this procedure will be performed. But good news, I can still go to school and get the ball rolling after I have the pump.
I guess that I did misunderstand about you seeing the doctor. It only made me upset because you actually help people and are informative for those of us who have many questions and are nervous. You are informative and this is what we all need. It makes it all so hard when you don't have the facts and to be honest, most doctors honestly don't have time to be informative as much as we need to be. As I have wrote before, this particular post is a blessing for people, such as myself. I don't know if you knew this or not, but I actually googled with questions concerning the pump, and your post comes up. So, many are touched by all of the information.
I will still pray for you Bob. Just reading that your doctor treated you this way upset me and was very unfair to you at that particualr visit. Maybe it was only one visit, but people who give of themselves, need prayer. Just my belief....what can it hurt?
Good Luck Bob and God Bless,
Aloha,
Sheila
P.S. If you do pray, please do so for my appt. July 1st with my new pain specialist. Bob, I am not letting this hold me back from going to college for nursing. At least I will have the pump when I do get my license and I will be ready to get to work and out of the system (SSD). This will make me feel so much better to be able to help others. You never know, I am still young enough and intelligent enough to go on to become a Physician Assistant and possibly pain doctor. There is scripture that states, "All things work together for the good of those who are called children of God" and I believe this. Something wonderful can come out of a bad situation

Hi Sheila,

If you are asking about the time it takes for getting the pump implanted and then adjusted for optimum pain control, I can respond to that.

The first procedure is an overnight hospital stay where they will simulate the pump using a standard hospital morphine pump that is normally used for pain management in post- operative patients. They will place a temporary catheter from the pump into your spinal cord and adjust the dose to be similar to what the pump will infuse. If you get relief from your pain, then you are a candidate for the pump.

Some clinics will also require a psychological screening before they consider one eligible for the pump. This is because many patients have other problems that they believe will be relieved by the pump. As we know, the pump only treats chronic physical pain and not other afflictions, some of which can be psychologically based. People who are severely depressed or have other such problems will probably be rejected, at least initially.

After a successful hospital trial, implanting of the pump can be a hospital out-patient procedure. The pump is placed in the abdomen and a feeder catheter is routed to the spine where it connects to another catheter that's inserted into the spinal cord and raised to the thoracic region which is about half-way up.

The surgery requires three incisions - one for implanting the pump, one small one on the side to aid in routing the feeder catheter to the back and another small one in the back for inserting the spinal catheter and connecting it to the feeder catheter.

While some anesthesiologists will perform the entire surgery, I think it's better to have a neurosurgeon handle the spinal portion as I had two catheter slippages that were finally corrected by a neurosurgeon who performed the last revision.

After the pump is implanted, it may take a number of clinic visits over several weeks to get it adjusted for optimum pain control as they will initially set it for a relatively small dose of medication. They generally limit adjustments of medication dosage to 10% in either direction until the desired effect is achieved.

The pump will last about 6 years at which time the battery will fail and the entire unit must be replaced. The pump will sound a warning beep when the battery is low or there are other problems. Generally, the pump is very reliable.

You can have MRIs, X-rays and other medical procedures with the pump implanted without causing any problems. You will beep the airport security machines like crazy when you travel but they can easily feel the pump when they do their pat-down.

I do hope you can have the pump implanted soon so you can go ahead with your career plans under good chronic pain control. At age 78, I'm now retired and I didn't start to have chronic pain until I was in my 50s when oral medications were the only solution to pain control.

From reading your posts, I can tell that you will make an excellent nurse, doctor or other position in the health field. I know your patients will be treated with compassion which is lacking for many these days.

Aloha,
Bob

Bob
what symptoms does one have when the intrathecal morphine pump line leaks. i currently have been experiencing horrible stinging pain near where i think the line is fed into my spine. the Dr. thinks it is muscle spasms but i wonder. i have had my pump about a year and half. i think it is the most wonderful thing ever invented. but early morning pain is hell. 10 spinal surgeries are not fun and i will not have any more as long as i can stand it. i am new to this discussion thing so bear with me all. thanks everybody

Hi Dan,

Welcome to this forum. Your's is the first question of this nature and I can somewhat relate to it but I haven't mentioned it previously in any of my many posts.

I also seem to have a leak in the area where the catheter enters the spinal cord which started some months ago. This results in what's called a seroma and it manifests itself as a hard, round lump about an inch or more in diameter. It doesn't cause me to have any pain and it comes and goes according to what position I'm in.

When I first noticed it, the pain doctor said to put pressure on it with a pressure bandage. This seemed to reduce the size of the seroma. I now use a belt that I keep on at night and sometimes during the day to maintain the area under pressure.

If I'm sitting in a chair with a solid backrest, it diminishes in size but if I do a lot of bending over, it returns as a hard lump. They said the clinic has several patients with this problem and there was nothing they could do other than instruct the patients to use pressure on the seroma. They didn't think it was serious and I've not noticed any change in my pain level or any particular problem since this started.

Since the pump is only producing a tiny amount of medication, the liquid in the seroma must be the result of spinal fluid leakage. For some people, this could result in a headache which normally occurs after a spinal tap where they aspirate a much larger amount of liquid. I've never experienced a headache or any other symptom from my seroma. I certainly do not notice any stinging pain in that area so maybe your doctor is correct in his opinion that it's a muscle spasm.

Please let us know if there is a lump or swelling in that area which will determine whether or not you have a seroma.

As for morning pain, I have it, too, but not so severe so I find that two extra-strength Tylenol or its generic (650 Mg.) tablets will relieve the pain almost completely. I sometimes take another dose near the end of the day depending on my physical activities. One should not exceed 4,000 Mg. a day if the medication is taken daily for a week or two or 2,000 Mg. per day if it's taken daily over a long period of time because of potential liver damage.

I agree with you that the pump is a wonderful device that's helped me return to a more normal life with little or no chronic back pain and which totally eliminated the need to ingest oral narcotics with their unpleasant side effects (mainly constipation).

Please feel free to post especially if you find the cause of the stinging and whether or not you have a seroma caused by spinal fluid leakage at the point where the catheter enters the spine.

Best wishes,
Bob