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Re: Pump versus oral meds? (Dr. W.)

Re: Pump versus oral meds? (Dr. W.)

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Posted by MLWhitworth, MD on March 19, 2000 at 06:02:20:

In Reply to: Pump versus oral meds? (Dr. W.) posted by John V. on March 19, 2000 at 00:07:29:

Each situation is different so I cannot comment specifically on what I would have done in your case. As for oral meds, I always use them as a prelude to the pump and if the patients do not have too many side effects, then I usually stick with oral meds. My target pain control is 60% reduction in pain or 60% increase in function with oral meds. The pump does not achieve more than this usually. So oral meds are usually increased until side effects become intractable. The highest methadone dosage I have used is 140mg/day on patients prior to the pump. Each doc has their own threshhold, but there is no ceiling on mu receptor narcotic effect using methadone. The only limit is an artificial one in the minds of the docs unless side effects become pronounced.

: I was wondering, Doctor, if you had a patient that was on a high dose of an opiod such as methadone, let's say 70+mgs. daily, and that wasn't controling the pain, would you then consider the pump?

: I can see where the pump has real good benefits, such as taking the administration of the meds out of the patients hands completely. At the same time, however, with the patient on oral meds, they can take them when they need them and as much as they need. All in all, which method of pain control do you prefer. We are talking about chronic, incurable pain sufferers.

: After I had a mylegram, CT scan, and MRI, my nuerologist told me that I had too many problems for surgery to be effective. He said that he reccomended treating the symptoms since surgery might not be successful. That's why I agreed with the pump. In your opinion, with the scarce information I have provided, do you think we made the right call. If it helps, I am a 44 y/o male.




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