Discussions that mention morphine

Pain Management board

Hey Alan, For me it was a matter of side effects, I couldn't reach a managable level of pain relief without overwhelming side effects. For others, they may simply not be able to find a level of pain relief with orals that allows them to function or even find a level of pain relief that's satisfactory when sedentary.

I didn't have prescription insurance for the 2 years prior to my implant so the only alternative was methadne . I had been on the same dose for 2 years and when we went from 120 mgs to 150 mgs, I just felt like crud all the time. No motivation, no labido, the sweating, nodding out, etc. Without insurance, although LA morphine worked well it just wasn't an option to spend 800-1400 bucks a month on Kadian or generic MSC.

There are also other things to consider, your DX, your prognosis, your ability to work or not. I have looked into finding something part time to get out of the house and help a little more with the finances, but I'm finding many employers really aren't looing for employees with implanted morphine pump. I would like o go back to school this fall but I'm wondering with training in a different field I would even be able to find work with the pump in me. It would certainly limit some prospects, anything that required a security clearance, anything where the employer may be put at risk for liability if I was traveling or driving while at work. There really aren't that many working scenarios I can think of that are suited with a pump do to potential liability

I would think many of the working folks taking meds don't tell their employers they are using opiates to manage chronic pain, it just brings up to many liability issues.

I look at the pump as a lifetime commitment that requires careful consideration. It does have many advantages like the ability to deliver a much higher dose before I hit the side effect barrier. I know most folks don't feel impaired by their oral meds as I didn't, but when you switch to a pump it's really amazing just how much you head does clear.

There are negative aspects of the pump too, It throws your hormanal system and metabolism out of whack. Sexual dysfunction is a common problem with pumps and I have to make a choice between function and pain relief or find that balance of pain relief and still be able to function. When talking to my doc, he explained sexual functinal isn't as big an issue with a 60 year old as it is to a 40 year old. I certainly can't speak for every 50 o 60 year old, but I would certanly like to remain functional beyond 60.

If you know you have simply reached some barrier with an individual doc who won't increase an oral dose, but you knw you can tolerate a higer dose without severe side effects or great impairment, I wouldn't cave and make a life time commitment because the doc you happen to see wn't use more than one 100ugh pathc at a time or won't exceed X dosage of whatever med you happen to be on. It takes months of titration and md changes to find what works best with the least impairement and you could certanly find another doc in the amount of time it's taken to titrate my pump with each med change or adjustment. It took 6 month to titrat morphine only to switch to dialuaudid after I found a godworking dose., I tried adding Marcaine but that caused to many UA problms, I tried adding baclofen and that caused to any problems once we went beynd a certan level. So it's still alot of trial and error and you need to have a doc you trust that's going to continue to work with your pump . If anything, pumps require more attn and more adjustments than oral meds to find the right dose, right med, and righ dosing schedule. So if the problem is with your docs beliefs, having the same doc implant a pump, you would likely run into the same problem regardless of delivery method. Just as some docs won't prescribe more than 1 100ugh patch, some docs won't exceed 5mgs of IT morphine or won't exceed 2 mgs of intrathecal dilaudid.

I truly have respect and a great deal of trust with my docs whether it's oral meds, pump meds or managing side effects. If you have any concerns about your doc, find a doc your comfortable with before you consider a pump, because you're basically turning complete control over to the doc with a pump.
Good luck, Dave
Hey Guys, My problems are all spinal, 3 failed lumbar surgeries 2 were fusions where the hardware broke because of non union of fusions. My pump is implanted in my lower abdomin and is slightly smaller than a hockey puck. A cath runs around my side and is inserted at L1/L2 into the intrathecal space and anchored to a vertabrea. I have heard about pumps being implanted in the hip but I can't imagine having to sit on the thing.
The new pumps have a 40ml resevoir where the older pump like mine have an 18ml resevoir. The size of the resevoir, flow rate, concentration of medication and the med used determines how long between refills. Obviously 10mgs per ml isn't going to last as long as 30mgs per ml.

I would be shocked if a GP invested the money into the telemetry units to program and read the pump, It's something your would more likely find at a PM clinic or a PM specialist that manages more than one patients pump.

Because Dilauid is stronger than morphine and fentanyl is stronger than both, the med makes the biggest difference in how long between refills. Now my pump is set at 5.1 mgs of dilaudid per day and I go about 75 days between refills even with the smaller resevoir. I started with morphine but even at 30mgs per ml I was only going 28 days between refills and recieving 12.5mgs of morphine per day. Obviously you would use less of a more concentrated med solution or a stronger med and have even more time between refills.

As far as side effects, If oral morphine caused nausea, you would likely achieve relief before you were given enough morphine via the pump to cause nausea, so it would still be worth trying. Just to give you an idea of the difference in strength of oral Vs Intrathecal morphine, My last oral dose of morphine was 600 mgs a day, my last dose of IT morphine was 12.5 mgs a day. They switched me to dialaudid because of the risk of developing a granuloma at the tip of the cath when they reached a concentration of 30 mgs per ml. Morphine just isn't as soluable as dilaudid and fentanyl.

By switching meds, I can go more than twice as long between refills and don't have the risk of developing a glob of insoluable morphine at the tip of the cath in my spine. A granuloma can block the cath, and cause spinal cord problems if it grows large enough and it's a dangerous opertion to make an incision in the spinal cord to remove and replace the cath.

Just to be clear, the pump is not a cure all, it's just a tool and the goal most docs shoot for is 50% relief. 50% relief to one person may mean they can return to work, 50% relief to me, means I can stand in the shower without help.

The biggest advantage is the clear head because oral drugs run through your entire system where IT drugs stay in the spinal cord where you have exponentially more opiate receptors than anywhere else in your body. Pump meds are adjusted just like oral meds, there isn't a one dose fits all and they usually increase in very small increments, an extra mg of dilaudid per day is a hge increase. They started me at 2mgs of morphine per day and it took 6 months and 16 adjustmants to reach 12.5 mgs of morphine a day.

Another big advantage is the ability to program the pump to deliver more at certain times a day. For example My pump increases the flow rate by about 20% from 7pm to 9am, and then slows back down for the day time.

When they do a trial they usually do a psych screen and then can either inject a single bolus dose IT or set up a pump and catheter to deliver meds for a couple days while in patient. If it relieves 50% of your pain it's considered a success and they schedule the implant.

As far as side effects, because your given so little compared to orals, you can avoid some side effects that large doses of orals would cause. Nausea, Drowsiness and itching have never been a problem with the pump where it would come and go with orals. The side effects that are similar or more common are constipation and urinary retention.

They do use pumps for problems other than back pain, but if you have nerve damage or sciatica, a spinal cord stim may be the better tool to help manage your pain.

There are two different types of pumps, Battery operated that are programable but the pump unit itself must be replaced every 3-5 years when the battery dies, and a vacum design that delivers a constant dose controlled by the concentration of medecine they fill the pump with. There are also adjunct meds they can mix with opiate solutions like Bupivicaine/Marcaine to add some numbing properties, Baclofen for spasm or spacticty or Clonodine to enhance the effects of opiates.

The amazing part of the pump is how clear your head feels, it still has limits as far as pain control unless you willing to be sedated. Having realistic expectations of the relief it can provide without knocking you out is what makes the difference betwen someone satisfied with their pump and those disapointed. If someone thinks it's going to relieve all their chronic pain, they will likely be disapointed because comlete pain relief is not the goal in treating chronic pain and can't usually be obtained without sedation..

You still have to find that balance between pain relief and function which means you still have to learn to deal with some degree of pain or discomfort. If they increased my pump to relieve all my pain, it would simply become an internal anesthesia device and leave me sleeping 20 hours a day.

If I missed something just ask.
Take care, Dave