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Old 09-11-2010, 08:44 PM   #1
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Question: how to switch to pain pump from strong meds?

Hi, I am a chronic pain patient and have been on heavy doses of pain meds for many yrs. I take per day: methadone (90mlg), neurontin 300mlgs.
(3per day), Oxycodone (5mlg.) up to 6 for brk. thru pain. A muscle relaxer (one at bedtime) Anyway, I have been on this dose for a long time and it doesn't seem to be working for me anymore. I have some serious pain issues that has to do with my spine. I had a huge surgery to fix my spine from my first back surgery.
(my spine virtually collapsed) I am fused from pelvis to T8. Plus other issues,(FIBROMYALGIA, OTEO ARTHRITIS) What and how does a person switch to a pain pump from STRONG oral meds? Won't there be withdrawl issues? I know that after my surgeries that I had a terrible time cause the pain medicine they gave me wasn't as strong as what I took at home. It was horrible pain. Until they realized that my meds at home were 6 times stronger than what they were giving me at the hospital. Anyway, any info would be appreciated about this subject. I have heard some good things about the pain pump. Although I hate to think of basically another surgery to put it in. But the way it is now I am suffering and in constant pain. Thanks ahead of time. babyboomer6

Last edited by babyboomer6; 09-11-2010 at 08:46 PM.

 
Old 09-12-2010, 12:36 AM   #2
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Re: Question: how to switch to pain pump from strong meds?

Hey Baby Boomer, Whn I switched from meth to the pump I was taking 160 mgs of meth per day, I absolutely hated how it made me feel, But I didn't have script insurance at he time. that alone was a large part of my decsion, I also used 30 mg roxi for BT. I'm sure every doc does the conversion different, Meds delivered intrathecally are anywhere from 100 to 300 times more potent than the same med delivered orally. Docs are likely going to be concervative. I started at 2 mgs per day, I had about 10 days worth of meth and I didn't even finish the meth I had although I was nowhere near the dose I needed. They made the first couple of adjustment every week, then every 2 weeks and once I got to about 8 mgs of morphine per day I was able to wait till my monthly apt to get to 10.8 where I stayed for the first couple years. But it took 6 months and about 16 adjustments to get to 10.8 where my pain was managed.

The big difference was given equal relief without the meth head. While on orals and I had been on 600 mgs of Kadianthen generic MSC before loosing insurance and swithced back and forth between meth and morph after having tried oxyC and the patch and never really getting relief enough to stand for more than a half hour. As my insurance situation changed from year to year I would move between meth and morphine. I had been in severe pain for 8 years and 3 fusions before even finding a doc that prescribed opiates.They simply didn't use them in the early 90's on non cancer pain and most didn't even exist. Every surgery I had I was given 2 5mg percs every 4 hours, They didn't make 10's or 7.5s back then.

So given my history of surving with little to nothing, I as able to look at the big picture, I suffered tremendously for years but knew my doc would continue to work with me untill we found the right dose. We talked at length about how often we could adjust things in the beginning,d weekly seemed fair from a safety stand point although it was extremely rough the first few months coming off meth pretty much in less than a week. I never exceeded what I was allowed in BT oxy which stayed the same from orals to pump to this very day. I trusted my doc would eventually get me to the right dose and do his best to limit the suffering during the transition. I don't think I ever had an increase by more than .8 mgs a day and and that was 3 months into it it once I got past 6mgs a day where it wasn't a huge percentage increase.

If you don't trust your doc you shouldn't go with a pump, control is something you have to turn entirely over to your doc. After 6 months I was getting alittle better relief with a much clearer head. I didn't realize just how impaired the orals had made me because I was living such a sedentary life. But once the dose was right, my head was clear enough to have the motivation to start making real changes in my lifestyle, I started working out on an elyptical machine daily, like 6 times a week untill I was on that thing for 45 mionutes a day with dumbells in my hands, I lost 40 lbs, and went back to work part time which I never could have done on orals. The end result is that it was well worth what I went through to to be where I am now.

I still work part time, I've taken several vactaions which I never could have done even on orals, and my life is completely different. We are alot tougher than we think we are, as harsh as it seems, I don't think many people have died from pain. I did have a heart attack while on a high dose of orals at 36 due to the constant high BP pain induced, but I would go through that 6 months again in a heart beat to make the change the pump brought.

In my casse, 50% relief is about as good as I'll ever get given the condition of my failed fusions and broken hardware, L1-S1. I still crunch and squeak when I move the wrong way or just move in general but my life is so much better without the haze orals left me in that simply became an exceptable part of life to not be in the kind of pain that made you question going through another day. The recovery from the last fusion was a much greater nighmare than what I experienced transitioning to the pump. So I guess it all depends on what you have experienced and the fact I knew their was light at the end of the tunnel this time. Regardless of how long it took to get there, I knew my PM doc wasn't going to leave me worse off than before. That's exactly what happened with the last surgery. There was no light after the last surgery, my surgeon had me down to 30 Vicodin a week 4 weeks post op and I pretty much had to beg for them every week, then the day came when he said no more and I was left bed wridden for the next 9 months untill I found a doc that used pain meds to treat chronic pain.

If I had given up on the pump after 3 months and asked to go back to orals, My doc probably would have done it, but I never would have made it to where I am now, Im still working out, I still working part time and make the most out of life rather than simply surviving on a large dose or orals. It's been 7 years and I just had my pump replaced, and my life is better than it's been since 93. It's still improving, partly due to the pump and partly because I realized it's up to me to do my part, excercise, stay actiive, push myself and get out of the house. There is nothing worse than being homebound with nothing to talk about other than what I saw on TV that day. Even with 160 channels, Life outside of the house is so much better.

At work I don't even take BT meds, because they cause enough head fuzz, not to be able to concentrate, focus or function. I have to learn new comp operating systems on a weekly basis and I simply cant do it on orals. I don't even like driving taking orals because i can feel them. Everyone talks about accomadation, That just means getting used to somting, It doesn't mean your head is as clear as possible. That's something a pump can do if your expectations and goals are realistic. I could complain and complain and get the pump cranked up to the point of nodding off every time I loose interest in whatever I'm doing, especially in the seated position alone n the house, but I will never go back to that way of life knowing I can function at the level I do know. Yes I pay for the days I work, It takes a good two days to recover, but just getting out makes it worth while.

So much depends on what you expect and are wlling to except and are willing to strive for. Don't expect to be pain free in 8 weeks after the pump, it's going to take that long to feel normal after taking meth for years. If it happens that's great, but if you expect it, how will you respond to the disapointment, unless you trust your doc is going to keep working with you to find the right dose. Your really not going to die while he's titrating the pump, you may have some bad weeks or months, but in the long run 6 months was nothing compared to the first 7/8 years I lived with the pain and nothing to manage it aside from antidepressants and relaxtion techniques.

I know one patient that had to change pump docs 3 times over 6 years because the first two had some preconcieved number as far as what they felt was safe, just like some docs have with orals. If a doc won't go above say 80 mgs of oxy a day, I doubt he would ever feel comfy with a patient with a pump delivering more than 2 mgs a day. If your doc truly understands pain and medication, their is no ceiiling as long as it's aproached safely and you can tolerate the side effects and are willing to except those side effects.

Good luck and keep us posted. When will you have the pump implanted,? Some docs wil also slowly decrease the orals as they add increase the pump. Personally I didn't want to spend another day on methadone. Every doc is diferent and every patient is different. But yur expectations will be the biggest factor. If you expect complete relief, you may never be happy. It simply may not be an option. If you understand meds have their limits and price, you will get their and get their safely. Take care, Dave

PS, sorry about grammer, It's 3:30 am, I worked 8 hours today and am paying the price, But I had a lot to talk about when i got hiome, that alone is priceless to me now.

 
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Old 09-12-2010, 12:59 PM   #3
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Re: Question: how to switch to pain pump from strong meds?

The pump does work for for many people, and it's certainly worth exploring, but I have some questions about your current meds. What is the Neurontin prescribed for? Nerve pain? As for the Methadone, have you tried any other hi-potency narcotic, such as the fentanyl patch? Since you said that you've been on this combination and doses for a long time, perhaps your physician would consider dc'ing the Neurontin, since you're not benefitting from it, switch you to the patch and dc the Methadone, and keep the oxycontin for BT. I'm just thinking out loud here, and suggesting ways to hold off on another surgery for a while. Keep us posted.

 
Old 09-13-2010, 03:09 PM   #4
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Re: Question: how to switch to pain pump from strong meds?

Quote:
Originally Posted by daveseavy View Post
The pump does work for for many people, and it's certainly worth exploring, but I have some questions about your current meds. What is the Neurontin prescribed for? Nerve pain? As for the Methadone, have you tried any other hi-potency narcotic, such as the fentanyl patch? Since you said that you've been on this combination and doses for a long time, perhaps your physician would consider dc'ing the Neurontin, since you're not benefitting from it, switch you to the patch and dc the Methadone, and keep the oxycontin for BT. I'm just thinking out loud here, and suggesting ways to hold off on another surgery for a while. Keep us posted.
I guess the neurontin is for nerve pain. I had a Dr. put me on the fentanl patch once a few yrs. back. I loved the way it worked. Didn't last the full 72 hrs. Anyway, she moved away and sent me to a pain specialist and he put me on methadone. That was about six yrs. ago. I agree that I may benefit from switching to the patch and OxicontinIR. But how to make the switch would be another story. Methadone I understand is so much stronger than some of the other LA pain meds. Like six times stronger than morphine. Anyway, any of you gone from methadone to the fentanl patch? I may need to talk to my PM doc. about something like this first. Thanks for your responses guys. You've given me a lot of good info. babyboomer6

 
Old 09-13-2010, 07:28 PM   #5
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Re: Question: how to switch to pain pump from strong meds?

Fentanyl is actually much stronger than Methadone. It's 60 - 80% stronger than morphine. It would be a gradual change - probably 12 or 25mcg/hr patch and slowly reducing the methadone. Since you've been on the patch before and tolerated it, you likely wouldn't have much trouble switching. Good luck and let us know what happens.

 
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