Shoreline

Hey Pat, the first step is to do a trial in which they shoot for a 50% reduction in pain. By no means is the pump a cure all for all pain. I presently have morphine in my pump and the old sychromed 1 system only has an 18ml resevoir, so at a moderate dose of morphine I'm only lasting 33 days at tops before each refill, you also have adjustments to make with any med they choose. I'm on adjustment 13 or 14 , can't remeber now how many times they have inched the flow rate up since June 3.

At the time I investigated what was new and coming out and found out about the sucnhromed 2. The newest version of the programmable battary operated pump. The advatage of the Synhromed pumps are that they are programabale and can deliver a higher flow rate in the am or pm , whenever your pain is at it's worst and when you would normally need BT meds. The new pump the S11 is what's beng implanted now and instead of a 18ml resevoir that I have the new one hads a 40 ml resevoir which can mean months between refills. Another thing that determines how often you need refills is the flow rate and strength of med. Morphine is the wekest opiate mg :mg they can use so simply by addswitiching to something like Dilaudid or one of the fentanyls this could doyublt the time between refills or even extend it longer. The disadvantage of the programabale battary operated pump is the battary dies and the entire pump unit needs tobe replaced when this happens , somewhere btween 3-6 years, again depending on the flow rate.

Medtroncs came oput with a versoion of the Arrow pump called the Isomed, It works off of a vacum principle and doesn't use bateries. The amount and delivered is based solely on the cmcentration of the meds placed in them. Which basically means insteasd of a click of a botton to increase th flow rate they have to increase the concentration of the meds because the Isomed and Arrow pump only deliver at one steady constant rate. So the only way to adjust the flow rate is with a stronger concentration of opiates. Refills are more expecnsive than simple telemetry adjustments and it takes time to find the right dose of IT meds and extremely important not to set your hopes so high, thinking it will relieve all your pain and promise a return to normallcy. That wopuldbe ideal but depending on your problem may not be possible even with the strongest meds at the highest rate.

I had the pump implanted because ZI reached igh doses of oral meds and ran into aa side effect wall that was just intolerable. My optons were limted without insurance to only methadone and the cheapest BT med I could find which is either MSIR or Dilauaid.

Althugh the pump has decreased my level of fdaily pain, I haven't got the increased function without addtional pain I was hoping for. But that'sdue to spine emchanics. I have failed fusions from L1-S1 with broken and toggliing hardware, no fusion at L5-S1 at all and some gaps all along the fusion. Even at night when the pump is delivering additional meds, the highest rate it';s presently set on. When I walk, the screws in my sacrum toggle, and slip in and out of the wholes that have deterioarted around the screws. S when a screw slips and crunches, which happens with almost every step I take, It's still hurts like helll.

So I bascally traded a better delivery suystem, no expensive LA meds for better pai relef as long as I remian sedentary. Once i start walking the grinding and crunching resumes and no amount of med is going to fix it. The last surgery was my 3rd failed surgery., and getting back on the surgical table to roll the dice and hope another attempt at fuusing is much more cmplicated than a virgin back that needs it's first surgery. For whatever reason I just don't fuse well. It may have been the way they tried to fuse me or it may simply be my physiology that has prevented fusions and proper union of bone which would have prebvented snapping 2 sets of hardware. The hardware n my now is failed and there just isn't anything around at the moment I can do to try to fix it.

My head is much clearer, I don't nod out from meds, I have less side effects, But i can't ay it's changed my life in the sense I can fnally return to work. I still have the same limitations but have better pan control. I tend to do more because I feel better in the day but pay dearly at nght for what I've done in the day.

I'm just one case. I know folks that have had great functinal improvement from the pump. It just depends on the stability of your problem, Is it going to continue to rogress and worsen or is your spine stable and your simply left with pain management as your only alternatve to have some quality of life.

Nornmally docs willmax you out on oral meds before goning to a pump. when you can't tolerate the side effects or can't get relef from orals, There are several ther opioids they can use in the pump. Aside from dilaudid, =you have the fentanyl family, Carfenbtanyl, Suffentanyl, Affentanyl and then adjusnt meds they canadd like bupivicicaine for numbing, baclofin for spasticity and clonidine to control the release of the calcim chamell blocker NK-1 which carries substance P which is a potent neuro inflamatory aget that you only see in chronnic pain patients. Cp is very differently chemically and physiologicaly than acute pain, a different part of you brain recieves acurte pain mesages than does chronic pain essages. Different neurtransmitters and the directions they flow are different with CP than acute pain.

There are several way to to the trial of the pump, One is in patient, they implant a temp cath into the intrathecal space and use a PCA machine to deliver meds, this can be adjusted a couple tmes a day and the stay is usually 3 days to adjust the meds and decreasse the oral meds. The second is outpatient with a portable pump, where you check into your clinic or docs office for adjustments and reports and the thirds is a single bolus injection into the Intrathecal space. They can do more than one trial or make adjustement to the Bolus injections if you don't hi the 50% mark.

Whhatever method of trial you use, if you decide to go through with it, the implant isn't a terrible op, nothng like back surgery, just some incision surgery and if you don't get an abdominal binder to hold it in place the first few months so it doesn't cause pain when it bounces around when you walk or dirve before it's comletely set in the pocket on it's own.

The level of relief everyone gets is going to be different, but anything better or ncluding a 50% reduction is considered a success. There is no magic conversion that gaurentees relief and adjustments are a part of the process and more expensive time of the implant procedure. Once you reach a level of relief tha's exceptable, with the newer pumpswith larger resevoirs you can extend refills out to as far as 6 months apart.

I hate to say I'm disappointed with the pump, But I understand it's not going to numb my spine when somthing shifts. Instability is a problem the pump can't manage and when my spine shifts it's like having no meds at all. It just a matter of laying down, getting things back in place and pressing on.

I resently had BUpivicaine removed from the pump due to urinary retention, It was replaced with Baclofin and it's taken about 3 weeks for al the bup to disperse and now I'm realizing how much the nimbing agent helped. Swithcing meds to a more potent med that would take less MGs per day would extend my refill dates but it's almost like starting over with the titration process. I would hate to need 14 adjustment to get the dilaudid dose right.

We have some other pumpsters, that have been able to return to hobbies like garedening and a more active lifestyle, and I am more active, I just pay for it more at night. I've been disabled since 99 and the LA meds and now the pump has been a god send, otherwise i would still be bed ridden.

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