Morphine Pump Advice Please help "BAD HEADACHES" - Pain Management Message Board

coastline · 10-01-2006, 12:55 AM

I had a Codman 3000 morphine pump implanted Dec. 2004. Degenerative Disk Disease, L5/S1 Fusion became tolerant to opiates so went with the pump after 5 years of Pills that eventually wouldn't give me any relief and I felt as if I was having a heart attack from the pain causing elevated blood pressure. I have had a recent increase (twice in the last 80 days) in the Morphine, Clonadine and the muscle relaxer that is in the refill. The doctor orders in my pump coctail from a supplier and it takes him maybe 4 minutes total to remove left over Medicine, refill and give me a bolice and put a bandade on the spot. Even after an increase or two over the past 80 days my pain level is terrible and now I am getting TERRIBLE HEADACHES which I never had until very recently and I don't or can't understand why the HEADACHES. I wouldn't think the headaches would be a side effect of the increase of my pump meds. I have a doctor that runs around like a Rooster with his head cut off, he doesn't have time to even discuss how I feel, he just told me he had to hurry and fill my pump as he had to pick up his kids, so I didn't even get the opportunity to discuss this with him. It amazes me how one doctor can support/maintain every patient in a medical facility that has about 15 or more employess in a 6000 squarefoot surgical center/PM office.His time is stretched beyond belief and I have to drive 150 miles one way as he is the only doctor in my area. WHY THE SEVERE HEADACHES each and every day??????

donaeis · 10-01-2006, 06:16 AM

It is theoretically possible for the spinal catheter to migrate out of the spinal fluid, leaving a hole that would create headaches. If the headaches are positional (get much better when lying down but are horrible when sitting or standing), then this should be considered by your pain doc especially in light of the lack of pain control. It could also be the medication itself...sometimes with higher concentrations of morphine, people get headaches. Check your blood pressure as that can lead to headaches. Otherwise, may not be related at all to the pump...

Shoreline · 10-01-2006, 08:38 AM

Hi Coastline, Donna is right, a spinal fluid leak either from the cath pulling out or simply moving to much could cause fluid leakage around the cath or through the hole the cath was in, but like she described spinal headaches are classic in presentation. They increase when your standing or walking and are relieved by laying down, not completely relieved but laying down is the only thing you can do other than throw up if you move about too much.

The other posibility is that morphine is causing the headache. It is a side effect because morphine increases inner cranial pressure. You may have reached the max amount of morphine you can tolerate. If your simply getting no relief, they should check the pump to make sure the cath is still in place and the resevoir isn't leaking etc. If the meds aren't being delivered into the intrathecal space they won't be anywhere near as effective.

You may have to make an apt at time other than when a refill or procedure is scheduled. Procedure days can get very hectic and they don't like to do medical evals at the time of refill, I also have a pump although it's a medtronic, at the clinic I go to they don't even refill oral meds at pump refill apts. We have apts monthly for folow up and dea apts which are nothing more than pill counts, refill date checks and picking up a script. Again, they don't do much at the DEA apts because they don't allot the time needed to do a comprehensive follow up. If you need a change you need to schedule a follow up with a doc or NP to relay info to the doc managing your pump. It sounds strange, but it doesn't sound unusual since I've been playing by the same rules for 6 years now. Procedres and refills are scheduled on the procedure side of the clinic and that's all they do at that apt. If you need an increase, decrease, change or anything that has to be relayed to your pump doc we have to do that at a follow up apt.

If it is the morphine causing the headache, hopefully it's a side effect you can accomadate to, plain old tylenol and motrin still work on headaches even if your recieving large amounts of opiates orally or through the pump. If it doesn't get better you may need to make an apt to discuss a med change to something like dilaudid or one of the fentanyls.

Good luck, Dave

charliecat31 · 10-01-2006, 01:05 PM

I have some input on the spinal fluid leak headache theory. I don't know if there are varying degrees of spinal fluid leak that could produce varying degrees of a spinal fluid headache, so I could be wrong here. But I have had a spinal fluid leak and believe me a headache from this is dibilitating.

I couldn't have gotten online to post a message about it if my life depended on it. My husband had to rent a van and put pillows in the back so I could lay down to get to my doctors office. So unless you can get a mild spinal headache from only a small amount of fluid leaking I would say you are not having this problem.

But you do still have a problem... Maybe you could call the office and ask to speak to one of the nurses and tell her/him what is going on. I know I often have better luck going that route than trying to call my doctor and talk to him over the phone. Or you could do like Shoreline suggested and make an office visit appoitment to talk to your doc. - either way you need to find out what is going on.

I think all doctors that fill pumps probably have a different way of dealing with other concerns during pump refills. I'm very fortunate that I get everything taken care of in one appointment - pump fill? check. RX refills? check. concerns? check. But I've also been with my doc for over 5 years and everyone in the staff knows me AND MY HUSBAND by our first names without a chart in site.

I hope you find some relief for the headaches very soon!

coastline · 10-01-2006, 04:16 PM

Thank you all so very much for your input and most of all your valuable knowledge as I always read Shoreline's answer as he is very knowledgeable because I have learned so much from his kind and easy to understand information that he has posted to this forum in the past. You are all a great asset to me, this forum, and I thank you from the bottom of my heart for your effort. I am fortunate enough that I do get my oral medication prescription wrote the day I go to the doc as they know I do not abuse my meds plus I live so far away, and we are on a first name basis as well. It is so nice to have that trust between the patient and the whole staff their, they are just so overwhelmed with patient's that the Doc just runs from one to the other. I will call the office on Monday and try to schedule an appointment to discuss this. I am sure they have a technique to check my pump and cathedar to ensure it is not leaking somewhere. I am on an extremely low dosage of Morphine, that is what my doctor told me and the headaches started when I requested a very small increase as I told him I really didn't want any side effects and up until they filled it this past month I hadn't been expieriencing the headaches. Thanks gang for the response and the valuable information. I truly appreciate each and everyone of you and the time that you took to give me your advice. God Bless