I have been using an ip pump for 18 months. The pain Dr. has tried morpine (up to 7.5) and hydromorphone up to 7.5 but I feel nothing. The temporary pump gave me 60% releif but the implanted has done nothing. Now my pm Dr has refered me to a another partner that wants to try prialt. It is expensive, $3000 a refill and the warnings I find on the web regarding the drug seem scary. He says he will monitor me closely but wonder has anyone else had any exp. with the drug. I have had two fusions and a lamenectomy but never have had less pain after any surgery. I also take oxycontin 20 twice a day for four years. Could a higher dose of this drug be a better choice?
I wonder if the pump is inserted properly. The catheter can move out of the epidural space and I think it would be wise to have that evaluated. It doesn'y make sense that the trial would bring relief, but this doesn't?? I would talk to my doctor about this. If the cath is not where it needs to be, it doesn't matte what they fill the pump with! Good luck and keep us posted!
I agree with butterfly, I have a pump and what they gave you during a trial was no where near 7.5 mgs of dilaudid. It would have taken weeks to work a dose up that high without killing you. What was you last oral dose before going to the pump. If you have a medtronics synchromed pump, It has a side port they can run dye through and check cath placement with flouoscopy. Has anyyone even checked the cath placement before they put you on a med with a 20% chance of causing a psychotic break, not to mention bring you off 7.5 of IT dilaudid. .
I have had 3 back surgeries, the last a failed 6 level total lumbar fusion that I've broken this set of hardwaretoo. I use 6.2 mgs of dilauid per day and get about 50% relief. Some days are certainly worse than others, but my expectation given the condition of my spine are realistic. To get no relief from that much dilauid, is crazy. Is it nerve pain your trying to ease, Radiculopothy or leg pain that just doesn't repond to opiates or are you talking back pain? Either way, what's has changed from the trial to now?
I sure as heck wouldn't detox in prep for prialt only to find out the cath is no longer in your IT space if it hasn't been checked. I see the largest group of docs in in the area ad they have yet to use prialt due to the severity of side efefcts listed. The main doc at the PM clinic is a neurologist/psychiatrist so it's not like theyy wouldn't know what to do for a psychotic break, but due tolackof positive feedback they have never found the need to use it. I've been on the same dose for over a year now and had the pump for 3. The only time I have needed adjustment was when they titrated morphine and then swithced me to dilaudid and titrated that. 50% relief is still the goal and about the best I ever get.
I would certainly be looking for a pump problem rather than amazing tolerance and total lack of relief given the dose of dilaudid.
I was bouncing between 120 mgs of meth and 600 mgs of morphine a day prior to the pump, so I'm not low dose either, but my trial worked, and the pump works. There is no rational explanation other than pump failure or cath placement or granuloma blockage. Unless your response to the trial was purely psychological. You thought it would bring relief, therfore it did. They actually recomend doing a plecebo trial to rule those patients out because the plecebo effect is a very real thing. But 7.5 of dilaudid is a huge dose that many cancer patient would never require before their death. For you to get no relief doesn't make sense and certainly doesn't justify the risks of prialt before checking the pump and cath placement which is very simple and has no risk.
Good luck and How frustrating this must be. I would want the diluadid tested. All IT meds are compounded by hand and nobody is immune to addiction or abuse. You may not be getting what your supposed to if the compounding pharamcist has a drug problem. Do you test positive for dilaudid in drug screens, Have they considered testing the remainder after a refill? You may be the victim of some addict that wears a lab coat. Doctors, nurses, cops,lawyers, judges or pharamcist, it really doesn't matter, Abuse and addiction can happen to anyone. Pharmacist are no more immuned than you, me or the homeless stereo type.
Take care, Dave
Last edited by HBMod07; 11-10-2007 at 10:50 AM.
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I can't go into all the detail that Dave did, but my mom has the pump and they ended up maxing her out on the meds as well as changing and adding meds. After two years of this they FINALLY took a look and her cath had become unattached. She just had it redone this past week. So I would have that looked at first as everyone else suggested.
My new pain Dr def wants to check the cath first before anything and have the placement of my cath checked. It sounds to me like the tube might be clogged. I cannot understand why my doc has not suggested a check before.The pump is currently filled with hydrocordone. I def felt a relief with the trial pump. After about two days it just sort of started to feel better during dinner.that is the only reason I agreeed to have the pump inserted. I was so excited with the temp pump. I thought I was going to have my life back and I could return to teaching.I just started crying i was so happy to be able to bend and sit for more than a few minutes.
it is such a bummer to not have anything from the inserted pump. I asked my pain pump Dr. how many he has treated hundreds or thousands and he said about 25. It to me sounds so scary i really do not want to use it. He said that most of the problems patients have had is from starting at too high a dose. He said his nurse would monitor me by phone everyday to see about reactions. I cannot afford the prialt just living on my teachers pension and a few dollars made working here at home. I hope that it is just the placement but it will be a couple weeks before it can be checked. I will let you know what is happening. Thanks for the response