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  • At what point should I request a "Pain Pump"?

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    Old 12-27-2015, 12:03 AM   #1
    roadiez
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    At what point should I request a "Pain Pump"?

    Hi folks..... First things first. A little bit about me. I'm 45yo male with 4 cervical operations under my belt..
    I'm fused anteriorly from C3 to C7 & Posteriorly from C3 to T2.
    I have 17 screws, 2 more broken halves of screws, 2 6-8 inch rods, 1 cage, 2 plates & both pieces of my Iliac Crest hip bone in me rather than using a cadaver bone.
    I constantly have migraine headaches. I do get some relief post-op. But they always come back 90 to 120 days afterwards any of my cervical operations. I guess because the spinal cord is regenerating & causing this. Not sure at all. Just a thought. My ROM(Range of Motion) is almost none existent, Moving basically inflames my pain. But I refuse to confined to my recliner. To me that would be a very slow death. I want to get out & at least drive around town & such. Since my work opportunities are gone & am on SSDI now.

    I know in the future I'll have to get my lumbar worked on as well since it's screwed up as well too.

    I am currently on 60mg of oxycodone a day with no end of that in sight. I was on 3 10mg Valium a day but since having that transferred to my PM it was cut down to 2 times a day which is not enough at all. They think it's way too addicting. I say otherwise. Since I'm the one taking it & not them. So I have to save them for when I really need them for relief & such.
    So for my thoughts I'm going to on my next appointment going to ask for an up/review of my current pain medication. As I am getting no substantial relief. I was going to ask for the following:
    Oxycotin ER, with so much Oxycodone for Breakthrough relief.
    My current thinking was to continue with the pill for of pain meds for another 2-3 years. But the more I think of it I was wondering why wait that long.... If I could get more immediate relief with a "Pain Pump", Why not explore my options now.

    I was just going to throw out this question to the forum to see what the consensus was.

    1. If I should just stay on the oral meds.
    2. Explore options of the pump.
    3. What has been the results of people that have tried or currently use pain pumps & if anyone is on Medicare or Medicaid what has their experience been getting one with this type of insurance/assistance.

    I appreciate any & all replies in advance.
    Roadiez
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    Cervical:ACDF C4-C7 & Posterior Corpectomy C4-T1. Now 2 Broke Screws @ T1 level Posterior. Severe Migraine's, Multiple white spots on brain (Unknown Why).

     
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    Old 12-31-2015, 06:33 PM   #2
    Johnsangel13
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    Smile Re: At what point should I request a "Pain Pump"?

    I see that you are struggling so much with this. I am on SSDI as well and on Medicare and Medicaid. I have the Metronic pain pump and boy its a life saver for me. Yes I still get flares up of pain but absolutely NOT what the pain was before I got it. You can ask your doctor for more information on this. Before you can get one you have to go through a trial run meaning they will put in a temporary lead in and put the medication to see if you get a 50% relief from pain. The insurance won't pay for the permanent one unless you have at least the 50% reduction of pain. It has been a God send to me. It doesn't always keep the flares from coming from time to time but nothing is 100% in the pain process anyway. With the pump you won't be getting as much in the dosage because it goes directly in the spinal cord so its hitting what it needs to. For me, I no longer feel chained to the pills so to speak. If you do end up getting it you will have to go in at least once a week to have adjustments made to get a good level. They can only turn it up so much at a time. Good luck.

     
    Old 01-03-2016, 12:45 AM   #3
    roadiez
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    Re: At what point should I request a "Pain Pump"?

    I have another question....With me having all or most I'd say 90% of my pain coming from the Neck/Cervical area & the rest from the lumbar area of my body.... Will a Pain Pump work for me?
    From my understanding the leads are put in the "Lumbar Area".... Will this still work for me? I haven't been able to find an answer to this & was wondering if it would.

    Thanks in advance.
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    Cervical:ACDF C4-C7 & Posterior Corpectomy C4-T1. Now 2 Broke Screws @ T1 level Posterior. Severe Migraine's, Multiple white spots on brain (Unknown Why).

     
    Old 01-03-2016, 10:14 AM   #4
    Shoreline
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    Re: At what point should I request a "Pain Pump"?

    Hi Roadiez, I am SSD and have Medicare, I had 3 failed fusions in the 90's, the last was L1-S1. I have had a pump since 2002, I'm actually on my second pump and will need this one replaced in the next 18 months. Medtronics Pumps generally last about 7 years and then need to be replaced. The thing with pumps are that not every PM doc is certified or qualified to manage a pump. So if your doc doesn't do pumps he likely isn't going to offer one. When My pump doc left the area I had a tough time finding another doc, my new one is out of network . That alone was a hassle to get Humana to understand having a pump is a unique situation and not a single PM doc on their list even messed with pumps.

    To me The difference between pumps and orals is the amount of side effects and the amount of cognitive impairment. I would say the pain relief wasn't that much greater but the head fog is decreased greatly so I am motivated to do the things I want to keep me busy and distracted. As far as when, I was taking over 600 mgs of LA morphine a day when I switched to a pump. I had tried LA oxy, LA Oxymorphone, Methadone and LA morphine and Duragesic pathces. This was back before Medicare even had a part D to help with prescriptions. So my decision was pretty much based on financial issues. I couldn't afford anything other than Methadone and I hated the way it made me feel despite getting decent pain relief. I would think your insurance is going to want you to exhaust all other methods of PM before giving you an OK for a pump or a trial. If you haven't tried any Long acting meds, you have a ways to go before considering a pump. That's just my opinion and again, does your doc even manage pumps?

    As far as would a pump help a cervical issue, yes it would. Basically the medication goes into the sac that surrounds the spinal cord and this makes crossing the blood brain barrier much easier than taking orals, The general conversion from oral to Intrathecal is anywhere from 100-300:1 meaning if you take 100 mgs of oral LA morphine the IT equivalent would be .3-1mg of IT morphine infused over 24 hours. Now meds like Bupivicaine/marcaine that require the med to be delivered directly to the spot your trying to partially numb may not be as effective since they don't insert the cath into the cervical space, It will be inserted at the lumbar area. I also have clonidine mixed in with dilaudid as an adjunct to help the dilaudid work which seems to help. Baclofen for spasticity can also be mixed with the preservative free opiate options.

    Have you tried Botox for your Neck, My wife gets quite a bit of relief from Botox every 12 weeks.
    Good Luck, Dave

     
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