Chronic Pain

My Name is Charles.
I'm new to the message board but not so new to the back pain and the Morphine Pump.
I fractured 2 vertabrates, herniated 4 disc's and crushed 4 fauset joints L-5 to S1..(sorry for any spelling error's)
I did this in March of 94, since then I've had 13 back surgeries with lastest ones being a new morphine pump and the cage with the and 2 rods.
I had my first pump put in 1997.
Before the pump I was on liquid morphine, percocets and flexiril.
After I had the pump put in it seemed to be a life saver and it still is. It's the best thing that ever happen to me, I mean it got me out of bed and the wheel chair. I've had great luck with the pump it gave me my life back. Actually I shoud say the pump and a great doctor saved my life. Before I found him I went through 63 doctors and out of the 63 I found 2 that really cared, the other 61 could of cared less. I'm sure this is nothing new to you or anyone else who goes through severe pain.
I have had the pump for 10 years and I also take Methadone 10mg. 6x's a day to help with break through pain. I know we do alot of things were not supposed to do but we have to have some what of a life.
But like I said the pumped is a blessing, the only problem I'm having with the pump and it just started with in the last 3 to 4 months is it's getting kinked and shutting off on me and causing me to go through with drawls 2 to 3 times a month. My doctor says it's because I've lost alot of weight and when I'm stuck in bed for a period of time. There in the process of trying to correct it.
I think the pump would be great for you it has for me even though I'm going through this little detour..

quote:

Originally posted by usarmedforcesvet:
I had a multi-level fusion l/3-S/1 and now have 6 pedicle screws and two rods in my back which was done 4yrs ago and am still having a lot of pain issues and have gone through the medicine cabinet so to speak with the V.A. morphine, cyclobenzaprine etc. and along with pain running down the legs I am having mobility troubles. To make a long story short would it be possible to have a pump such as this applied even though I have had a fusion? I have really heard good things about it and am interested in having it implanted if possible. Thank you for your time.

Hi Charles,

Glad to hear that the pump is working so well for you despite some failures. I also had several failures, three of which were caused the catheter slipping out of he spinal cord and one unknown problem all of which resulted in withdrawal which, as you know, is most unpleasant. The last failure was apparently due to the feeder catheter kinking as the x-ray indicated that the spinal catheter was in its normal position. There might have been an air bubble that interrupted the medication flow.

The problem with trying to determine the cause of temporary failures is that the feeder catheter does not show up well on the x-ray unless they inject contract dye into the pump.

I hope you can avoid any further problems and thanks for posting.

Hello my name is Mike. I had the pump installed 2 months ago, and I visit my doctors office once a week for adjustments. I am wondering is it normal to experience a lot of bad days during this period. I will have one good day, and then many bad days in succession. I am still taking the oral meds during this process. Can anyone tell me how long the adjustment period will take, and if this experience is normal. I usually feel bad all morning and by late afternoon I am feeling a little better. But it starts all over the next morning feeling bad again. Right now I am at 4.0 mg/day on the morphine pump. I am sure it is different with every person, but at what number will I start to experience some real relief? That question may be difficult to answer. Any imput is appreciated.

quote:

Originally posted by Mike:
Hello my name is Mike. I had the pump installed 2 months ago, and I visit my doctors office once a week for adjustments. I am wondering is it normal to experience a lot of bad days during this period. I will have one good day, and then many bad days in succession. I am still taking the oral meds during this process. Can anyone tell me how long the adjustment period will take, and if this experience is normal. I usually feel bad all morning and by late afternoon I am feeling a little better. But it starts all over the next morning feeling bad again. Right now I am at 4.0 mg/day on the morphine pump. I am sure it is different with every person, but at what number will I start to experience some real relief? That question may be difficult to answer. Any imput is appreciated.

Hi Mike, I have only had the pump for 1 month and all of a sudden I am experiencing the same problems about mornings. At first I was doing great. I keep wondering if something is blocked but then I feel better that evening. If you find out a cause, please post it. Thanks

Hi Mike,

Sorry to learn that you are having problems with your pump. Mornings have always been the worst times for me as well but the pump resulted in considerable improvement in the pain level.

Are you sure the pump itself is set to supply 4 Mg./day of morphine? This seems like a very high level. It's a bit difficult to convert the pump's flow rate in millimeters to the equivalent of the oral dose measured in milligrams so it's likely that the 4 Mg./day is actually the equivalent of the oral dose you would be taking without the pump. That is not a particularly high level of morphine so your doctor may increase the dose more frequently until you see some real improvement in your pain level.

The pump can also be programmed for a "bolus" dosage whereby the medication delivery level is temporarily increased during certain hours of the day such as the early morning. You might want to inquire about this.

Because you are still taking oral morphine and having the pump adjusted so frequently, your physician is probably attempting to gradually move you completely from oral morphine to the pump. In other words, the pump will be supplying all of the morphine you need and the oral doses will be discontinued. You may still be given a prescription for a narcotic such as hydrocodone to be used for "break-through" when your pain level increases beyond the ability of the pump to control it.

Bear in mind that most of us cannot ever expect to be completely pain free even after the pump is adjusted for optimal medication delivery.

Hi Bob,

I think we touched on a subject that, at best, can be confusing. The print out from my pump states that my current amount of Morphine is 4.501 mg/day. I am sure that there is some correllation to what the concentration level is. For instance, under concentration it states 10.0 mg/mL

Of course, they will be changing my medication to something else because of edema in my ankles. I said I would take the swollen ankles over the back pain anyday! LOL

Have a wonderful weekend.

Connie

quote:

Originally posted by Bob Engelbardt:
Hi Mike,

Sorry to learn that you are having problems with your pump. Mornings have always been the worst times for me as well but the pump resulted in considerable improvement in the pain level.

Are you sure the pump itself is set to supply 4 Mg./day of morphine? This seems like a very high level. It's a bit difficult to convert the pump's flow rate in millimeters to the equivalent of the oral dose measured in milligrams so it's likely that the 4 Mg./day is actually the equivalent of the oral dose you would be taking without the pump. That is not a particularly high level of morphine so your doctor may increase the dose more frequently until you see some real improvement in your pain level.

The pump can also be programmed for a "bolus" dosage whereby the medication delivery level is temporarily increased during certain hours of the day such as the early morning. You might want to inquire about this.

Because you are still taking oral morphine and having the pump adjusted so frequently, your physician is probably attempting to gradually move you completely from oral morphine to the pump. In other words, the pump will be supplying all of the morphine you need and the oral doses will be discontinued. You may still be given a prescription for a narcotic such as hydrocodone to be used for "break-through" when your pain level increases beyond the ability of the pump to control it.

Bear in mind that most of us cannot ever expect to be completely pain free even after the pump is adjusted for optimal medication delivery.

Bob, thanks for the info. I checked my paperwork, and it states 4.000mg/day, 0.167mg/hr. Under concentration it states: 12.5 mg/ml. Don't know if I have the abilility for the bolus dosage you mentioned. I will check. I am not sure I understand the mg and ml ratio. I do know that the pump holds 18ML, and I have not had a refill yet. It has just been a little over 2 months since my surgery. Thanks for your input. This site has been very helpful.

Hello All!

This is my first post. I am so impressed with all of the information shared here!

I have read through many of the posts and have not seen this question answered regarding installation of the intrathecal pump. I am a small female with not a lot of room between my rib cage and abdomen! I am considering the pump, and after 7 years am certainly hoping it is the answer to my problem. However I am concerned over the large 3 inch device in my small midsection! Is there anyone out there that can offer some insight into how the pump affects general discomfort (not surgical pain)?


Thanks in advance for any response!
RisnShine

Hi RisnShine,

That's a good question that probably only a surgeon can answer. The newer version of the pump is larger than the previous one so that it can hold more medication before a refill is required; however, I believe they made it thicker rather than increasing the diameter. I think they can find a way to implant the pump in your case but it's certainly something to consider before proceeding.

Best wishes and good luck. Bob

Thanks Bob...I'm sure you are right. They have no problem with the implant for me; I was just wondering if anyone had actual experience. I do have a friend who used to be a nurse with Medtronic, so perhaps will call her as well.

Right now, I'm trying (for about the 9th time!) the new form of gabapentin, Lyrica. So far I've not been able to get to the minimum dosage recommended because of the side effects; dizzy, etc. I have been on the fentanyl patch for a total of 5 years (on 2 1/2, off 1, on 2 1/2), and just went off of that in June as the patch was wearing off and I chose not to increase the dose.

Thus, I'm reconsidering the pump that was offered to me 7 years ago (I was young then and afraid of the long-term risks)! I feel that it might be just the thing for me b/c of the low dose needed and I seem to be very sensitive.

So, that's my rambling. This forum is great and I plan to continue to monitor it.

If anyone is interested, there is a trial for the pump by Medtronic trying out gabapentin. You get everything for free!

Thanks again!

Hi Bob and RisnShine:

First of Bob, I want to add my cheers to you. What you have done with this blog is absolutely wonderful. Thank you again!

RisnShine, I am not thin but I am a female and just had the surgery about a month ago. I was not prepared (and quite shocked) for the amount of swelling after the surgery and how long it lasted, in fact I am still swollen. Seriously, I went ond purchased maternity tops, I would have bought the bottoms but could find any on my short trip out. That's the only negative that I am going to tell you. Vanity, Vanity, I complained about appearance but don't forget the magic.

Good Luck and God Bless
Connie

I forgot to add that I have been on the oral medication of Lyrica for about a year. There are a lot of possible side effects but most of them you will get used to.
when they switched me from Nurontin to Lyrica I was very skeptical but it works! I did not know that it is/will be available to put into the pump. What great news. Thanks

Thanks for the info Connie!

I had not thought of the swelling. I had abdominal surgery before, but the incisions were small, thus not much swelling. I've always thought of myself as not terribly vain, but alas, I believe I am after all!

I've decided I'll ask my Dr. if they can't use the old pumps that were smaller. I don't mind going back more often to get them filled and perhaps that will be a possibility. And yes, if I do the pump, I'll go with the trial of gabapentin first and will let you know how it goes.

Yes, I can definately see a difference in pain levels on the Lyrica and like you, I was VERY skeptical since I had tried so many other versions of the anti-seizure meds. Right now I'm finally at the dose they want, but also cannot walk, at least not in a straight line, cannot see well, and certainly cannot drive!!! But hopefully those side effects will decrease.

Thanks again for your valuable input!

Hi!
From what you describe so far, it sounds similar to what I have and I want to know if you have been given a diagnosis?
Thanks,

Conie

Hey Connie,

You asked about my diagnosis. I have scarring at the dorsal nerve root. This was caused by the back surgery I had in March 2000 to clean up the massive rupture at L4/L5. The surgeon, while he was in there, also cleaned up old scar tissue from my previous surgery at L5/S1 (a massive rupture too). Supposedly there was too much manipulation done of the nerve roots, thus causing the scarring.

My condition followed the typical case, with my getting a good amount of pain relief after the surgery, but unlike my first surgery the pain then began to get worse and worse. I had gone back to work but after 2 months I stopped again to try and allow meds to take effect. But the pain kept increasing and ultimately was worse than before the surgery!

As EMG done 6 months later confirmed the diagnosis. And once, we my PainDoc was doing an RF procedure, the needle actually bent while penetrating the scar tissue! So, guess the EMG was correct!

I've asked a thousand times if there is some way you can go back in and extract the scar tissue but every specialist has said it would likely make the problem worse.

I hope that helps. What have you been told?