Discussions that mention morphine

Pain Management board

Hi Treacleinpain, I haven't had one but to pevent one they changed my meds last yar. I was on Morphine with a small amount of Baclofen. However at the rate I was on, with the 18ml pump I was at their comfort cutoff point. They need to use 30mg/ml just t o give me 4 weeks between refills. Apearently morphine and baclofen aren't quite as soluable as dilaudid and the Fents.

From the description of the surgery it does sound risky, they have to make an incision in the cord to remove the cath.

Why do you ask? General concern because you have a pump or Concern about getting one. Are you getting good relief from morphine and don't want to switch? I'm supposed to switch back to morphine at my next fill in 2 months but the docs not really comfy and knows he doesn't have much room to adjust things, however the relief seems to outweigh the risks when I weigh everything.

I do know a lady that has gone years at a high concentration of morphine and hasn't had a problem. I also know folks that have them removed because it didn't work on their pain or had pump malfunctions and leaks.Another friend had problems with spinal fluid leaks for months after the cath was inserted. Any number of bad things can happen when they stick a cath into your spinal cord or it can bring relief with a clear head you coldn't achieve with oral opiates.
Good luck, Dave
Hello Dave.
Thanks for replying back to me and being as helpfull as you can be.
Dave I asked this question because I actually have a Granuloma and I am having surgery on the 17th March and Im scared witless, I come from the UK And Morphine pumps are rare here in any case (If I have ended up in hospiatal no-one knows how to care for me they are very nervous and I have to tell them to contact someone from my pain team who then tells them how to treat me before getting to me themselfs.)
When my Granuloma was first diagnosed my Dr was scared for me as was his collegue, they had to contact other pain teams at other hospitals because of how rare they are, and of course contacted medtronics themselfs.
Anyway getting back to me ;) I only had my Pump in for 15 or 16 months when I started to have increases in pain which I thought was because I had two bad falls.
It as now been a year since then; They have tried alsorts to try and get rid of the thing! :mad: but nothing worked and now its got bigger and my Nuero obs are getting worse so its time it came out so I've been told, There is no choice so my dr says :( .
So this is why I ask the question, Just interested if anyone else as had one so I can be well informed. I do go to another site for pumps you probably have heard of it, and there is a chap there who is going through almost what I am going through, but we are having different ways of doing things surgicaly in our respective countrys..
Thank you again Dave.

Treacle.. :wave:
Hi treacle, Thanks for the extra info, I'm sure i good do some research and find out more about the surgery, but what's normal practice her e may not be normal in the UK.

Because I'm planning n switching back to morphine, do you mind if I ask you some questions? Do you have the new synchromed pump or the older model. You would know by the 40ml resevoir.
Do you remeber what your concentration was, where you maxed out at 30mg per ml and whatwas your flow rate per day. I'm just courious if there was something about the way it was managed that may have caused the problem. Using a high concentration delivering a low dose seems like it would create more problems where I imagine you tried reducing the concentration and speeding up the pump to deliver meds faster through the cath in hopes of disolving things. Have you had a blockage in the cath yet and if so, could that be the cause of the increase in pain. Getting less medication than your used to is a big deal when the meds are this strong delivered intrathecally. The pump slows down after the alarm date and when that happens it sends me into withdrawal very quickly, now I simply waste a little in he resevoir and am sure to refill before I get near the alarm date.

I know it's not helping you to answer my questions, but surely there is a good NS in the UK that can remove the cath and not damage things, I will cetainly pray for the best.That does seem odd to develop a granuloma so quickly and makes it a little scarrier switching back to morphine at the concetration I was at.

Have you talked to medtronics yourself yet. They were great when I was investigating the pump. I talked to their tech dep, CS dept and the local rep. The local medtronics rep may also be somene to talk to about finding the best qualified surgeon to replace the cath if that's your plan. Are you going to leave the pump in and try a new cath?
The rep should also be a good source of statistical data with this kind of problem.

Often a rep sits in on the implant surgery and I would imagine they would sit in on a surgery like this as they have some interest as far as the outcome.
Good luck with surgery.
Hello Dave.
Of course I don't mind about questions you fire away and I will do my best to answer them..

Firstly I dont know the concentration, But I do know it is way different from the USA here as they obviously have learnt things from you in the USA and try to do their best doing whatever is wrong they try to right it, so I imagine its ok!
I do know its all sealed and made just for me when needed and the pharmacey chap himself is very nice and seems to be on the ball.
I do know our Orthopeadic and nuero surgeons and pain annesthetist go to the USA to different conferences to hear new things very regulary.
Here we are still not able to use Piralt, My Dr was going to try this medication on me maybe if my granuloma went, As we expected it to be passed in september 2005 last yr but was not.
Anyway back to me and this 'Inflamatory Mass' as medtronics like to use the term, I still say Granuloma :D
Dave at the time I was getting increasded pain I was only on 8mg a day plus taking Oxycontin ect for breakthrough pain.
I was increased to 10, then 11, then finaly 12 mg just a short time after this I had a dye test this showed nougthing so was given an MRI just 3 days later, this was an emegencey appointment (In the UK you can wait upto 6/9 months for one of theses, so I do wonder if my Dr did see something but did not want to worry me there and then.) This MRI showed a small granuloma, so the plan was to take me off my meds in pump gradually, then run it on saline with me back on oral medication.. I was origanaly on Morphine and clonidine, I must add here my pain annesthetist is so very good and would trust him with my life..
Whilst back on Oral meds I ended up taking 780mg of Oxy a day plus loads of other stuff nerve meds (lYRICA, AMYTRIPTYLINE,VOLTROL , loTs of antimetrics WHOOPS SORRY CAPS, PLUS MANY MORE.)Anyway this made me very ill and ended up in hospital for 3 weeks, I was given another MRI whilst In hospital and granuloma had not changed.
Before I was allowed home my dr decided So that I was not so sick, they decided to lower the takeme off Oxycontin amd put me on fentanyl patches, then put clonodine in my pump without saline and anything else hoping this might help disperse the mass.
8 weeks later unfortunatly I was admitted back into hospital for almost the same thing but very ill indeed they thought they were going to lose me.
My Dr siad after many other Drs had tried to insert a decent canula "I am a anesthetist and I cannot even get in a canula, my body was shutting down, they had to use my foot then that shut down eventually to just get blood they used my fermoral artery (only annesthetist) and I was put on a drink and food chart as my digestive systom slowe dright up and I could not take anything nor pass anything full stop!
My Dr deciced whilst I was I hospital he would do revision surgery trying to move the catherter down from T12 to L2 but he could not it was stuck and the biggest fear was a major bleed due to the artery's being there, all he managed was T10. And now it is still there but bigger, and my electric shots, numbness ect are so very painfull, If it was not for this Laptop my husband bought for me this christmass I would not be posting, I could not before and I still go in fits and starts. It as been a year since this all started.

The difference in procedures with the other guy from America is my Dr wants me flat on my back at 'Least 5/7 days (I maybe in hospital more than this I have been warned) this is due to my Dr changing my medications to maybe Dialudid and he siad as I have been getting say 12mg It could be leathall to give me this equivalent dose again as the morphine as been going somewhere else and obviously the granuloma so It will be like starting all over again so we have to titerate up very slowly.
Also yes Dave I am keeping pump in as it is now only 2 and half yrs old 3 yrs years this yr, (We just hope that by disturbing pump it won't upset it, as they have to make incision again in stomache removing old scar tissue to connect new catherter and remove old catherter) they also want to put in a new 2 piece catherter as mine is a one piece; plus due to them going into the dura ect to get to the pump and then also punctureing me again with new two piece cath I will certainly have headache.
This other Chap appranlty is having the same procedure I think but only spending one maybe two nights in hospital. Yes I would rather go home, Infact I thought I was, My Dr siad "no way you stay in', so it looks like I have not alot of choice, he also staed this is due to our ill I was all last summer being in and out of hospital he wants to make sure when I go home I am well this time :) ..
I must go now as I am hurting, Please ask me anything If I have failed to tell you, or anything else for that matter, And Oh yes I have older model, as My Dr as siad when I have next one It holds more medications, making refills less close together as I too usually have to go every 4 weeks. Origanaly I was told It would be about 10 weeks inbetween refills; mine maybe was as first but it got closer each time, I can't wait for it to be further apart as I hate going to hospitals, I get all heated up with them, My husband says he can see the worry in my face, Yet I should be used to it after all this time, and I have known this Dr I have for 11 yrs.

Take care for now.

Treacle, aka Diana :angel:
Hi Deanna, Again, I'm sorry to hear about the problems you had. In order to get 4 weeks out of the older synchromed pump with an 18ml resevoir, they would have had to use 30 mgs per ml, I was recieving 12.4 mgs of morphine per day when they decided to switch me to dilaudid. The nice thing was I started out with about 85 days between refills, but as the titration process goes on I'm at about 6o days now. Titration is the tough part, it took 6 months and 16 adjustments to egt to 12.4 mgs a day which I was very content with. Morphine workd well and I had little side effects. But as a matter of safety, they switched to dilaudid last year. Iiiiiiii had probalems with UA retention so we remved the bacloden we ahad added and that helped some, but for some reaon the dsose of dilauid I'm on plumeted testosterone levels and caused other problems so I wanted to switch back to what worked without the problems. I have the side effects pretty much under control using supplemets an other meds now but know I couldn't tolerate much more dilaudid. So the next step would be one of tehe fentanyls. The linci I go to has over 100 pump patients and they haven't used prialt yet eiteher. Appearently there is about a 20% chance of develping psychological side effects like hulicinations, pshychotic breaks, etc with prialt, and my docs consider that too risky. So they don't use it and have yet to meet another patient that has prialt in their pump. I guess it's not quite the miracle drug it was first reported to be.

In the US our insurance companies pretty much decide how long we need to spend in the hospital, :rolleyes: Doctors can always ask for more time and over rides , but it just depends on the problem. I would think that laying flat is actually a good thing to manage the spinal headache after the "IM " is removed. You're bound to loose some fluid during the surgery but with an incision, I imagine you would have some continuous leakage untill the dura heals and closes. Even the process of throwing up from a headacehe could open the incision back up.

So staying in patient and flat on your back is likely the safest way to recover from a surgery of this type although our insurance providors would prefer we take a chance and go home, rather than continue to pay for a hospital stay. That's one of our our biggest problems with healthcare, The final decision rests in the hands of those paying and the buisnes POV doesn't always agree with the medical POV. The insurance companies do hire nurses to denie doctor requests and medical procedures so that it appears there was some medical interpretation of things, but last I heard docs had a little more training than a nurse that reads froma a book what the average recovery time should be from any surgery.

When I went in to have my last fusion revised, I had broken the hardware and done damage to discs below and above the old fusion, the insurance company initially approved a 2 day saty. I wnent into the OR at 7am and came out at 7pm, according to their first prediction I should have been ready to go home the next day :yikes:. Fortunately I was able to stay a few more days for a 6 level fusion, there was no way the pain could have been managed with oral meds.

You did answer every question or give me the info to figure it out since I was on the exact same dose and refill schedule that you developed problems at. Very scary and I may have to reconsider going back to morphine or switch to something entirely different like one of the Fentanyls. Maybe someday they will be able to add a small amount of prialt to one of the opiates which might reduce the risk and increase the effectiveness of whatever opiate they happen to use. I've been the guinea pig enough times, so I think I'll let someone else step forward for that one.

I do wish you the best and understand about starting over and the titration process. I wish there was an easier and faster way to regain the ground you have lost, but hopefully with the new cath and dilaudid you will find a level of relief you couldn't reach with morphine and be able to go a couple months between refills. Try to focus on the light at the end of the tunnel rather than the dark part you have to pass though first.
Good luck, Dave
Thank you for your support and encouragement, I need it believe me..
Dave you mentioned your testosterone issues, I am getting a bit of an expert on this ;) I have had this happen to me too but on a womens term. Apparently it is very rare for this to happen to women who have a pump or on morphine, My periods ect(Hope this does not embaress you, if this does I appologise) Anyway this all went haywire when I was on morphine just prior to having my pump; then when the pump was implanted just a while later it got worse and I felt unwell, this started when I was 37 y/o and I am now just 41y/o I was put on the endiocrenologist team and they basicly told me I had almost zero hormones, no eggs at all if I had wanted more baby's I would need IVF (Has if I could have anymore!!) by now I was aged 39 y/o They siad I was way to young not to have periods and have put me on more pills to help me which have helped alot, Women usualy do not go into their menapausal years untill roughly 50 to 55 yrs and usualy daughters take after their Mothers, My Mother was 55 yrs of age so I should have had quiet away to go, They siad I had gone into premature menapause and would need help untill Im about 50yrs of age. The thing is Dave also the Drs at the time were so matter of fact with me, It was like telling a young man in his prime you cannot father children so tough luck! I have since seen someone more compasionate :) My husband too has testosterone problems due to a pituatary tumour he once had a few yrs ago, he as many hormone probs and other health issues and still works and looks after me and our 3 young teenagers he is a diamond truly. My kids have grown up with my back problems as It all started when I was 20 years young :bouncing:

Dave I know we have different ways our govements treat us re: health, But by god I do feel for you when you say sometimes they let you go from hospital after such a short stay, It must take you forever to recover, and say you have no-one to help care for you at home?

My dr is also worried about infection they are so very vigilent with all of what is going to happen to me. We only have about 10 pump patients at our hospital not many at all, most people have not even heard of intrathecal pumps where I live, infact each time I go into hospital the nurses do not even know how to care for me, most have never seen/heard of one they have to have a care plan from my pain team..My pain consultant always visits me each day whilst in hospital on the ward never anyone else. and if staff on that ward let me suffer with my pain at all they are in for a severe telling off..
Having this pump is a wonderful thing and I will still want it even after this alfull year plus other stuff that as gone wrong with it before this, It as worked once for a while, but I guess I have just been a little bit unlucky but things will get better, and hopefull longer times inbetween refills yippee!

Thanks again Dave.

Diana x