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  • Medtronic Pain Relief Pump with no relief

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    Old 05-14-2007, 11:42 AM   #1
    PhiPhilip
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    Medtronic Pain Relief Pump with no relief

    My husband had a Medtronics pain relief pump implanted in November of 2006.

    The doctor originally started him with with a 25% concentation of mrphine and when that didn't work, he upped it to a 50% mixture of morhphine. He was getting 25 mgs of morphine a day, but still had no relief from his pain.

    The doctor determined the catheter had a leak, so my husband was oepned up again and the catheter was fixed. The doctor sid that he couldn't go up on the morphine doage or the concentation, so he changed the morphine to dilaudid and my husband is now getting 20 mgs of dilaud at at a 50% concentation rate, and is still in pain.

    The doctor is not big on giving breakthrough meds and only gives my husband 90 30mg of Roxicets per month, which still doesn't not help his pain at all.

    My husband has been on oral pain meds for over 20 years and is 62 years old. He justs wants to live the rest of his life without back pain and his doctor is telling him that he can't increase the amount of dilaudid or the concentation and is wanting to turn the pump down.

    Any help or advice you can offer will be greatly appreciated. Thank you in advance.

    Please excuse my typos . I'm new to this board and can't seem to find spell check ... lol.
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    Last edited by PhiPhilip; 05-14-2007 at 12:13 PM.

     
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    Old 05-14-2007, 12:03 PM   #2
    mudbone
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    Re: Medtronic Pain Relief Pump with no relief

    Hello, I don't know that much about the pumps, but there are several people here that have them and I'm sure you will get a reply about different concentrations for your husbands pump. One thing I can help you with is advise on a your dr's willingness to help. Most people go through several dr's to fianally find one that works on their particular problem. What I am saying is, if this one refuses to do anymore and you think more should be done then the answer is simple- get a new PM Dr. I have switched around mainly because my last dr was just a primary physicion and she told me thats all she could do for me and that I should see a pain specialist, which I did and thats the best thing that I've done! Just dont give up, and give this board a little time for some better replies. You wont be dissapointed here. Best of luck for your husband.

     
    Old 05-14-2007, 02:24 PM   #3
    PhiPhilip
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    Re: Medtronic Pain Relief Pump with no relief

    Thank you Mudbone. . I noticed that you're in South Florida, too. Do you happen to be anywhere near Boca Raton? If you are, can you recommend a PM doctor? . The doctor who is is filling my husband's pump is the neurosurgeon who implanted it, and I don't think that he knows much when it comes to pain managmenet, which is why he's telling my husband that he was to turn it it dwn and finally shut it off.
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    Old 05-14-2007, 03:37 PM   #4
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    Re: Medtronic Pain Relief Pump with no relief

    I have had three pumps to date implanted. The first in 98 the second in 2001 and the last this past year. Did your husband go thru a trial with the pump to see if he would recieve relief? Does he go to a pain clinic or pain management group or hospital? I nero put my last pump in but I go to a hospital run pain management group that takes cre of my refills and any break thru pain meds.Did they place the cathador in the right place for the pain control? If you don't have answers to these questions I would go to a pain specalist who can help him get some relief. The pump will not make you total pain free but it does help me alot and some others in the room also gets some help from the pump. I hope this helps Goog luck take care and stay safe geifer

     
    Old 05-14-2007, 03:54 PM   #5
    PhiPhilip
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    Re: Medtronic Pain Relief Pump with no relief

    Quote:
    Originally Posted by geifer View Post
    I have had three pumps to date implanted. The first in 98 the second in 2001 and the last this past year. Did your husband go thru a trial with the pump to see if he would recieve relief? Does he go to a pain clinic or pain management group or hospital? I nero put my last pump in but I go to a hospital run pain management group that takes cre of my refills and any break thru pain meds.Did they place the cathador in the right place for the pain control? If you don't have answers to these questions I would go to a pain specalist who can help him get some relief. The pump will not make you total pain free but it does help me alot and some others in the room also gets some help from the pump. I hope this helps Goog luck take care and stay safe geifer
    Thanks for your response. My husband goes to the same neurosurgeon who implanted the pump for weekly increases and refills. His neurosurgeon works out out of a major hospital , but it or he does not pecialize in pain managment and is now wanting to decrease his medication and turn the pump off completely. When he asked the doctor to refer him to a pain management specialist , the neurosurgeon ignored him. It's difficult to find a PM doctor here in south Florida because my husband is on SSD and everyone wants cash, which we can't afford and no one is will to accept his Medicare.

    He had one trial prior to having the pump implanted when they inserted morrphine into his spine and had to stay overnight and in bed, so of course, he wwasn't in a lot of pain since he wasn't able to move around or get out of bed.

    The catheter was replaced as it had a split in it.

    He knows that he won't be totally pain free, but his pain is unbearable and I feel so badly for him. He walks with a cane and he has trouble getting out of bed in the morning. He just wants to lead a normal life. As it now, he can't do anything and I do all maintenance and yard work. I'm not a well person either because I suffered a stroke 7 yers ago, and now I'm stuck doing all the things that he used to do and can't.

    I hope that this answers your questions, and thank you again for your help.
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    Old 05-15-2007, 06:05 AM   #6
    Shoreline
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    Re: Medtronic Pain Relief Pump with no relief

    Phi Philip, Although your are saying the right things as far as not expecting to be pain free, it still sounds like you expect him to be able to do yard work and help out in ways he can't. The fact he can walk with a cain may be a great acomplishment for some, the fact he does get out of bed may also be a great acomplishment. Once they turn the pump off and he can't get out of bed and can't walk at all, walking with a caine may sound pretty good. I really don't know what realistic should be for him, But expecting not to have to make changes like paying someone to do simple things like mow the greass when you want to be able to do these things may not be realistic. If that's what he's shooting for, then he may never be satisified with the pump and this would be why the doc saus take it out and turn it off, because regardless of the dose, he won't be satisfied unless he has his old life back or at least some fegree. My life is nothing like what it was prior to injury and, multiple surgeries and multiple sets of broken hardware, it sucks to have to pay to have the grass cut or to pay to do interior painting, but everyone has their limits and if that's beyond his, he has to learn to except this. If you expected him to start pitching in with yard work after the implant, your expectations weren't realistic. A succesful trial is one that relieves 50% of his pain, for some 50% means they can go back t work, for others 50% means he can take a shower by himself without falling and can walk with a caine when he couldn't walk at all prior to the pump. Degrees of relief , just like pain are subjective. He's on a whopping dose of meds and if this is as good as it gets, continuing to ask for increases that don't bring more relief or more function just destroys the relationship with the doc. He's wondering what would it take to satisfy this person, if the onluy thing that does is to have his old life back, he may never be satisfied.

    It sounds more like a consult with PM psychologist would be more appropriate as a PM doc really can't do much more as far as opiates for your husband., He can also treat depression and use meds like antiD and antiseizure meds for nerve pain, but if he has leg pain, foot pain from radiclopothy, no amount of opiate is going to relieve that pain and keep him awake. A point comes when the side efects of the meds become more impairing than the physical problem. If the dose just allows him to sleep all day and saty up all night, it's hard to find the benfit in treatment. If he's walking daily and trying to increase where he couldn't before, then progress is being made.

    Just not the progress he hoped for. But I don't know all the details, don't know what you or he really expects, but do know even the pump has limits. It's kind of hard to push a lawnmower with a caine, or balance a weed eater in one hand and use a caine in the other, perhaps these aren't reasonable expectations.

    With the help of a pump I was able to go from walking for 6 minutes without looking for a place to lay down to excercising for an hour a day on my feet, It took 6 months and a monumantal effort to work through the pain I was going to experience anyways, but it was worth it in the end. I still have limits and yard work isone of them, but I have teturned to work part time. What has he done since the impant to rebuild what he lost prior to having the most advanced pain relieving tool at his disposal. Did he return to PT, is he walking daily, or is waiting for the meds to relieve lenough pain that this doesn't cause discomfort. If that's the case, he's got a long wait ahead and docs that won't see the value of what they are doing for him.

    Good luck, Dave.

    Last edited by Shoreline; 05-16-2007 at 10:56 PM. Reason: OOOH NO. sorry

     
    Old 05-16-2007, 10:53 AM   #7
    PhiPhilip
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    Re: Medtronic Pain Relief Pump with no relief

    Dave, thanks for your response. I guess I didn't explain myself very well. I actually enjoy doing the yard work, and have always done it because I feel it's good exercise, even though it is more difficult sincre I'vre had a stroke. I was using the lawn as as an example of
    things that my husband is unable to do.

    My husband actually has has an appointment with a PM doctor today because last week the , neurosurgeon said that he wanted to start turning turning his pump down and eventually off. My husband knows and
    understands that he will ne never be 100% pain free , but he says that his pain is now worse than before the pump as implanted. As I think I mentioned earlier, his neurosurgeon does not like to give him breakthrough medication.

    My husband has already had 4 back surgeries, and , needs another. He also has stenosis, sciatica on both sides ,and he has two knee replacements on the same knee. Also every disc in his neck is bad and the neurosurgeon told him that his neck couldn't be fixed.

    Although I don't know badly he feels, painless, I don't deny that he is in a lot of pain. He knows several people who have had the pumps implanted with amazing results and I know that he is disappointed. and He just wants to be able to lead a half-way normal life without staying on the sofa or in bed all day.

    I'm guess I'm just trying to find out if anyone else has had problems or if there is anything that he can or should be doing. I'm not sure that I tust his neurosurgeon when he says that he can't anything else for him. It's frustrating for me, so I know it has to be even more frustrating for him.

    Thank you again for your help :-)
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    Old 05-16-2007, 11:57 PM   #8
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    Re: Medtronic Pain Relief Pump with no relief

    Hey Phi, Thanks for taking the time to explain. I took the time to clean up my mess of a post so your husband can read

    You might have answered the question in your post. You said he knew people that had amazing results, that has to set the bar high.. You also said he is basically waiting on more surgery and one area can't be fixed. That's crucial as far as the pumps ability, you can only set your expectations so high when there is a mechanical problem going on waiting to be fixed and one that can't. Say the problem is blown discs, DDD , whatever, if bone grinds on bone when you walk, a pump isn't going to prevent that from hurting. It would be like thinking you can stick you jhand in fire and the extra pain wouldn't hurt. If the meds are satisfactory when he's sedentary, and he has mechanical pain, pain caused by movement of the spine, bone on bone, slippage or nerve compressions. Those are all triggers for intense pain more like acute pain rather than the chronic pain he's managing on the couch or laying down.

    You can't mask instability or compressions or anything that;'s triggered by movement. All you can do with a back is strengthen the core muscles around it and those muscles can stabilize the unstable portion of your back. I spent 8 years and 3 surgeries trying this method and have been doing the PM thing since 93 when there was no such thing as a pump for someone that wasnít dying or had MS and needed Baclofen for spascticity.

    There is a huge mind body connection and that in no way means the pain is in your head.. It just means how and what you feel emotionally and psychologically effects how you feel/interpret and respond to these things physically.

    Personally, 3 surgeries was enough for me. The last was to replace and revise a 3 level fusion with 2 rods and 6 screws. That failed I broke the hardware crushed the discs and nerves above and below and the quick revision turned into an 11 hour total lumbar fusion. L1-S1. It failed too, now I have a junkyard of screws and rods in my spine and most surgeons I talk too tell me I had 3 that failed and wrecked my life, what makes me think a 4th is going to make me feel better? Statistically with the number of attempts combined with the number of levels they need to do, I have a 140% chance of failure, the only reason to do this would be pure desperation and hoping the docs can do something I canít.. Loss of bowel movement, ability to walk, it wouldnít be anything I had a choice about.

    Even successful surgery isn't going to give me my life back, at best there are docs willing to go in, revise and lengthen it. Do crazy stuff, like remove a rib from each side, run a bar from hip to hip, Rip every disc from T10 -S1 out and use cages and back it up with posterior hardware after they extend it up 3 levels. It's just so absurd I can't imagine recovering and being better from a longer fusion with more hardware. I guess it could stabilize things but I've been able to do more with muscle then they could with titanium.I canít work 2 days in a row, but I can work 8 every other day right now.

    It just took realizing, expecting some monster surgery to make you feel better when the last ones failed to help, is asking for too much,. Expecting a pump to prevent the pain of bone grinding on bone and screws pulling in and out of the holes isnít realistic and I get that. I have to except that this is as good as it gets but itís much easier knowing I am doing my part with keeping up my responsibility not to let myself deteriorate and lose more strength, muscle and even the ability to walk if I stopped long enough.

    Some docs will promise a lot at 3000 bucks an hour for OR time, but we really are just guinea pigs when it comes to spine surgery, There is no right way or wrong way to due a fusion, you can't find the stats on front approach with cages or posterior with screws and hardware. Docs do what they were taught and a few do branch out and try different methods.

    I would think twice about the next surgery if it's a revision of failed surgery, Once you have put your future in a docs hands and it fails, that trust doesn't come so easy. If he's hoping and rolling the edice that this will be the surgery that fixes it, get several other opinions before proceeding with a doc that promises success. At best promising stabilization so things don't get worse is a good thing. See what I mean about expectations, If he goes in expecting to come out stable with something like bone on bone grinding to stop, that's reasonable, to expect to come out of your 5th spinal surgery, if the same spot has been done over and over, redcuing pain isn't the surgeons goal, it's secondary to stabilizing the spine.

    If anything has effected someone life to the degree that this is how he's living now, he does need some help dealing with the things he can't tell you because it's scarey or he feels guilty for not providing or whatever the problem is, I look at a psych as another doc to use as a sounding board, to discuss my options and to learn to except and to question how much worse would things be if he started walking 8 minutes a day every day, Would tomorrow night be any different than tonight? He may hurt a little more, but is that anything new? There is no doubt he would benefit from the exercise and just knowing he gave it his all today to take some control back of his life gives you reason to get out of bed. This kind of life isn't acceptable to anyone and we do make choices. Even though we can justify that choice, it doesn't mean it's the best or the healthiest or promises to reduce his pain tonight.


    I picked the one that caused the least pain and caused the least movement of the part of my spine I need to stabilize. Just keeping your abs tight for 8 minutes while you walk with perfect posture is a workout compared to hours spent on the couch. I promise he will benefit from some type of exercise.

    I also have a feeling something still isnít right with the pump, thatís too much not to feel any better or the pain from mechanical movement is so severe, maybe it does justify going back in just to stabilize it and prevent that movement.

    Take care, Dave

     
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