Howdy, I've had a pump for 2 years now and the biggest change is the clearity it brings along with the relief. A pump is about the the size of a can of tuna is placed in your lower abdomin and a catheter runs around your side to your spine and is placed in the intrathecal space that can deliver morphine, Dilaudid, one of ther Fentanyls or the cone snail toxin Prialt. They are also used to deliver baclofen to MS patients to treat spasticity. There are a few other adjunct meds like clonidine and Marcaine that can be added to increase the effectiveness.
1/300 is very ballpark so don't get hung up on numbers. If you were taking 300 mgs of oral morphine and not getting relief, that conversion doesn't stand true for everyone. 1/300 would mean the pump would deliver 1mg of morphine per day or .0042 mgs per hour. You may find you're closer to the 1:50 or 1:100 ratio but the advantage is you're delivering opiates to your spine where you have exponentially more opiate receptors than anywhere else in your body. It doesn't circulate through your entire blood system and can provide more relief with less side effects and you can maintian a much clearer head.
Going from oral meds to IT meds was like going from a very gray place back to a world of full color. Intrathecal meds are not side effect free but you can likely reach a greater level of relief before you run into intolerable side effects. The biggest problem I have had with IT meds is UA retention .
The pump is refilled at 2-6 month intervals depending on which pump you use and the size of the internal resevoir and the flow rate and concetration of meds.
There are two types of pumps, battery operated and vaccum or pressure operated pumps. The biggest name in pumps is medtronics and they make both. You can go to the medtronics site and check out the different models and do some more reseacrch. The other manufacturer is Codman which I belive is now a division of Johnson and Johnsonn. The pumps with batteries are programable and can be set to deliver different rates at different times during the day. For example if you have more pain when you wake they can set the pump to increase from 5am to 9 am , if you have more pain at night it can be set to deliver a higher rate starting at whatever time you need. It gives you more control over the dose you recieve and allows you to manage more pan when you need it. The draw back is the batteries die somewhere between 3-5 years depending on the flow rate . When this happens they replace the pump and connect it to the existing catheter. The surgery itself is minor compared to any back surgery I have had..
The other option is a spinal cord stim which delivers electric current to specific nerves to drown out nerve pain.. Stims are more often used for nerve pain in your extremeties and pumps are used more frequently for actual spine pain or other types of somatic pain. Although some foks do have luck treating nerve pain. Unforurtunately nerve pain just doesn't repond as well to opiates as other types of pain. The decision is really up to you and your doc and a trial of either device should be performed prior to having an implant.
A psych eval is another portion of the trial process and trials can be done on the pump either in patient or out patient with an external pump and temp cath or they can simply do single bolus injections into the epidural or intrathecal space. The goal they shoot for a succesful trial and implant is 50% pain relief.
50% relief is just as personal as ones pain rating sysytem. A 5 to me may be a 3 to you and a 8 to someone else. 50 % relief for me means I can walk without assistance and help take care of the house and cooking where 50% to someone else may mean they can return to work. It's not a miracle cure, just another tool that hopefully allows greater relief without the severe side effects of oral meds.
Once you have a pump, you start the titration process all over again. That 300:1 conversion was an absolute joke for me. I started at 2mgs a day based on my previous oral morphne dose of 600 mgs, after 16 adjustmants in 6 months I was at 12 mgs a day and had about 50% of my pain relieved. I still have days where it feels like the pump has stopped and BT meds don't work . That's just due to the condition of my spine and the mechanical instablity that still exists after 3 failed back surgeries. 50% relief is the best I can achieve without feeling imparired which isn't something I'm willng to tolerate the rest of my life. All in all, It was a decision I would make a again but there are potential risks of infection, malfunction, catheter problems,etc. There really is no gaurentee, that's why doing a trial is so important and reporting honestly. IF your not getting 50% relief from a pump, it's likely not worth it.
As far as your oral dosage, it's really not that high, but some docs prefer these devices for the wrong reasons and some docs understand the limitations and capabilties of these devices. It is a big decision, that's why you do a trial and psych eval and talk with your PM doc about your expectations with either device.
Pumps and Stims can be removed and sometimes folks simply don't get the relief they hoped for or have complications that require removal or replacement. Nobody should sell you on the idea of these things being a gaurenteed cure all that will give you your life back. If your severaly disabled by your pain, they can be a great tool to improve the quality of your life. Hopefully you know what to expect after a fair trial and getting all your questions answered. A proper trial means discontinuing your orals to really see what the pump can do, However I've seen folks continue their meds during the trial and of course they report increased relief, but the idea is to see how you do without the LA orals meds.
Same for the SCS , it's just a tool to help mask nerve pain with altenating electrical stim to disrupt the pain signals, similar to what you might have experienced with a tens unit but much more effective.
Medtronics is a sponsor on this site and I have seen several direct links but it's falrly easy to find at www.medtronics.com
, then look into advanced pain therapies.The synchromded 11 is the programabale battery operated pump and the Isomed is the non batery operated pump that may last your entire life without having to change pumps out. Medtronics was very helpful when I was making my decision, I talked to the company and the local rep along with seveal patients.
The trial process is the most telling, not everyone responds well to opiates, if your pain s neuropathic it's even tougher to manage with opiates and some won't reach their target of 50% relief. Even though much smaller amounts are delivered, you can turn up a pump to the point where it would be quite impairing. It doesn't eleviate all side effects but hopefully can provide better pain relief with less side effects and without the hassle of oral meds.
Something that does sound a bit odd is your dose being so low and looking into a pump before trying all other options, the other things that is worrysome is your use of demerol for BT pain. Long term use of demi is flat out dangerous due to risk of toxic metabolites that build up. Demerol is the only opiate that has this risk and it makes no sense for any PM doc to use demi when he has other choices. Demi isn't used in pumps for this reason.
AS far as cosmetics, yup, you can see the pump once the intial swelling goes down and depending on your size it can be very noticable. If you have little body fat a pump looks like a tuna can slipped under the skin,. If you have some body fat, they can scoop a bit out so that it lies more flush to your skin. I have lost 25 lbs since my implant and my pump is much more noticable and it took my wife some time to get used to it without getting the willies when she touched it. But everyone is dfiffeent and they do make slimmer models with smaller resevoirs, however with a smaller resevoir comes more frequent refills.
Refills are no big deal just a sub Q injection directly into the pump itself, they remove the old juice and replace with new, I can get in and out in 5 minutes if they hit the fill port without having to dig around. This forum has a search feature and you can pull up previous conversations about pumps and scs while you wait for others with pumps and SCS to come along.
Everyones experience is a little different so it's important to talk to foks that have pumps, talk to other patients that your doc has done pumps on and ask if they are satisifid. All docs are different and docs can have mental limits on the dosage they will deliver via pump just like some docs have limits with oral meds. I've read about docs that won't go beyond X number of Mgs a day which may leave some patient with minimal pain control. I have also read about peope with pumps still using as much or more oral meds as before.
Everyone is different and every doc is diffeent in some way. Your satisfaction has alot to do with your expectations. Just because it's 300 times stronger or 100 times stronger, doesn't mean your going to get 300 times the dose. Instead of 300 mgs of oral morphine they would start at 1mg a day, delivered by pump. In theory that should provide the same relief as the oral dose. Due to less side effects you may be able to reach a dose that manages your pain better, but untill you do a trial you won't know if either device is right for you.
Take care, Dave