Hey OIrchid, I'm back. LOL
I did forget to metnion that one of the most common uses of the pump is to deliver baclofen to MS patients, It simply isn't posible to take enough oral baclofen to be efective on MS however when delivered IT it becomes about 10 times more effective. Perhaps if you aproach the pump from it's most common use for MS, it wouldn't be such a great leap to add a little opiate and see what response you get.I can only imagne 20 years of radiculopothy but every doc has his own opinion regarding the use of opiates. . After my last 12 hour , 6 level fusion they sent me home with 5 mg percocet and had me off al opiates within 6 weeks.
There are some other tricks like using Nemanda, a potent NMDA blocking agent that has the same property that makes methadone so efective on nerve pain is available. I doubt there will be one method that falt out covers all your pain, but if you get 30% relief from opiates, 100 percent from lyrica, another 10% from adding nemanda, the combined effect is what you need to measure,, not a meds individual effect alone on the pain. As far as umps, the literatire does say for spine pain and nerve pain it just takes much more opiate to manage nerve pain and if it's been 20 years, MS may sound like a sound DX but if it's preventing you from having a reasonably recnt MRI or CT that may find something like a compression that may be able to be relieved through minimally invasive surgery, I'm not sure I would take the surgery card off the table. I understand demylanation ocurs with MS, But it doesn't mean you couldn't have more than one problem contributing to the pain which means you may need decompressive surgery before you can truly address the problem. When was the last surgical consult you had with fresh diagnostics.
One of my biggest pet peeves is when non surgeons make surgically recomendations. Your PM or GP aren't qualified to tell you if you need surgery, even if they believed you did, it doesn't mean a surgeon would perform surgery he doesn't think you need but you PM does. Have you had lidocaine infusions, Pumps can also deliver marcaine directly to the spine which may provide aditional relief. Even though it's been 20 years and you may have tried the antiseizure meds, If you didn't try them with oiates and with nemanda, you may find there is world of difference in using one of those meds alone and using one of those meds in conjunction with a multi faceted aproach to PM.
Good luck, Dave