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  • Help ! Morphine pain pump dilemma

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    Old 10-11-2016, 01:39 PM   #1
    fstellabotte
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    Help ! Morphine pain pump dilemma

    I have had a Medtronic SynchroMed II for 11 years.

    In Dec 2014 the pump was replaced due to normal battery end of life. The catheter was scheduled to be replaced, but for some reason the Surgeon did not replace it. At the time this concerned me because the catheter failed a pre opt test, and there was a Medtronic letter to the doctors saying this catheter should not be used. The Surgeon assured me that he fixed the tangled area and all should be fine.

    Two years later, January of this year, something failed and I experienced very nasty withdrawal symptoms that landed me in the hospital. In March I had a pump Myelogram where a radiologist and a Medtronic tech declared that the pump and catheter were faulty and should be replaced.

    I have seen 2 surgeons and one spine specialist since then, all 3 doctors have recommended that I donít use the pain pump and move to an electronic stimulator device. I whole heartily agree with them, as I believe that the pump is the cause of several issues.

    The dilemma is getting off of the faulty pump quickly. Since March I have had 3 episodes of intense withdrawal, one episode lasted for 3 days. Oral opiates do not help.

    I need to get rid of this pump as soon as possible, as I am now having headaches when I stand or sit from a lying down position. Is there a rapid detox program ?

    Are the electronic stimulator devices as good as the doctors say are ?
    Two of the doctors showed me studies saying that long term opiate use causes more pain in the long term.

    Any thoughts or suggestions would be greatly appreciated.

     
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    Old 10-11-2016, 05:52 PM   #2
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    Re: Help ! Morphine pain pump dilemma

    Sorry you are dealing with this. Hopefully someone with a pump will come along to help answer your questions, but I'll give it a go.

    Detox programs vary by area. A typical inpatient detox program will be for people dealing with addiction, and may have mandatory meetings and such as part of it, and not enough medical support for pain patients.

    Awhile back I was forced into trying Suboxone, and my doctors wanted me to go inpatient for the switch as I was on high dose Methadone. Suboxone requires the patient to be in withdrawal to start it, and Methadone had too long of a half life, so I had to switch to something else first. It would have been in an inpatient treatment center which didn't differentiate addiction patients from pain patients, and I just wasn't comfortable with it. They had rules such as no phones, visitors only at certain times, etc. I as concerned I wouldn't be any shape to speak up for myself and my husband wouldn't be able to be there to advocate. I was also concerned the options for comfort meds would be limited (as they don't give anything that can be desirable to addicts, such as benzos or Ambien), and aren't set up to treat pain (with non-opioids). Additionally, it would be on my record that I was inpatient for opioid dependency.

    Thankfully I convinced them to let me make the switch at home and I was way more comfortable with the decision as I had my home, husband, and lots of meds at my disposal (some prescribed for that purpose and some I already had). I see no advantage to doing any sort of detox type program unless you literally have trouble sticking to a taper schedule (which wouldn't necessarily mean addiction...its tough to put yourself in increased pain and withdrawal knowing you have enough pills to make things better) or there is a medical reason it is dangerous for you to taper on your own. Long story short Suboxone wasn't a good med for me, and thankfully I was allowed back on Methadone, but at only 1/3 the dose, as they just plain weren't comfortable prescribing high doses anymore. I've managed ok with it as with the whole switch process I underwent so much withdrawal that my tolerance significantly dropped.

    Do you have a pain doctor willing to switch you to orals (or a Fentanyl patch) and taper down? A good plan would be to have your pain doc switch the pump to saline (I seem to remember it can't just be shut off), convert that dose to an oral long acting med, give you a good amount of short acting meds (as they must be conservative with conversion and there is a good likelihood you'd have some withdrawal), have you follow up frequently (increasing the dose at first if needed to make you comfortable), and taper you down slowly enough to minimize withdrawal (as a percentage of total dose, not a set milligrams per week). Its very dose dependent, but this would likely take many many months. Some folks prefer to do a fast taper, but that of course can be painful, although there are some meds that can be used to help (such as Clonidine).

    If oral opioids don't help your withdrawal symptoms, then either they aren't withdrawal symptoms, they aren't trying a med that works well for you (everyone is different), or they aren't trying a high enough dose. Its likely the dose.

    Some folks find a stim device helpful, but for many, its only part of their treatment plan. Doctors are really moving away from using opioids for noncancer chronic pain; many folks are being tapered down or off them, sometimes unfortunately without other helpful treatments being found (as typically opioids were used as a last resort). It is highly unlikely that a stim device could provide as much pain relief as a well-tuned pump. If you weren't getting good relief from the pump though, it may be easier to match it. It can however at least be a good option for some types of pain. There are also chances for complications such as the permanent device results not matching the trial, leads migrating, etc.

    Any chance they can do the external stim trial before they remove the pump? Or, at least before they taper you off opioids? It would be unfortunate to put all your eggs in that basket then be stuck with no pain relief if it isn't significantly helpful. Like you probably know from the pump, the whole process can be quite extended as well. If your doctor isn't giving you options and planning to utilize multiple treatment methods as an alternative to the pump, you may want to consult with a new one.

    Yes some studies have shown that some folks have increased pain long term from opioids. However, for some of us, we have lower pain levels than we did before, have been able to maintain our dose over time, and don't have any other good options. Hopefully patients were started on opioids only after trying and failing numerous other treatments. If the patient had been experiencing escalating pain levels over time which didn't respond to opioid dose increases, then that is a good example of a case where it may be a good idea to taper off the meds (hyperalgesia). Best wishes.
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    Kate
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