Re: Morphin Enjection In Back
Hey Dave, The only reason I ca think of to give an intrathecal morphine injection is while doing the single bolus method for a pump trial. There are a number of ways to do the trial, single bolus, portable infusion pump with a temp cath placed in the IT space or in patient with a pump delivering meds to the intrathecal space. Believe i r not, tmedtronics "the manufacturer of the most used pump recomends doing a plecebo injection to rule out candidates that get pain relief because they think they should get pain relief. I've met people that failed the pump trial because they reported relief from saline.
If they used an actual opiate, one injection could easily fail if the dose isn't high enouugh or you simply don't respond as well to morphine as you would to dilaudid or one of the Fents. If they used .8 mgs you may have gotten relief at 2mgs or relief from the right amount of dilauidid or the right amount of Fentanyl or suffentanyl. The single bolus method doesn't allow a doc to make adjustments which is no different than the initial setting they use for the implant. They started my pump at 2mgs a day and I was miserable, but after 16 adjustments over 6 months I was getting significant relief at 12mgs a day. IF they happend to use substantially less than you require, you wouldn't notice a huge difference. It would be like getting one mg of morphine IM, not enough to make a difference.
Was his conversion from oral oxy to oral morphine to IT morphine acurate? That's hard to say because most literature has IT morphine between 50 and 100 times more potent than oral morphine. That's a pretty wide varaible and hard to say if the right conversion was used for you or the right dose was used to obtain relief if an opiate was actually used. With so many questions still unanswered, you may show up at your next apt and find you passed the initial phase of a pump trial by not reporting relief from a plecebo. Another part of the trial process recomended by medtroncs is a psych eval. The longer trials using portable pumps or in patient, allow the doc to make daily adjustments to your dose to allow the doc to find an actual working dose. The single bolus method is a one shot kind of deal unless you know he's willing to work on the dose and med with future injections, so I wouldn't be convinced a pump is out of the question by one blind injection.
My initial in patient trial was a complete failure due to a spinal fluid leak from placement of the cath. I ended up getting a blood patch on day 5 and waited 6 monhs before I would allow them to try a single bolus injection. But at least they had the info from my in patient trial and could start based on where they left off which by the 4th day, they had increased the dose 4 times that of the starting dose they calculated. They adjusted the dose a little more and the bolus injection was a success.
What you have been through so far really isn't enough info to predict whether a pump would work or not. If that's the only chance your doc is giving it, you may want to keep the option open in the back of your mind should you ever want to try again with a different doc that uses a different method if he's completely ruling out the possiblity based on one injection.
Good luck, Dave