Chronic Pain

Hi Chet,

They generally implant the pump in the belly area where people have most of their fat accumulation and where there is the lowest possibility of damage from external trauma. In my case, it was pretty well hidden until I lost some belly fat for some unknown reason so now it protrudes and moves around a bit.

I use a belt or the waistband of my trousers or shorts to more or less keep it in place. The newer pumps have are larger to store more medication which reduces the refill periods but they may be more noticeable in very thin people for that reason.

I haven't heard of places other than the abdominal region for placing the pump but perhaps someone will post this information.

Bob

The Medtronic SynchroMed® II pump cones in a 40 ML and a 20 ML size, same diameter but different thickness. They say that the 40 ML works for most patients but that some require the 20 ml. Is that the one they're considering implanting in you, Chet? The Medtronic web site says it's only 0.78 in (19.5 mm) thick. Is the problem the thickness or the diameter? (I'm assuming thickness.)

Hi RJ,

I wasn't aware that the 20 Ml. pump was still available but that's good to know. Because I'm having some problems with the thing protruding due to loss of belly fat, I may opt for the smaller one when I get the current unit replaced in a couple of years. In my case, the thinner unit might be better.

A lot depends on how much medication is being used by the patient. The larger unit reduces the frequency of refill visits.

Thanks for the information,
Bob

I went to medtronic.com and found this page for healthcare professionals:

http://professional.medtronic....n/overview/index.htm

That's where they give the exact dimensions of the two pumps. I assume their site is up to date.

Not sure how to do this.. This site seems to have to most info I have found..
My Mom has had a morphine pain pump for 4 years now and has been experiencing nausea for several months now. But it has no rhyme or reason. Good for a few days then bad for a few. She has tried changing her diet on other things. She does travel from different altitudes and wonders if that may be the cause. Any one have any Ideas.. Thanks,
Karla

Hi Karla,

Thanks for posting on this site. I started this thread some time ago and we have many people posting their questions and experiences with the intrathecal morphine pump. We welcome your participation.

The fact that your mother has had the pump implanted for so many years, apparently without problems, it seems unlikely that it's the cause of the nausea unless there has been a change in the morphine dose caused by a catheter problem or something else that would make her experience what is one of the opioid withdrawal symptoms.

You didn't mention if her pain level changes when she's experiencing the nausea. Having had withdrawal myself on several occasions due to catheter slippages, I can ascertain that nausea is one of the major symptoms but the pain level also increases at the same time because of the lack of or reduction in the morphine reaching the spinal cord.

If she is only experiencing nausea with no change in pain control or other symptoms, it's unlikely that the pump system itself is the cause of or a contributor to the problem.

Altitude changes can cause the pump to slightly change the medication being infused but I have flown on numerous occasions and did not experience any such problems during those times.

Has she contacted her pain clinic or pain management physician regarding this? It would be worthwhile to get his or her opinion and also to check the pump's output to see if there has been any changes in its output since her last visit.

Also, please let us know if she experiences any changes in her pain level when the nausea is taking place. In addition, is she taking any oral opioids or other medications for breakthrough pain or to control any chronic pain that the pump is not properly handling?

Bob

I seem to be having trouble navagating my way around and place a posting in this blog, I have posted here twice and both times the posts ended up in other blogs. Could it be every time I register for a posting am I getting directed back to the Home page? I would appreciate any direction or advise as to what it is I am doing wrong?
Thank You in advance
Brad

Hi Brad,

The fact that I can read your post and reply to it means that you are doing it correctly. I don't know how you can end up on other threads but maybe I don't understand the problem.

In any case, you are on the thread entitled "Willing to share experience with intrathecal morphine pump implant" in the Healthcentral.com discussion forums for discussions on chronic pain.

If you are interested in making a comment or asking a question, please post again the same way you did it this time and someone will respond accordingly.

Bob

Hi Everyone,
My brother had his operation about 1 1/2 weeks ago and is in tremendous pain. He has about a 6 inch incision on his lower back, a 4 inch and a 2 inch on his side. Two of them are stapled, which only adds to the pain. He is not sure if it is worth all this pain yet. He did get a fungus infection on he head from all the medication he was on. Has anyone ever had this? I am going to see his doctor at the end of this month and will decide for either the operation or the implant. My question on the implant is does it releave the pain in the legs and buttox area or only in the back? The back alone would be great but everything else is an added bonus. Thanks,
Cheddar

Hi Cheddar,

I couldn't determine from your post the type of implant your brother received but the sizes of the incisions seem unusually large. Mine were not nearly that big except for the one in the abdomen where the pump was implanted.

As for your question about the type of pain that the pump is designed to control, there are two types of implants depending on the location of the chronic pain. If the pain originates in the back, an intrathecal pump will infuse small amounts of morphine or other opioid medications directly into the spinal cord. However, if the pain is in the legs, the physicians may implant a stimulator that's an entirely different device compared the pump.

The stimulator produces electrical impulses which impact the nerves and help to reduce the level of pain. I'm not personally familiar with stimulators other than a TENS (Transcutaneous Electrical Nerve Stimulator) unit that works in a similar way as the implanted devices but is entirely external.

Before I had the pump implanted, the chronic pain sometimes interfered with my sleeping. I used the TENS unit to provide temporary relief. The device simply masks the pain by producing modulated electrical impulses transmitted by means of conductive patches held against the skin with a sticky substance. The generator is a little smaller in size than a cigarette pack with wires connecting to the skin patches. The user can adjust pulse width and rate of the electrical pulses.

Of course, an implanted stimulator will not involve any external wires or patches and the generator itself is implanted similar to the pump.

I hope this helps answer your question. Please post any additional ones you may have as other posters, who are using an implanted stimulator, may have more information.

Bob

Hi Cheddar,
I do know that with the pump, it helped only with the pain in my back. You also asked if anyone else had as much pain as your brother is having after having the implant. And I can only speak for myself, but it is worth every bit of it. Like your brother, I also had unusually large incisions.
I completely understand the pain that your brother is suffering with right now. I was also in a whole lot of pain due to incisional pain. But I was better within a week. When I woke up from the implant surgery, I had no back pain at all because my Neurosurgeon programmed my pump for a pretty large bolus dose. It takes a little while to get the rate of medication delivered directly to the spine but all in all, it was worth it for me. I was taking a constant release Morphine oral medication(Avinza) before the pump was implanted, and the pump provided much more significant pain relief than the oral meds did.
In the end, in my opinion, the pump is worth it.
I had to have the pump removed in June due to a severe infection because of a tear in my skin, right on my belly where the pump was. I am on a large dose of a new Dilaudid Extended Release pain medication, Opana ER 30 mg, and the medicine that I am on now doesn't even compare to the pain relief that I received from the pump.
I hope that your brother will be feeling better soon.
Take Care,
Sheila

Aloha Bob and to everyone else who frequents this post,
The Intrathecal Narcotic Pump is going to be reinserted very soon, probably the 1st week of August. I have all of my pre op done July 31st. My Neurosurgeon is worried about my blood pressure because I keep ending up in the hospital due to it being so high because of severe pain (level 9 or 10). He already consulted with my insurance company and they are willing to authorize this procedure for me because I am costing them a bundle in hospital stays and with meds as well. My meds alone are $1,477.00 a month.
This time, my Neurosurgeon is going to have a plastic surgeon to assist with the surgery. There is something wrong with my skin because it keeps tearing, forms a hole and then infection sets in. So to bypass all of that, he is bringing in one of the best plastic surgeons that there is, so I feel very confident that this pump will stay in. I have already had 2 implanted and 2 taken out. When I have the pump, my pain level is only a 3 or 4. I have double concentrated Dilaudid at a low rate and I also take 3 Lortab 7.5 along with exercise on my treadmill 3 times a day and I do excellent.
To everyone out there, please keep me in your prayers and in your thoughts. I'm not nervous, I just need the blessing of God with this whole thing. I have 2 wonderful children who are the ages of 17 and 10 and also a loving husband, not to mention a good family.
Take care all and please keep me in your thoughts and prayers. I will post back after my surgery.
God Bless
Sheila

Hi Sheila,

Glad to learn of the good news. Best wishes for a successful surgery and a renewal of good pain management after the pump system is re-installed. It's a good idea to have the plastic surgeon assist if you have skin healing problems. A neurosurgeon in attendance would also be good but if you haven't had spinal catheter slippage problems before, it probably isn't necessary.

Aloha,
Bob

Hey, Bob:

I am writing this sitting in the waiting room of a hospital while my wife is undergoing the procedure to have the pump implanted.

We are both hopeful for real benefits from this device, as she has experienced chronic, often severe pain related to metastatic breast cancer, and has been dealing with a significant loss of quality of life due to the side effects of her pain medications.

I have just read the Wikipedia page on the pump, and am alarmed. How often to implant recipients experience some of the serious problems outlined there?

That page is at:

http://en.wikipedia.org/wiki/Intrathecal_pump

I would sincerely like to hear feedback. Thanks in advance!

Hello all, it has been a while since I have posted. Just wanted to give a quick update. I found a pain clinic in Lexington that does the implants and is highly recommended. I met with the first doctor who said I was definitely a candidate for the pump. I go the 13th for the psychological exam, and then meet in early september with the doctor who takes care of the implants. I am guessing they will then schedule the trial, which I am very nervous about. I was also told that they have a neurosurgeon to install the pump. Hopefully it will all work out soon, hope everyone is finding ways to manage with the pain. I will keep you posted on the progress.