Discussions that mention morphine

Pain Management board


Hi,
I have long term back pain. 20 years. It is getting worse, so the PM&R dr.
says it is time to meet with the surgeon. What type of pain relief?

I am told the Electronic pain relief gives you approx. 50% relief the first year and down to 10% after 5 or 6 years. The Medtronics unit we were shown has a battery with a 9 year life. Does anyone have this model and if so, how do you like it? Does ANYONE have the pain relief from electrical ...uh...lines? Sorry, I don't know the technical terms. IF you have one of these units, would you use it again or get a morphine pump?

Morphine pumps: We are being offered one that has a battery operated pump. Are they any good? That is, do they seem to deliver sufficient morphine to stop the pain?

The other type of pump is hydraulic I think. Does it last longer than the electric ones? I mean, the electric version has batteries for power - - what powers the hydraulic version?

If I understand it, you cannot get an MRI or a pace maker with it in place.
How about airport security?

My PM&R doctor also said ...at my pain level...I would have to take meds orally. WHY? Why not increase the morphine dosage if you are still in pain?
AND I was told I could only get a 30 day supply of morphine, but I have read of people with a 60 day supply. The only reason I can see for me getting a 30 day is because I will use a higher dosage daily. But why can't we get a larger container?

AND....AND the final question (I hate needles) HOW do they get the morphine in to the container? I have visions of a velcro flap or a zipper. I don't see how any container could "reseal" itself every time a hole is poked in it. After a year, that container (rubber?) would have at least 12 holes in it. Doesn't it leak?

Thank you so much for your patience, since I will be asked to pick one in 2 weeks, I am trying to learn all I can.
The other pump you are referring to is a Codman 3000 by Johnson and Johnson. It seems as if Medtronics (battery operated) has been around a long time. I have a friend who just had to be cut open after only 5-6 years because of battery failure. My pump I believe runs or operates off of a freon type gas. They predetermine the mixture or strenth of your medicine and the pump constantly releases it continuously, but it seems as if I read a thread once by SHORELINE who by the way is very knowledgeable about this kind of stuff, be he seemed to indicate that the Medtronic pump does have advantages, like it can be programmed to give you more medication during the active hours when you need it the most, and less at night when you are resting. Research your options very well as it is a very important decision and ASK< and ASK and ASK questions so you can make an imformative decision. Luckily I have medicare and BCBS of Fl, you will need all you can get because I got the bill in for my last injection for Morphine/baclofen/Clonodine refill and the doctor billed the Medicare nearly 2600.00 for the one shot and I didn't even get a Bolus injection. The insurance comany only settled for like half of that amount but that is expensive for a 3 minute procedure that it takes to refill my pump. Good Luck, and mke sure you really reasearch all of your options before making a decision, The stiulator was never mentioned to me so I don't know anyghing about that only the pump combined with some breakthrough meds keep my pain at fairly tolerable level, but I seriously think that thier isn't any treatment option that will give you 100 pain relief, you will probably have to live with some level of pain, just try to get something that can manage your pain the best and try to deal with the rest of it. Good Luck and never give up.
Shoreline, let me try to answer some of your questions and perhaps express myself better.

My meds are Avinza, 180mg a day. Demerol 150mg a day. I take 90mg at 8am
and 90mg at 8pm. For me, it seems Avinza is not a 24 hour med, it is a 12 to 15 hour med. So by taking it 12 hours apart I am estimating that I will rarely have more than 120mg at any one time. My PM&R dr. had originally set my upper limit of Avinza at 120mg per day due to Respiratory problems. I think my current regimen should still be close to the 120mg he wanted.

I take another dozen or so prescriptions not related to pain.

I am not sure which pump he was referring to. Since I have not really held the units, and I have not spoken to any surgeons, I am guessing which unit I would want. I do NOT want a pump that sticks out where I can bump it. The DVD we watched had a large lump where the pump was. I would bang that on something and cause a problem. If small enough, I would like the 40ml unit.

If I had a 40ml unit, do you have any idea how long it would last if it were matching up so that it gave me equal to 180mg of Avinza? I think I am awkwardly asking how many days a 40ml would last if it gave me the equal to 180mg of Avinza.

What are "LA meds"? I do not understand that sentence in your post. "I use Roxicodone for BT but no LA meds..." What does LA mean?

You mentioned withdrawals. If you were away from home and might run out of morphine, can you use an oral morphine until you get home? Or do you have to find an ER ?

You make an excellent point. Who IS going to maintain the unit? I don't know.
It has not been discussed yet. I was told I WOULD get a remote control unit to maintain a proper ...uh...balance?

I understand none of these units will take away 100% of the pain. I never thought about how I would transfer from oral to a pump. Why did you do it cold turkey?

AND when I do the test run with a pump, how do people convert? Other than cold turkey. I would have to have enough morphine to keep me out of withdrawals. Whew, you are really helping me here. I had never thought of any of these things. Your comments are a real eye opener.

I initially had urinary retention and constipation. I found relief for both of those problems, or least enough of a solution I can "live with it." I just saw my urologist and she ran a lot of tests. Her conclusion was that my urology problems were due to pain. I am not sure how much of this urologist stuff I am allowed to say, so I will drop it with that.

I have read your posting a couple of times. You refer to a "50%" relief of my pain. Right this minute, at 180mg of Avinza, I feel like it has stopped 75 to 80 percent of the pain. This is the most relief I have had from my lower back since I hurt it again in June 2001.

I am medically retired. I was in the Air Force 20 years, so I have a retirement and medical. I am very lucky. My medical is Tricare Standard (PPO) and I pay for a supplement that pays the rest of the bill.

You have a good handle on the pain situations. We are lucky to have people like you to help us through these things.

hurtin4sure...A Codman 3000 was not mentioned. My PM&R dr. has his likes and dislikes, so he is sending me to the local clinic that does medtronics. I
certainly don't know one from the other. I wish I did know more. As both of you have said...ask..ask and ask some more. I will research what you have said.

Thank you very much. I have read the posts twice already and will read it again. Some of the terms are new to me...LA..dilaudid...the concept of only relieving 50% of the pain...a lot of food for thought...thanks again.
I had a morphine pump implanted about 3 years ago and will be glad to answer whatever questions I can for you about it.

I have DDD in 3 discs and after trying everything that was available to me and it failing and being told that further surgery was not an option, we needed to concentrate on a lifetime of pain control. My PM doc recommended doing a trial of the pump. That went well and we decided to go ahead with the pump. For me the trial period was about a two weeks long. It was not a matter of getting the dosage high enough, but to make sure I wouldn't have any reactions to the morphine. I had to go to the doctor's every other day or so to have it checked and the dosage adjusted during the trial. My PM doctor did the actual surgery to implant it and does all the monitoring of the pump.

I've had some success with the pump. It has brought the pain down when I do absolutely nothing. Most people get a much higher pain relief than I've been able to get, but with my back as bad as it is, I still have to take oral meds and am extremely limited in what I am able to do.

As you know there are two types of pumps. One works on hydrolics (the kind I have) was Arrow now Codman and the other by battery. The are filled differently and the dosages changed differently, so there is a big difference between the two. From what I understand the battery one has to be replaced every so often (forget how many years) to replace the battery - this requires another surgery. The hydrolics one works by just that and is expected to last for 20 years or more.

Has the doctor shown you the actual pump so you can get an idea of how it works and what it looks like? You can see pictures of it online as well to get an idea. They implante the pump resevour (about the size of a hockey puck) in your front (one important thing is to discuss placement with your dr. - mine was very considerate of where he placed it and it's just under my ribcage) and there is a cathetar that goes around your side and connects to a port in the spine. Mine has to be refilled about every 60 days. They insert a special needle into the pump and remove the remaining morphine (there are no preservatives added so they have to drain it each time) and then refill it. It's not very painful, less than having blood drawn or about the same, as long as you have a good tech.. With the Codman they change the dosage by increasing the amount of morphine that is filled into the pump, so it takes quite a while to get your dosage up. It has to be done in slow increases and for me it took months to get my dosage high enough.

Back to placement... if placed too high it can get up under your ribs, too low and pants would be difficult to fit. Even with mine where it is I have to wear low rider jeans/pants because a normal waist band is annoying.

The pump is not visable at all with clothes on, but does poke out some without clothing. The cathetar is almost impossible to find unless you feel around for it and the port in the spine does poke out a little.

It's difficult to say what dosages would equal what because they don't figure them like oral meds.. This is going directly into your spine so you don't have to take near as much for the same effect - plus your body is not having to have it going through your system. But I've found that most people still need to take oral meds to alleviate their pain. My pump is set at 30ml which is about as high as they usually will go with the dosage and gives the same amount constantly. There's this whole formula that they use and it sounds like Shoreline is much more of an expert in that department than I am.

As far as going through air port security - you are given an ID card and are to carry it with you at all times. You can then give this to them and they will understand what is going on. It's made out of titanium by the way. I've been through a metal detector at the courthouse and it didn't even set it off.

Appointments for refills are scheduled for a few days before your "alarm date" (when your pump will run out) and this should be taken into consideration when you are planning a trip, etc.. I don't know if an ER would be able to refill your pump for you if you were out of town. My doctor has to order my meds and they come in mixed and ready to be used.

I hope I was able to add something to what the others have already so wonderfully posted. If I can answer anything else, just let me know.

Good luck and please take your time making this decision. I'm in my mid 30's and will have this for the rest of my (God willing long) life. It is not meant to nor is it going to take all of your pain away. Please make sure you are dealing with a doctor that has a lot of experience with these and can tell you exactly why you should have one model over another and that is willing to answer all of your questions as many times as you need.

Take care:D
LA means Long Acting. Any medication lasting more than 8 hours is pretty much considered to be "long acting". The Avinza you are on is considered a LA medication.

I don't have any advice about the pump, I haven't had one. But I do have some concern regarding the reason why you are getting one. If you are at 80% relief of pain then your pain goal is met by medical standards. It is not the goal of any PM to have 100% relief, this is unrealistic for many reasons and your doctor may be setting you up for a hard fall and sometimes it can also lead to addiction through self medication because 100% relief doesn't last long and some individuals take it upon themselves to get back up to 100% when they fall short of it.

When an individual is initially placed on medications they've not taken before and the level is adjusted appropriately there's what one calls a "honeymoon period". This period of time is when an individual gets high levels of relief, 100% relief for instance. Because of tolerance issues and our bodies adjust this "honeymoon" or period of great relief can often be very short lived (weeks or months) and a certain percentage of pain comes back. The only way to get that same level of relief is to increase the levels of your medications.

As posted by Shore many times in other posts, you'll be chasing medications in the same way that an addict does and you may never get the amount of relief you believe you should have.

The actual goal of pain management has never been 100% relief, most doctors shoot for 50-80% relief tops because they understand that to give you 100% relief will leave you believing that you must always have this level of relief and again, it's unrealistic in the sense that you'll be on very high levels of medications before you know it.

I think the guys gave you some wise advice, definately ask lots of questions, especially as to why you are going to have a pump implanted and are you actually a candidate? Most doctors require a psychological evaluation and often pumps are left as a last resort for individuals who gain no relief from higher levels of opiods/narcotics. 180mg isn't that high of a level to be honest and if you have 80% relief with that you are getting more relief than the average person. Because you have stated you have problems with asthma on several occasions I would be concerned as to how you would react to morphine via the pump. What will happen when the day comes that your medication no longer stops the pain and you can't increase your morphine? Remember you are going to have to have surgery to have it put it and if there's a problem then surgery is the only way to remove it. It's a huge step, especially since you haven't tried diluad or fentanyl which are alternative medications that can be put in the pump. I would think that if you are unable to take that medication you'd be at a dead end when it comes to the usefullness of the pump itself.

Whatever you decide, I hope you do what is best for you in the long run and wish you lots of luck.
Charliecat31---
Thank you for helping me.

After reading your posting and the others I wonder about a couple of things.

1. Did you or anyone else get the option of an electronic or morphine pump?

2. Do all the pumps have remote controls? The two I was told about both
have the remote controls. In fact, I got the impression you could change your settings immediately if there was a problem....a spike in your pain.

3. The battery type seem to have a lot more flexibility when using it: Increase/decrease the dosage easily. Here is the question I want to ask and say it "just right". Let's say a person can adjust the dosage at any time. And suppose this person is receiving 15ml of morphine per hour (is it per hour or per day?).....anyway...if you are getting 15ml and hurting quite a bit, why can't you turn the pump up from 15ml to
20 or 25ml to stop the pain? WHY would you suffer if you can just increase the morphine dosage?

5. Trial periods ...did everyone get exactly ten days? Or if you are happy with it after four days, would they terminate it? I mean, really, we can get oral or a pump...right? Not counting an IV...not practical.

6. Charliecat31, one sentence you used...I didn't understand it. "I've had
some success with the pump. It has brought the pain down when I do
absolutely nothing." What did you mean by that?

7. The electronic pain relief unit they told me about has a battery that is guaranteed to have a 9 year life. And you can re-charge it while it is in your body. I wonder how THAT is done??

I understand what you are telling me. This is a lifetime commitment. I have heard of people having a heart replaced, and even replaced again. If these pumps fail you...can you avoid withdrawals with oral meds? Thanks again, I will read your posts several times before August 8th. Nothing happens fast.
I was told about the pumps in March 2006. I will finally get to talk to the doctor almost 5 months later. Glad I wasn't in a hurry. :)

Any other comments greatly appreciated.
180mg of Avinza equals how many Mg of morphine in a pump? There must be a chart somewhere to calculate what would be needed. Other than asking the dr.
where can I find a chart like this?

Any help appreciated.
Hey Dlfo, I happened to pick up the Kadian conversion book the manufacturer sends toPM docs. Just as an example, They were converting dilaudid to morphine, The conversion rate is anywhere from 1.3 to 7. That's a pretty wide range and everyone is different. The route of delivery makes a difference. Dilaudid is far more efficient when given IV than when given orally.

Like kissa said you not on a high dose and 80 relief is where docs should be considering cutting back if your not taking adantage of it and excercising, and doing something other than swalling pills to improve your condition.

If your concerned about respirtory surpression, you take the same risk of respirtory supresssion with Intrathecal meds delivered by pumps. Opiates are opiates regardless of how they are delivered. Eventually side efects will prevent you from further increasing wehter it's oral or pump. If you start out trying to obtain better than the 80% relief your getting with avinza, how much higher to you think you can go before you impaired by side effects, or can't pee without being cathed or can't have BM without being unimpacted weekly.

You seem to think it's strange that it took 5 months to finally talk about the pump as if it was somehow being withheld. I talked to my docs who do the implants and management themselves for 3 years before I did an actual trial. The first trial failed due to spinal fluid leak and I waited 6 more months before doing another trial.

The main question the pump doc is going too ask is why do you want a pump. If your answer is to get better than 80% relief when your already their with orals, A doc with any credibility would tell you to come back when you can no longer obtain pain relief with oral meds or just laugh you ourt of the office. Then again, he may be willing to make 30K for 2 hours work and straighten you out as far as what to expect. Once you have a pump, if the doc sauys I don't go above 2 mgs a day,which is equal too 600 mgs of oral morphine on some charts and youmay actually take a giant step back if he's not willing to shoot for the same absurd goal you want.

My dose was more than 3 times what yours is before I even considered a pump because it is the last resort. I was experiencing intolerable side effects and couldn't get better than 50% relief from orals. The benefit of the pump is it doesn't circulate through your body systemeically. If you take LA orals on top of a pump, you defeat every advantage of usig a pump. If your able to work now, and aren't satisfied with 80% relief, By the time a pump is relieving 100% of your pain and you have to adjust it at every visit to maintain that level, the drugs themselves will impair you to the point of disability. Is that exceptable in your mind. To trade yourbrain and other working parts of your body for 100% relief. Your not planning on having kids are you. I guess they do make Viagra and why shouldn't you have some of that, but cialis lasts longer so that's the one your entitled too because it's the better drug.

Just because they make a stronger med, doesn't mean you are entitled to a stronger med, better delivery system or even should consider a pump.

My doc said that when you can no lopnger obatin relief from orals or the side effects become to imapiring then we should talk about a pump. That made sense to me because I had resonable expectations. There is no amount of medication that would relieve 100% of my pain and leave me fiunctional.

As far as bolus doses, delivered with an at home telemetry device, THose don't change your settings or concentration, They simply alow a slight increase for a limited period of time. The reason they use higher concentrations like 25mgs per ml or 30 mgs per ml is because a patients dose is so high they have to come in so often it becomes a hassle.

I hopped between 120 mgs of meth and 600 of oral morphine "Kadian and generic MSC." But morphine is morphine. The initial conversion the doc uses will be between 100:1 and 300 1.

At 100:1 your morphine pump dose would 1.8 mgs a day devided by 24 hours.
That equates to a delivery rate of 0.075 mgs per hour. Although the home bolus telechnology is available, it doesn't mean you will get it, or the doc may remove all orals in place of a bolus device. The home telemetry uinit does not have the ability to increase the mix ratio/ concentration of the meds that are in your pump. When your meds are ordered for refill the doc chooses the concentration, whether it's 15mghs per ml or 30 per ml.

The only thing the home telemetry unit can do is increase the flow rate for a 1 or 2 hour period. If .075 was you constant flow rate a bolus would mean the pump would speed up and deliver at a rate of say .080 per hour for a couple hours, The telemetry device may be set to allow you to do this once a day or twice a day but parameters are set by the doc. Other wise they couldn't predict your refill date and these preservative free meds at whatever concentration with whatever adjunct med, have to be mixed by a compounding pharmacy. I live in VA and my group uses a pharamcy in Fla, so they need 2 weeks advance notice to order the meds.

Going from .075 to .080 doesn't sound like a lot but it's a %5 increae in what you were fealing and intrathecal meds don't require the large 10, 15% or 20% increases to make a diference. 5% can be the difference between tolerable and intolerable side effects.

If the doc goes on the conservative side, he would use 300:1 as your starting dose and your starting dose would be .6 mgs a day or .0025mgs per hour. . If you have a 40 ml resevoir, and the doc started on the wild side "wreckless" and used 50:1 conversion to start. 180 mgs of oral morphine would equate too O.2 mgs per day or .oo83 mgs per hour (.0083 X 24 hours =0.2 per day). Usingg 50:1 and a daily dose of .2 mgs a 40 ml pump will last 200 days with a 1mg per ml concentration. :rolleyes: I just don't see how a pump could not deliver enough meds to manage your pain. :dizzy:

How your doc that doesn't do pumps can predict you will need to continue long acting Avinza and BT meds even with a pump because the pump can't deliever an equivelant dose is absolutely wrong. The pump can deliver more meds than you ever considered possible. 5 months or 10 years from the time you began LA opiates isn't the time to think about the pump if your getting 80% relief. What unwanted side effects are you experiencing that won't allow you to increase the oral dose of avinza, not that should need an increase at 80% relief. You need counseling to learn to cope with the remaining 20%. .

continued.
You having a pump installed now would be like asking for a pump implant for sprained ankle. Your meds are giving you maximum relief with little to no side effects. What's wrong with the orals other than you see the potential for even greater if not absolute and complete relief? Good luck getting passed the psych eval and good luck trying to maintain 100% relief, you won't be able to and if you could it would be because your using morphine when tylenol would due. If nothing less than absolute relief is exceptable, you will likely wash yourself out of the proghram. To thinK you need a pump and to continue avinza is totally absurd.

I could flip flop between 120 mgs of meth and 600 mgs of kadian, they started my pump at 2.0 mgs per day. It took 16 increases over 6 months to get back to where I was with oral meds. How could you possibly tolerate les than 80% relief for that long? Are you willing to take a giant step back and spend 6 months titrating morphine? What if they can't find a level of morphine that satisfied you that allows you to urinate without a cath or you loose all labido or become impacted from constipation. The answer is they do a another conversion, start on the low side of dialaudid or fent and increase 5-10% at a time untill your reach relief or intolerable side efects. I've met folks at 18 months post op still trying to find the right med and the right dose.

However your not at that point now with orals so why would you consider a lifetime commitemnt to a doc you don't know. If he thinks the conversion is always 600:1 or 300:1. You don't know how this doc will respond to weekly calls for an increase when they start you at 1/10th of what you may actaully need. If you think 5 months is too long to wait for a consult, how are you going to manage 5 months to titrate your pump back to the same level of relief your geting now. Pump meds have the same potential to cause respirtory supression as oral med, IV meds or IM meds. Opiate are opiates. That's what they do.

God help you or the doc if you BS your way through a psych eval by adjusting you expectatins to make them sound right or reasonable. The pump is not the end all of all pain and your expectations are totally unreasonable. AIf I reported 80% relief they would ask if I wanrted to try to reduce my dose. Do you not get how outragous it is to expect a doc to continue to adjust and try stronger and stronger methods to knock a 2 down into 0 pain.

It's the last resort when relief can't be achieved through oral meds. You should be jumping for joy if you can work, meds are avilabele that provide 80%, relief but just knowing there may be something better out there makes you feel entitlted to whatever is used by anyone else. I have a pump, why shouldn't you?

At best my pump relieves 50% on a good day, 50% to me means I don't need my wife to help me stand in the shower when I bathe. You have no clue as to what you could be going through or the levels ofpan you could be dealing with. You haven't even had back surgery and you want the most expensive and highest tech device to manage your pain. Honestly you sound like the most entilteled, self indulgent and unrealistic patient I have ever met. Your not entitled to a morphine pump simply because they make them. Your just as entitled to a 3 or 4 level fusion that may heal you comletely so you don't have to spend the next 40 years dependent on opiates.

You may not like being at the pumps docs complete mercy. Docs that use pumps aren't any different than docs that use orals. Some docs won't exceed certain oral doses and some pump docs won't exceed certain IT "Intra-thecal" doses. What if your doc won't give you what you want, do you think it will be easy to find another doc to take over management and help you try and obtain better than 80% relief. Will you have it removed next year because you don't like the lump and it only gives 80% relief?

You're tied to this doc for life or untill he leaves the area, then your on your own to find another doc that has the 30K in aquipment to manage these things. With such a low dose or oral meds that are more effective than most CP patient will ever experience even during a honeymoon, I think 200 days is plenty of time to find another doc wiling to try and help, but I doubt you will have luck finding a doc willing to shoot for complete relief because you can't cope with the remaining 20% and believe you shouldn't have to experience any discomfort or make a single change in your life to accomadate your horiabbly dehydrated discs.

Shaving 3 strokes off your golf handicap is not a qualift of life issue that demands a med increase or a pump implant. So far you have said nothing to indicate oral meds aren't completely efective or as effective as any rational person would be able to except. You don't need a pump. You need counseling to learn to except the remaining 20% of pain that morphine isn't wiping out.

I don't even want to tell you any more because you may use it to convince a doc you do have relistic expectations or you are experiencing intolerable side efects just to get a pump that you think will relieve all your pain. The only problem is you have to find a doc that thinks that's realistic. :dizzy:

Giving you info on how to convince your doc because your not satisfied with 80% relief isn't doing you any favors. IF your presently working, how will you justify being too doped to work in 3 years if you continue on the same path. I hope your not married or have kids, because they seem to get upset when daddy can't be woken up again and is drooling on himself in the lazy boy.
That's where you headed. It would be one thing if you had 2 months to live. It's completely different when you have another 30-40 years and no concept of what's realistic to expect.

Thank god your geting the relief you do and cancel the pump doc, he may be just as crazy and proceeed with adeice that will need increases monthly the rest of your life to maintain your expectations..
Dave
:wave: Glad to help in anyway that I can. Here are some answers to your questions.

1. Electronic or morphine pump? I assume you are talking about a Spinal Cord stimulator vs. a morphine pump?:confused:
My doctor and I discussed the two at length and decided the pump was a better option for me. It's been several years and I honestly don't remember why the pump was better for me, so I can't help you much there.

2. Do all pumps have remote controls? No. The Codman (mine) does not. On mine the only way to increase the dosage is to increase the actual concentration of the morphine when the pump is refilled. It delivers a constant flow only. The other brand I believe you can adjust the settings, but don't know anything more about it.

3. Can't help you with this one, don't know how that would work.

5. (you skipped 4;) ) Trial period - I believe they do the trial period for a specific time to make sure how it is working out, so I would assume they would not terminate it early. The trial is very important to make sure you do not have bladder/bowel reactions, heart reactions, etc.. This should not be shortened or taken lightly.

6. My comment of pump controls pain down when doing absolutely nothing... If I lay in bed or my recliner and do absolutely nothing, the pump has helped with pain control. But for me, if I get up and do anything at all, the pump is not enough pain control, so I'm still faced with taking oral meds and extremely limited in what I am able to do. I've been declared Permantly and totally disabled by W. Comp and Social Security, even with the pump. And the pump does not mean you will receive SSD. It actually made my case harder because it was assumed I have better pain control.:eek:

7. No idea what this is. I'm starting to think you are talking about something other than the Spinal Cord stimulator and I have never heard of this electronic thing so I can't hellp you there.:confused:

I'm glad you are taking this decision so seriously. It is a big deal and something that requires a huge commitment. If you are able to avoid going to this extreme, I would. BUT... if your pain is [COLOR="Red"]not being controlled sufficently, then the pump is a good option. I've reread your posts and it sounds like you have fairly good pain control with what you are currently taking. The biggest advantage to the pump is that your entire body is not having to absorb so much medication and you would be able to lower the dosages of what you are taking orally. For me, being so young, that was a big factor. Not having to take so many narcotics, etc and having my liver and kidneys filtering them for so many years to come. But this is [COLOR="RoyalBlue"]not the only reason to consider having a pump implanted. There are so many factors that go into if you are a good candidate or not.

Another thing you need to understand is that it takes many months :eek: after the pump is implanted to get the dosage up to where it needs to be. I believe it took me approx. 6 - 8 months to get it up as high as mine is. The increases have to be done very slowly, is why it takes so long. During this time you will probably be going to your doctor more often than the every 60 days for refills. I don't remember if I mentioned that I would expect that most, if not all doctors would have you go through a pysch eval before implanting a pump. The answers you provide are very valuable to your doctor in determining if you are a good candidate for a pump, so please be honest in this eval.. It's also important to talk to your doctor before hand about how high he is willing to go with the dosage in the pump. I'm not sure if all doctors are willing to go as high as mine did with me, so you need to take into considerations what limitations he may have.

Not all PM docs fill pumps, so if your doctor retires, moves or you move out of the area you are going to have to find another doctor that fills pumps. My doctor actually has a patient that travels over 1,500 miles to see him every 2 months because she had such a hard time finding a dr. she liked when she moved. This is something you also need to take into consideration.

Thene there is the cost to consider. I believe my doc told me that the pump alone is $20,000 PLUS! Mine shouldn't have to be replaced, but there are very few people that have them implanted so young, so there is always the possibility that I will need a new one down the line. That means a new pump, another surgery, etc. and another very large bill. I don't know what kind or if you have insurance - but if you do, you better make sure that they cover pumps, refills, etc.. The refills alone are expensive!

I honestly believe that the decision to have a pump implanted is a very personal decision and that you have to consider ALL the pros and cons about. [COLOR="Magenta"]Ple[SIZE="4"]ase - talk to your doctor at length about it. Is your doctor the actual one who will be doing the surgery and filling the pump? If he's not, you need to make an appt. with the one who will be. Ask him all the same questions. Write down all of your questions and take them with you to your appt.. One thing that I found was helpful when I've had a lot of questions is, I fax them to my doctor as far before my appt. as possible and that way he has time to go over them at his convenience and then can basically just tell me the answers when I'm there. Of course you can take more questions with you if you think of them after. Another thing is when I take questions to my appt. is that I write them down and leave plenty of room between the questions so that I can write down the answer when he tells me. That way I won't forget what he said.

Please make sure you are dealing with a doctor that has A LOT of experience with pumps. Some doctors out there do not and I would assume could make a great deal of money off them. However, you will be the one to suffer from an inexperienced doctor.

I wish you much luck in making this decision. Dave (Shoreline) has some compelling things to say and I hope you will take them into serious consideration. The wonderful :angel: people on this board are full of information and compassion and it is wise to listen to what they have to say.

If I can answer any more questions, please let me know. Take care and again, good luck in your decision.
I think Dave makes some very compelling points that should be carefully thought about before going ahead with a pump. I am a bit disturbed that a doctor would willing place a pump in a patient who has greater than 70% relief, has not tried different medications and has not had surgery to try to resolve the problem. Perhaps the doctor has planted unrealistic expectations as to what a PM actually does?

I know that we all strive to be as pain free as possible and sometimes will do almost anything to achieve that goal but we need to be realistic in terms of what medicine can actually do for us and what may happen as a result.

I've been a PM patient for about 3 years and have been on morphine for 2 of those years. I get maybe 50% relief on a good day. I have gone through 13 surgeries with #14 in 2 weeks. I have days where I can't even walk the pain is so severe and life as I once knew it has long since gone. From what I'm understanding by your doctors standard I too would qualify for a pump but it's something I personally would not do at this point in life when there are still other treatments I've not tried.

I guess what I'm saying is please really think long and hard about this and also consider other options first. Having the pump and getting greater than the standard expected relief almost gives cause to not ever have surgery and in turn the longer you put off surgery when viable the harder it is to heal and the more complex a surgery may become. I would really hate to see you create new problems while trying to fix a current one. Understanding what the actual goals of PM really are and accepting that you may never be 100% pain free is essential, without it you'll be chasing dreams for many years to come

all the best
Barb
I have read all of your posts. I thank you from the bottom of my heart for taking YOUR time to help me. You have shared not only your pain, but I can get glimpses past your pain into your emotions. Pain is difficult to quantify.

At my worst, I have fell out of my LazyBoy, writhing in pain and if the house were on fire, I cannot say I would be able to get out. I have said this before, and I have read it a second time. I am not good at expressing..at quantifying pain. After hearing of your experiences and how you handled them. I hope I don't have to go through that.

I will cover a couple of things, then want to try to cover your comments in more detail.

Right now, I am leaning AGAINST getting the pump. The way my doctor approached this ...was..like everyone got these pumps and it is just the way we do things. I am not exaggerating much.

I have learned so much from you. I wish we could all sit down and I could buy you a nice dinner....at the drive-in window of your choice :)

Seriously, I have only scratched the surface of this pump thing and thanks to you I am so much better off. What YOU tell me makes a lot of sense. IF my
oral meds are taking care of it, WHY get a pump?

The only reason I can think of is that the pump should allow you a better life. In that your body does not have to deal with all those opioids. I hope I am saying this right....If I was on a morphine pump, in theory, I would be using much less morphine. My brain would not be subjected to it in such high
dosages. It would be easier on my body? No?

I have so many questions I want to ask, but I don't want to take unfair advantage of your kindness.

FIRST: Wouldn't a pump be easier on my body? Less morphine?

Secondly: NO ONE at my doctors office has EVER mentioned blocking my pain
at the 50% level. Both doctors appear to me...uh...it seems their goal
is to stop the pain. Period. I am 60. Not young, not old...

Thirdly: I am confused. But in a healthy way. You have spent so much of
your time helping me and giving me a LOT to think about.

Fourth: IF I get a pump and don't like it...why not turn it off and leave it?
Would it hurt my body if it just sat there...not putting out drugs?
That question sounds dumb to me...but I am trying to ask you ....
uh...I guess I am asking just that. WHY take it out?

---------------------

I deleted the end of my posting. My brain is on overload. 2+2 = 5. I think I had sort of walked in to this forum thinking I would have a pump. Period. And life would be better, with few pain problems. Thank you again. We are so lucky to have you helping us. I do not trust my memory, so my wife goes with me to every dr. appointment. Nothing wrong with her memory. She does not remember my dr. covering ANY of the things you are covering. Maybe he thought I would back out if he did. If I didn't mention it, I am retired. Have been full time retired since the end of 2003. As for the SSDI thing, a local attorney who does nothing but SSDI cases reviewed my info and said it should be approved first time in. I have NOT heard that before, but he says they are getting easier to work with lately. I hope so. I just don't have the emotional energy to fight them. I used to love a good fight, but not anymore...thanks again.....
Hey Dave
About the spinal fluid leak - my doctor also said that hopefully it would heal on it's own. Hope knowing that another doctor said the same thing as yours makes you feel a little better that your doc was telling you the truth. Unfortunately it didn't fix itself and I had to go in for the blood patch (which like you was done in the clinic). I layed in bed for 36 hours or so experiencing pain like I never knew existed. Plus my doctor is about 70miles away:eek: , so my husband rented a van and put a blow up mattress in the back to get me there because I couldn't even sit up. Within an hour or two after the patch I was feeling like I atleast wanted to live. They kept me in the recovery area of the clinic for 6 hours or so to make sure I was doing all right and then sent me home. By the next day I was back to myself and have never had a problem since. I don't remember feeling much of anything when they did the patch - maybe because my head was in so much pain that I didn't have feeling left anywhere else in my body.

I was just granted SSD a few weeks ago and am still waiting on the figures. It was a long battle and it's been hard to accept that this is my life and I will never see any improvement:( . It's been over 3 years of filing, appeals, hearing, blah blah blah and I'm so glad it's finally over. My attorney was concerned that I wouldn't be approved because of my age, education, work history, but I was. Chronic pain is not one of the cryteria that is listed for approval,:nono: so getting SSD was very difficult.

I've actually been told that my discs are so bad that more surgery is not an option, so it was then a matter of life long pain control. I had my pump implanted a little over 3 years ago and there were so many things I had to take into consideration when making the decision. It's not a solution for everyone and quite frankly I don't think it should be an option for all pain patients. But for me, it was the right choice.

DLLFO - I'm glad to hear you are taking so much effort into researching the pump. I know it can all be a little overwhelming, but it's worth it to make a very informed decision. If you are getting the impression from your doctor that everyone gets pumps, then run as fast as you can (or slowly walk away:D ) and do not return to this doctor. Of course, make sure you have another doctor lined up first. Pump, spinal cord stimulators, etc. should be reserved as the treatment of last resort and only after careful consideration of each individual patient.

What you said about the pump allowing you to decrease your oral meds is true. You would be able to decrease your oral meds and therefore your body would not have to filter (for lack of a better word) the meds through your system. However, this is not and should not :nono: be the only reason for going with the pump. It is something to consider, but not the only thing to consider.

Please feel free to ask all the questions you want. If I get tired of talking to you, I'll let you know (JUST KIDDING:jester: )! Now, on to your questions...

Pump easier on your body - yes [COLOR="DarkOrchid"]AND no. Yes, you would be taking less morpine orally, but you are also subjecting yourself to surgery and complications. It is possible to get an infection at the site of the refill injections and this can be extremely dangerous. This is a possibility each time you have the pump refilled.

:confused: Blocking the pain completely????? What a nice thought! In a perfect world perhaps, but here in reality, I don't think that is possible for the majority of chronic pain sufferers.

Turn off the pump if you don't like it? I'm sorry, but that you are having this thought at all says you shouldn't have a pump implanted. No, you can't just leave it in your body without having it refilled. I actually talked to my doctor about this specifically because I wanted to know what would happen with my pump if I decided to get pregnant. I wouldn't want the morphine in my system at all, so I wanted to know what my options were. He said I would need to have the pump filled with saline on the same schedule to make sure the pump didn't go dry. Once you have the pump put in, it's a lifetime commitment of refills, doctor's appts., etc. This is part of what the trial is for, to see if you have any adverse reactions, etc.. Bottom line, once the pump goes in - it's nothing to screw around with. Also, you are talking about an extraordinarilly LARGE amount of money to have this done. If I remember right the pump alone is upwards of $20,000.:eek:

I'm glad you found this board and are finding so much information that your doctor isn't covering with you. The fact alone that he's not discussing this in such great detail bothers me.:blob_fire This is nothing to take lightly and I'm glad you are realizing that. I'm also glad your wife is so involved, this is definately a time when you need a strong support system. I don' t know what I would have done without my husband. It put a lot of strain on our marriage, the pain, the battles, the financial problems, but we made it through and are still going strong.

Hang in there my friend - and feel free to post all the questions and concerns you may have.
Take care
MORPHINE PUMP OR ELECTRONIC PAIN RELIEF? WHICH ONE? BOTH!!!

I spoke to my PM&R "person" today. Not the doctor. But he seems to be pretty smart. I asked him if I was on 180mg of Avinza and felt like I was about 80% pain free, what would he say? He said I have only been on 180mg a day for a short time. He is waiting for my body to settle down. After a month at 180mg, if I said I was 80% pain free he would cut back on the morphine. Say to 150mg. He said if they can get my pain cut back by 50% he would be happy. HUH?
I have asked my wife and she said before our questions, they had never, ever said anything about cutting the pain back to only 50%. (I worded this wrong initially ---Ya know...when you go in for an edit and misspell the word you thought you were correcting, it is time for adult supervision...)

Then again, I AM on morphine and demerol.

Another question of him today...if we put in the electronic model, that reduced the pain thru electricity...and after a year it did not work very good....could I take it out and get a morhine pump? He said yes. IF my electronic pain relief unit was not cutting the pain, my insurance would pay to have the electronic unit removed and a morphine unit put in. I called Tricare (my insurance) and they said yes...but again, only thru medical necessity.

It is so hard to know what to do. Again, if I am now 80% pain free..why would I need a machine? No answer. Next, I need to figure out what questions I want to ask the surgeon. Thanks for all of your help so far.

EDIT COMMENTS: My apologies, meds catch up with me and I can't ...express myself
correctly. If you read one of my posts, and it is backwards, that is, you can tell I have
written it wrong...please smile and realize it was NOT intentional, but at least I was "feeling no pain" at that particular moment. Thank you so much for not getting mad at me. I have seen that on some forums.
Good morning Charliecat31,
It looks disgustingly like I am going to live. I got a get well card from some friends...something like..."We hope you are feeling better" *
* By a vote of 14 to 11.

I am juggling between Mylanta and pain meds. For some reason my acid reflux is acting up. I have partial prescription of Prevacid, Nexium, Prontonix (something like that) and something else. I was told by the PM&R dr. Mylanta and nearly any other anti-acid will change the PH of my stomach and "bind" the morphine.
Soooooooooooo I will take the Mylanta, wait two hours and take the Avinza.

Thanks for asking....oh yeah...we have almost 20 kids, grandkids and friends of the grandkids here. One of our kids brought their "toy hauler", so ten slept out in that and the rest flopped around the house. Maybe valium would work?????
:) I am just kidding....hope things are going well for you...Dave
Yes Mam, last of the kids/grand kids leave at 6am tomorrow
morning. I will get back from the airport just in time to load
all my "films" and head over to Folsom, CA.

This Dr. (not sure if we are allowed to use Dr. names, so I did not) but he seems to have some positive things written about him.

I am not sure if I am just nervous or a little scared. I feel like a MAJOR chunk of my next ten to twenty years will be covered tomorrow. I know you have been there and done that. I see you have survived and with a wonderful sense of humor and camaradarie.

Right now I will just shoot for whining and sniveling. I am the guy who will not watch them give a shot on ER!! I am
NOT kidding. I hate needles. That said, I was on World Wide Alert with SAC for a decade and many tours to South
East Asia...my shot record would have papered an office wall. In fact, we were among the first military to get shots with an air gun (so we were told in July 1963..I was 17).

I already have thoughts like...ok, I get the Morphine pump.
I get new morphine every month (30 days???). What if I want to travel? Do you arrange to go to a clinic or hospital to get your morphine? Would you trust another institution to do it correctly? I already get one series of shots every 3 weeks. Which reminds me...here is one you have never, ever heard of. As we men get older, certain parts of us have problems and "voiding liquids" can be difficult. My
Urologist just did a cystocopy on me and said my problems are due to my pain. My BPH is an error in diagnosis. I did
not stutter, my BPH was an error and if I can get rid of the pain she thinks my other problem may go away. My wife went with me for this procedure. She verified what the dr. said. If I said something out of line, I apologize profusely.
It is directly related to pain. Has ANYONE ever heard of this before?

You have been so wonderful, I can't tell you how much help you have been. Thanks for helping me with my baby steps in this journey. I am so lucky to have a great, supportive wife and a group like you. Thanks again.......
I think those are great questions to ask your doctor before you give the go ahead with the pump. I hope that you've done the right amount of soul searching before comitting to it. With all the problems you've had with morphine I think there'd be a level of concern.

As far as voiding, this is normal with narcotics, especially with Morphine and Methadone I have noticed. I do not think getting the pump will rid you of the problem. I still have problems intermittently with oral Morphine and when I'm on a PCA machine it's worse. Generally it does subside over time but if it doesn't you might want to question the doctor about the morphine itself. If you search through the boards you will see that in fact many of us, men and women alike, have had problems voiding or urinating.

I do believe you are allowed to share doctors names but you can not share their address or phone numbers or contact info.

My guess would be on the pump as far as refills that you most likely couldn't get it refilled by any other doctor other than the prescribing doctor. I know others have mentioned in the past that it's been difficult to even find a doctor who will fill a pump after their primary doctor has left their practice so I imagine it would be even more difficult if you went on vacation. I would surmise that you'd need to schedule your vacation times around your refill times just like most of us do in scheduling regular PM appointments.

Good luck!
WOW...I never saw THAT coming. After all my prep this doctor set us down for
over 2 hours, explaining how he can fuse my spine.

He swears he has never had anyone who didn't come out better that they went in.

I asked about the morphine pumps, etc. and he said we could do those, but he thinks I should stronly consider the surgery.

WOW...Have any of you had back surgery??? I haven't. I am stunned.

I won't have back full mobility, but most of it and I will lose approx. 80% of the pain.

He also explained the discogram. He and the doctor who did my discogram are good friends. The way he explained it made good sense.

I will get a second opinion. In the hosp. 5 days...hmmmmm. He did not get into how much of my mobility I would have in it. He did say my discs from
S1-L5; S5-S4 are shot. We knew that. But the discs above that are as good as a twenty year old could have. That is good.
OK my friend, let me answer your questions as best I can about the pump

Yes you get new morphine with every refill. They don't put any preservatives in it so they drain out what's left (a few cc's) and put in fresh. Depends on the type of pump and your dosage, but most pump refills are every 2 months (to the best of my knowledge).

Having it filled somewhere else? Don't think this is possible. The meds have to be ordered so it's not like you can just walk into an ER or a clinic and have it filled. Best thing would be to have your pump filled as close to when you want to go on vacation and then have an appt. scheduled for as soon as you get back if you want to be gone for that long.

On to new business:D :D You spend TWO hours with your doctor?:eek: As wonderful as my doc is, I can't even fathum a 2 hour appt.. However, that's wonderful that he spent so much time with you and your wife explaining all the details and options, etc.. I haven't had surgery (only IDET), so I can't help you with any of that. My discs are so bad and so many that I'm not a candidate for fusion. Only advice I can give is take your time deciding what YOU want to do. Every surgery has risks and you could end up worse. But on the plus side, you could end up a heck of a lot better. Take some time, think about it. As you come up with questions, write them down and take them to your next appt.. What are his success rates? Can you talk to some of his patients that he's done surgery on? Those types of things. If he's saying he's never had anyone come out worse than when they went in that can mean a couple of things in my mind. #1 he's stretching the truth or #2 he's very thourough in determining who's a good candidate and who's not.

I'm so glad you have such a wonderful, supportive, caring wife - I'm sure she'll help you get through all of this. Sure don't know what I would have done without my husband during all the ups and downs of the past years.

As far as the voiding liquids goes - sorry, can't enlighten you any on that one.:D

Just keep taking those baby steps... And keep me posted as to how you are doing.:wave:
24 hours later...surgery?????

I was having a bad day yesterday, I cut my Avinza back to 5 a day, from 6.
Trying to avoid the stuff if I can. Last night I wished I had the 6th one. I am
taking baby steps. I am not patient enough with myself. After 10 hours of sleep I am doing better.

I discussed the "success rates" with my wife, but she said she looked looked up Lumbar Fusion in the internet and the article she read said the lumbar fusions were as successful as the knee replacements...which apparently are VERY successful.

I will probably do it, but it is scary for me. Pain hurts, we all know that. BUT it is the devil I know. Surgery, and the potential problems are scary. Does that make sense?

We have all been scared at one time or another, but this surgery is a Life Altering event. If I am in the 8% of failures...what happens? I asked the surgeon what is the worst thing that could happen? He thought a minute, and I do mean a minute (I was about to ask my question again) when he looked up and said, with a straight face......Death.

I almost laughed. I do NOT consider death as the worst thing that could happen to me. I think being crippled for life, in major pain, would be far worse. That would be mental and physical torture for me.

I am not sure I can mention his name or location, but WOW, I have never ever had any doctor spend that long with me. Professionally I mean.
AND we are supposed to get a second opinion, then see him againl. He said
5 days in the hospital and about 6 months of recovery...whew. I guess if I fully believed it I would sign up today. I am not sure I am making sense.
While I don't like this pain I am in, I am coming to understand it (thanks to all of you helping me).

I will go to the other sites here to learn some things, but I would think the people on our forums are the 8% whose surgery went bad. NO???

WOULD YOU TAKE SURGERY TODAY TO POSSIBLY HEAL YOUR PAIN???????
Would you??? Think about the great unknown versus what we have. Yes, I am in pain. Excruciating pain at times, but I can walk most of the time. He said no one ever came out worse than they went in?? I would agree, if he is telling the truth, and I have no reason to doubt him, they would almost have to hand pick their candidates. He sure grilled me. Have I ever smoked, do I drink excessively, do I do illegal drugs? I am to get a physical, an EKG and several other medical procedures first. Hey, you are right...he is "picking" his surgery candidates. Probably smart of him. He doesn't want a person on his operating table with a bad heart. Any possible surgery is at least a few months away. I would prefer January. Slow part of the year for me.
I also asked him how we get me off morphine after surgery? He didn't answer that question. He asked me another question and went on.

How do we get off opioids after surgery? I am hoping to be back on 4 Avinza's a day by the time I would be getting surgery. 120mg.

In closing, he spent a long time explaining how the discogram is read. HE REALLY understood it. He went thru every MRI/CT and XRAY we had there.
He pointed out that all of my other discs were as good as a teenagers. Then there is one Vertabrae that is sliding forward, just putting a new disc in will not help me. I wish we all had doctors like him.