Chronic Pain

Hi Bob, I've got a few more questions if you don't mind. I have been on 200 mg. of oxycodone for over a year and 160 mg. for 3 or 4 years before that with very dissappointing results. I go in thursday for the trial and in the last 2 weeks have cut down to 120 mg. [doc's orders]. I hav'nt had any side effects other than increased pain and a hard to describe "nervousness" type feeling. Does the morphine from the pump take care of any withdrawal symptoms or is it a matter of cutting back afterwards? Do you have a numb feeling where the pain was or is the pain just gone? Did you notice a difference immediately? How many times have you had the doseage adjusted? I have a lot of scar tissue as a result of several debridements because of an infection that Ive been told is the reason nerve block shots don't work for me. Do you know if that has any bering on how effective the pump will be? Does the amount of time that I've had problems have anything to do with how effective the pump will work? Also you previously spoke of an 'in-hospital simulation test' used to determine if the pump is viable for each patient or not. What is this test or procedure about? I realize that you can't answer every question but any info is appreciated. Also for Stephany - I would not have a back surgery except as a last resort. The 17 days I spent in the hospital battling the infection from the back surgery changed the amount of faith I had in the ability of doctors to fix a persons problems. Thanks - Tom

Hi Tom,

I will try to answer your individual questions based on my research and personal experience but, as I said before, I'm not a physician and my comments should be considered as opinions not based on formal medical training.

1. The pump will probably be filled with morphine or another opiate as selected by your physician. The reason your doctor is cutting back on your oxycodone is probably to give you a head start on withdrawal but, more important, to allow some increase in your pain level so that you can determine if the morphine pump test (see item 7 below) will be effective. The high levels of oral opiate you were taking could mask any relief that the morphine pump may provide during the trial.

2. I don't know if the morphine pump will handle withdrawal from oxycodone as they are different analgesic agents. I do know from experience that if the pump system fails, like the catheter slipping out in my case, or a highly improbable pump malfunction, you will experience withdrawal systems from whatever analgesic is in the pump. I keep some oral morphine handy in case of this to lessen the unpleasantness of withdrawal. I was told that catheter slippage and pump malfunctions are relatively uncommon.

3. I did not experience any "numbness" but just an immediate noticeable reduction in my chronic pain during the trial and after the pump was implanted. However, I was prescribed and still take hydrocodone once or twice a day for "breakthrough" pain depending on my physical activities.

4. After implantation, you will probably visit the pain clinic or physician every few weeks until they adjust the pump's dosage settings for optimum pain control. The pump is programmed externally with a small detector device that's held over the implanted pump by the patient. Because the amount of opiate delivered to the body is a very small fraction of the amount normally taken orally, they can make many upward dose adjustments before reaching an overdose level as could easily happen with oral opiates. If you are fortunate, you implanted pump will include a patient controlled device that permits you to increase the dosage slightly several times a day as needed to eliminate the need for taking oral "breakthrough" meds as I do because my clinic does not yet handle the self-administered adjustments to the pump.

5. I can't comment on if your scar tissue will have any bearing on the pump's effectiveness but I doubt it will because of the way the catheter is inserted directly into the spinal cord.

6. I don't think the amount of time you suffered with pain problems in the past has any effect on the how well the pump may control your chronic pain.

7. All potential pump recipients must have the in-hospital trial that places a temporary catheter into the spinal cord that's connected to a device that hospitals normally use to drip morphine into an IV line following surgeries. They adjust the opiate dose to simulate the pump and observe if the patient notices any pain relief over a day or so. If the test is successful, the patient is then a candidate for implantation of the pump and permanent catheter.

I hope this covered everything you requested. If I've missed anything, please let me know.

Regards,
Bob

Thanks for the info, Bob. It has been very helpful. I will be leaving to go to the hospital in a couple of hours and I will let you know how things went after I get home. Thanks again, Tom

quote:

Originally posted by Bob Engelbardt:
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.

Bob,

I am going to have the Medtronic implant within the next month. I was wondering if the implant has any limitations in what you can physically do, lifting, moving, normal activities, once it has healed. If you could let me know how long the healing time takes. I appreciate your input. thanks

Bob,
I Hope things went ok with your knee surgery last week. I'm sure you are recovering so when you feel up to it let us know how you are feeling!

Mike,

I know you addressed your post to Bob but since he had surgery last week he may take awhile to post. I had the pump put in in February so I can share my experience with you if that helps? I am getting back to normal and the pump itself hasn't limited my activities. I am still having pain so it is more from that. The adjusting takes a long time. Let me know if I can share anything else

thank you for responding. I appreciate any input. Has the pump helped with your original pain? I understand it takes awhile to adjust the medication itself. Do you feel at this point you made a good choice to have the pump?

Hi Mike and Jos33. I did have knee surgery and found that the pump does not seem to have any affect on controlling my post-surgical knee pain. I'm having to take some of my "breakthrough" meds (hydrocodone @ acetaminophen) to help with the knee pain. My back pain continues to be well controlled by the pump.

I believe most people who have the pump implanted will have to periodically return to the pain management physician to have the dose adjusted. They generally start out on a low dose and gradually increase it until the pain is mostly under control when the patient is performing normal physical activities. Breakthrough oral meds should be on hand for times when the pain becomes more severe because of activity or other reasons including emotional stress.

Patients should not delay taking the oral meds until the pain becomes severe because it will require a higher dosage to result in adequate control. If the patient has the self-controlled pump where he or she can cause a small but limited amount of additional medication to be applied as needed, this may preclude taking oral breakthrough meds but some people may need both.

Unfortunately, I can't control my pump so I'm unable to comment from experience.

The pump did not interfere with my knee surgery except that the anesthesiologist wanted to know how much morphine was being applied by the pump. Contrary to what one might expect, a person with the morphine pump may require more narcotic analgesic during surgery rather then less because the body becomes increasingly tolerant to opiates over time. I was surprised when the pain physician told me this.

I hope both of you are doing well and wish you a good weekend.

Bob

Hi Mike,

I certainly think it was a good choice and was the best method for controlling chronic back pain. Side effects are fewer (actually non-existent) compared to oral meds and the device is fully automatic so there's no need to remember when to take medication or how much. The most important step in preparing for a possible implant is the trial. If the trial does not reduce the chronic pain, then the pump won't be effective and they won't implant it.

Hello folks,new poster here.

Bob, and all,thank you VERY much for all your posts they are extremely valuable and I appreciate all the time you take.

A little about me. Im 46, male ,married with 3 grown kids, 2 grandsons.
I am an ex truck driver and now on SSD since 2/2003

Have severe arthritis, DDD (L4-L5 specifically), and vascular problems in lower leg. have had a total of 13 surgeries. 2 on back, 1 on left leg and 10 on both knees.

Have been on latest meds, Oxycodone ER (80mg twice day) and Hydromorphone ( 8mg, as needed for breakthru) for over a year now but they do VERY little anymore.

On 4/9 I went in for trial on the intrathecal pump...WOW!!!! Nearly 100% relief!! I felt like I could dance (never could before!LOL).This from a guy that was about ready to take a chain saw to his left leg above the knee to stop the pain!! Amazing!!
Thats the best Ive felt in 15 years and, Wife said it was the first time she'd seen me relaxed and up without a cane and really severe limp in 4 years!

I have been using a power wheelchair (because my shoulders have been affected by arhritis)to go most places as I cant stand, or walk for long due to the pain in the legs, knees and back and now MAYBE ,just MAYBE I wont need that thing!!

Yesterday I got news it was approved for implant!! I just had to share the news with someone!! I cant wait and I REALLY appreciate all the posts that have left me feeling very good about this. The DVD and book from Medtronic is OK.... but I wanted REAL people to tell me their experiences... THANKS!!


I just cant wait!! Ohhh...my pumop is the one that has the little palm pilot thing to give you a dose if you need it to do somehting unexpected.

I will have it done In Fort Wayne on next Thursday 5/3. I cant wait!


Ill let y'all know how it goes. I hope I can help folks by telling them my experience too as you all have done for me.


Thanks again,

Blu

This message has been edited. Last edited by: Blu,

Oh, also I wanted to address something mentioned above.

The sensation I experienced with the trial (mine was a 1 day for 2 hours thing) was this. At first a nice warm feeling in both feet then , and a kinda pre sleep tingling in both legs.
Im told this is the norm and what I can epxpect it to feel like when the real thing is done and working. its not unpleasantat all.

I also walk (like above, for no longer than about 5-10 mins) with a cane. It DID help with the weakness and spasticity I experience too!

Ohh...the scar tissue thing.I had a LOT of scar tissue form the previous back surgeries and they put the catherter right there where it was.
They had a VERY hard time due to the great amount of scar tissue getting it in there, and even bent the first needle and had to get bigger one, but eventually got it put in.

The relief and sensation mentioned above I noticed was in about 5 seconds. So...really fast.
I never knew how bad the pain and arthritis had gotten till it wasg one for a bit and the tial wore off. THIS is AMAZING!! I cant wait till Thursday!

The "palm pilot" thing will allow me to give myself a dose if needed up to 6 times a day they told me.

Hope this helps.

Blu

This message has been edited. Last edited by: Blu,

Blu,

How long between the trial and the actual surgery? I will have my trial soon. Thanks

Sorry, I did see you posted your dates. What I meant to ask is why is there so much space between the trial and the surgery?

Hi Mike!

Im on SSD, and Had to wait for Secure Horizons (Medicare) approval for payment is what the dr's office said.
That, and there is only 1 hospital (of the 4) in Fort Wayne that is a Medicare Hosp and my doctor only does surgeries there (I think) 2 days a month. They had originally hoped to get me in on April 19th (10 days after the trial) IF I was approved.

I go Monday for my pre surgical consult.

Do you know when your trial is? Will it be the several days test or the one like mine.

Just curious, and I really hope it works as well as mine did. If it does..you will be AMAZED!

Hi Blu,

Glad to hear that your trial went well. After the implant, you can look forward to a much more comfortable life where chronic pain is no longer something that you have to face every day. The initial pump dosage setting by your physician may be different from the trial so you need to be prepared for a number of adjustments before you reach an optimum setting.

I wish I had the patient control option that you and others were provided. The pain clinic I use doesn't provide that feature yet for some reason.

I recently had knee surgery which went OK but I'm having a lot of pain which the pump doesn't control. The pain clinic confirmed that the pump would not help with the knee pain so I'm back to taking oral meds and really not feeling very well. I guess I got a bit spoiled after so many months of chronic pain relief but it's returned now in a different area. Very disappointing!