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Old 10-18-2007, 07:06 PM   #1
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? for anyone with a pain pump

I need help, please!!!!!!

I have had back and leg pain for the last twenty years...diagosis was DDD and had ALIF at L4-L5 a year
ago. I have been on strong pain meds for the last 8 years, including AVINZA, MSIR, now the Fentanyl duragesic patch
and roxicodone. I also have MS, which is causing some of the leg pain, my MS specialist and NS say, from the damaged nerve pathways.

Will a pain pump help leg pain? The patch isn't helping my back or leg pain, and I have gone from 50 mcg to
75 mcg. If I continue to go up, do you think it may help?
Do or did you have leg pain?

I am almost at the end of my rope...I can't do anything I like to do anymore, without hurting around #8.

Please help and thank you.

 
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Old 10-18-2007, 07:08 PM   #2
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Re: ? for Shoreline or anyone else with a pain pump

I'm back!!!!!!

I forgot to mention that I have gone down the non-narcotic
route, also, with Lyrica, Neurontin, Cymbalta, and others, but nothing helps.

 
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Old 10-18-2007, 07:24 PM   #3
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Re: ? for Shoreline or anyone else with a pain pump

Hi Orchid, I would think they would try a stimulator or nerve blocks or possibly ablation procedures before reaching the point of a pump. The problem is, you haven't found a dose of orals that works, which makes finding a dose of IT meds less likely to work. If you know orals do work then you can reduce side effects and alot of hassle with a pump, but opiates are opiates and nerve pain just doesn't repond to opiates the way other types of mechanical pain do.

The only good thing about the surgeries I had is they diodid relieve the compressions before permanant damage was done. The last surgery relieved the last compression but left the fron of my thighs numb, but neuropothy isn't a problem I have to deal with at the moment.

You said you tried the anti seizure meds, I hope you didn't give up on them. They may be much more effective when used in conjunction with opiates, so I hope your still taking something. It's easy to say they don't help at all when used alone, But the best test of them helping is when you have some relief from the opiates and stop the anti seizure meds and see if it increases your level of pain. If it jumps 20 or 30 % you have a better idea if they helped. Anything that helps is good.

I wouldn't say it's not worth doing a pump trial, but I think you do have room with dosage and procedures that may bring a little more relief. Trail of an SCS would also make sense since nerve pain is what the SCS is really designed to help with. Nerve pain is the toughest to deal with and prior to surgery, no amount of pain med even took the edge of crushed nerves. I begged my docs to just sever the nerves, but they learned in the 70's that was a bad idea.


Good luck, Dave

 
Old 10-19-2007, 05:31 AM   #4
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Re: ? for anyone with a pain pump

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

 
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