Shoreline

Hi Wannabe, I think the point Memere was making was that althogh you have been dealing with this for a long time and it's a life long problem that requires continued care. I haven't read that you have been exposed to the doses and types of pain meds, specifically opiates to know if you couldn't be helped by an oral opiate.

The pump is going to deliever opiates and perhaps something like baclofen, but the big string of anti inflamatories to combat RA are still going to be needed, so it's not like the pump is replacing any of those meds. Ultram is hardly an agressive way to manage disabling pain and jumping from Ultram to a pump is like sending your 12 year old son that plays football well off to the NFL because he has potential.

I understand the need to control inflamation with steroids and anti inflamatories and then the meds to manage the side effects from those meds, but those are nothing to be ashamed of. You have RA and other than going to the new class of chemo meds they are using to fight RA the pump is designed to deliever doses and strengths of opiates medication you simply can't tolerate or reach orally. You have exponentially more opiate receptors in your spine, so deliveryving 1/100 the amount of opiate to the spine is a good idea in theory, but if your not presently taking opiates, why would a doc be eager to go staright to a internal pump to deliver something you can take orally.

A Rhuemys' discomfort with prescribing oral pain meds isn't the greatest reason in the world to have a pump implanted, I'm not saying it may not work and be very effective but why have surgery and take the risks of surgery if an oral pain med would work and you tolerate the side effects. You don't know if your doc is unwilling to try.

Pumps can be mismanaged or set too low just like oral doses can be too low, If your doc isn't going to be agressive at managing your pain with a pump because he/she still has the same phobias that prevent them from prescribing oral pain meds. It may be alot of trouble time and money to end up with a pump that isn't set to deliever enough pain medication to maximize the purpose you had the pump implanted. If the doc has some inumber in his head as to how many mgs a day you should need of morphine or any pain med he may never be willing to set the pump higher than some arbitrary number, maybe it's 1 mg a day, maybe 2 or maybe 6. But numbers don't gaurentee relief.

I have seen people with pumps that have to find other docs to take over their pump manamgement when they find out that the doc that talked them into implanting a pump never adjusts a pump above 2 mgs a day. Had they known the doc wasn't going to continue to adjust the dose to achieve max benefit, they probablyy never would have let that doc implant a pump.

Medtronics will give you a list of every doc in the area that is certified to implant their pumps, Knowing their are other docs in your are that do manage pumps is comforting but it's also a back door way to finding someone else to consult with.

I know if you came and saw my doc he certainly has the ability to prescribe prednisone and Rrelafen and when the subject of a pump comes up he would look at your history with oral opiates, if it's non existant, it's hard to sell an insurance company that this s the only way to manage your pain, Aside from selling the insurance company on the idea, he simply wouldn't go straight to a pump without trying all the orals first. He would need the data from the trial and error with orals to manage a pump efficiently anyway, which ones work best, what meds caused what side effects, what dose was working and how to convert that into an intrathecal dose of a med you responded well to orally.

Once you reach some type of ceiling as far as as side efects, cost, or abilty to function on oral opiates then he would consider a pump. So you have to wonder, is he only doing the pump so he can avoid prescribing orals or is he simply lookng at the options and concluding that because meds delivered by pump are 100 time more potent than orals why not go straight to the most efficient way to deliever meds, which isn't the best logic as far as managing pain.

I have seen miracles with oral meds and RA, One of my docs nurses was slowly being disabled by RA and she went through the PM clinic every patient has to go through before becomeing an out patient at the practice I go to, and she went from considering quitiing her job because it was too ddifficult to work with her arms so twisted by RA the palms of her hands were always facing outwards, to getting enough relief to use PT efectively and return to work. With the right dose of orals and the work she put into PT you couldn't tell there was a thing wrong with her by looking at her. Palms now face in and she can get through the day on the right dose of oral pain meds plus the common meds to control inflamation that any doc can prescribe safely.

I know you can't write your entire history, but have you ever tried an LA pain med like Oxycontin, LA morphine, Duragesic patches, Opana or methadone? Any long acting pain med at all that would be a good indicator opiates would help and since they help, using a pump makes sense. The only pain med i saw you mention was Ultram and if that's all you have been exposed to, why would a doc jump to a pump if any of the oral pain meds could be just as effective.

If you have any specific questions please ask, but my big question is why wouldn't they try orals before taking the risk of implanting a pump to basicaly do the same thing an oral med can do.
Take care, Dave