Hi Charlie, It's actually the protocol medtronics want docs to complete just like the trials. Medtronics also recomends using a plecebo dose for some of the trials to see if the patient responds to it and reports relief. I have actually met someone who's sister failed the trial based on a positive plecebo response.

I had to do the MMPI for the 4th time in 13 years in PM and then met with the psychologist for the eval. The MMPI is the "Minnisota multi phasic personality inventory" It's like 600 questions and the same question is asked in round about ways to check for honesty.

IF you go to medtronics site these pumps are listed under advanced pain control, as in the last line, most effective. It shouldn't be made available to anyone that asks, there are steps to get from square one to square 30 and if long acting meds, or non opiate methods work, it doesn't make sense to make a lifetime commitment, a lifetime arangenment with the doc and turn complete faith over to a doc to control your pain. It takes a lot of trust on both parts so you want to be sure you are confident in that your doc will continue to work at maximizing the pumps efficiancy. Efficiancy isn't just pain relief, it's return or increased function. They know they can deliver enough dope to knock anyone out with intrathecal meds, It's the most potent and effective delivery sytsem available. IV meds aren't squat compared to meds delivered to the spinal cord.

I've seen folks have the pump taken out because they didn't get relief, I think it's safe to assume that all the steps of screening may have prevented the pump from being implanted in the first place.

The pump is just a tool though, it's not the end all of pain unless your dying and then over sedation and needing a cath just to pee because you getting a high dose is worth doing if you end stage cancer, Having your pain relieved but not being able to return to work or leave forthe house for more than 2 hours because someone is willing to accept having to self cath to empty their bladder in order to stay as pain free as possible. The idea is to be as functional as possible.. If someone asociates a feeling that orals create with pain relief, they won't get that feeling from trial doses and may not report success.

A succesful trial is one that relieves 50% of your pain without the present oral meds. The right way to do it is discontinue meds and try the pump. Unfortunately not everyone folows the protocol and uses the pump in addition to oral meds, they will likely create a potential false positive indication.

Even though you feel your jumping through hoops, You halso have to interveiw the doc that is going to be managing the pump, You don't want somone that you aren't comfortable with managing it. If they didn't do their best with orals, they may have the same ideas with pumps. As long as they relieve some pain, that's the best you can get.

Personally 50% is the best I can do and that's on a good day, More medication may equate to more pain relief, but it also equates to more urinary retention, less labido, ED, more constipation, more drowsiness etc. Although there is no true limit to what a patient can get used to safely, there is a limit to the side effects a patient can tolerate and their doc manage.

Althou 50% doesn't sound great, I have a lot less side effects than the only opiate I could faford which was meth . My head is much clearer, I found enough relief and motivation to push myself harder than I ever had and it's paid off. I do pay for returning to work and everythig else i do, but I need to feel as useful as possible and need to be as fucntional as possible to do this.

More than likely your doc tests everyone with psych evals he considers for a pump. Following the manufacturer recomendations covers his hiney, and does weed a few people out that just want one because it's the best thing known. Why drive when you can fly first class? That's not really the best reason to have a pump implanted.

As far as the psych eval, just be honest, a CP patient that's reached the point they ned the most advanced pain system known ,that has never thought about suicide or shows no signs of depression, is trying too hard to give the answers they think the doc or test wants. That's how people screw up, Of course it's normal to be depressed, It's not normal to lie about it to get a pump though. The test is really quite funny, some of the questions they ask in the MMPI are very strange and make you wonder who would say yes to something like that.

Don't worry, ;)
Dave