Discussions that mention tylenol

Pain Management board


Hey Pat, We are not alowed to post limks to other frorums but if you do a search for Pummpsters, you will likely find the forum composed of nothing but pumpsters at Yah..

It's membership is nothing but pumpsters and people looking for pump information.

The couch potoatoe thing tinks and when the meds start hindering you more than they help you , I think you have reached a point where you need to consider something more invasive. There are plenty of folks that take 5X the amount of opiate mds you atke, Oxy doses in the 800mgs a day range, I';ve met folks taking 160mgs of meth 4 times a day, But it comes down to benefit VS the negative aspects of meds. The goal isn't to make you a tater, THe goal is to keep you moving. I defnitely move more and have had to do more because of an inury and DX my wife recently found. I've been able to keep up so my activity level s much higher with the pump, I just pay for t it a little more at night, but thank god for bolus doses with the SYnchromed pump. From &pm to 1am my pump rate increase from .350 an hour to .400 an hour. Since removing the bupiviacaine I also lost some ground but I wasn't ready to do the self cath thing and that was the main reson for removing the bupivicaine. The other meds I mentioned can also be used and here are 2 articles that exlain CP and the meds used, how they work and why.
Dr Danial brookoff, University of Tenn at memphis....
[url]http://www.hosppract.com/issues/2000/07/brook.htm[/url]

[url]http://www.hosppract.com/issues/2000/09/brook.htm[/url]

I understand about not wanting to stop or you may not be able to restart. i face thesame decision with a wheel chair. I could certainly be moremobile, travel and take my daughter to any number of local theme parks like Busch gardens and kings dominion, But I know once I give in and and go the wheel chair route, I'm afariad I'll loose the strength I have and the muscles will atrophy and eventually the chair won't be a choice. There are meds that can be addedorally that don't have the cognative impairment like Nemanda, a potent NMDA receptor blocker which you will reas about in article one.

I also think your conversion from meth to oxy is on the low side and there are certainly stronger BT meds that don't conatin tylenol. Roxicodone or generic roxi is available in 5mg, 15mg and 30 mg strenghts without the tylenol, However I do believe there is a benefit to using a different BT med than your base med due to different opiate receptor activation. Different opiates bind to different receptors. There is room to make adjustement orally but if you have reached the side effect threshold the pump may be the way to go.

It is a process of titration all over again, nobody gets the dose right the first go round, but if you look ahead and keep your eye on the light at the end of the tunnel, the pump can do things without all the cognative impairment that orals cause because IT meds don't run through yur body systemically and the amount used is minuscule compared to oral opiates. My present daily pump rate is only 8.6 mgs of morphine a day. Qiuite a strep down from 600mgs of Kadian or MSContin a day or 150 mgs of meth a day.My heads clearer, constipation isn't as bad, urinary retention isn't as bad and I can sleep so much better , 5 years of never sleeping more than 3 hours defnitely takes it toll.

Good luck with your trial, but they are going to shoot for 50% reduction in order to justify such an invasive procedure, It may take several trials with adjustments or several different trials or versions of trials with different meds. As long as your doc is commmited to helping you and you know up front what to expect as far as how long you have to wait between increases it goes much smoother. It would be 14 months down the road if they only allowed a monthly increase. The first few months I went in every 10-14 days as needed for increases.

Your starting dose is just a ballpark guess, It has to be safe enough not to harm and strong enoug not to send you into withdrawal. But even at the starting dose, switching from a high dose of oral meds to what seemed to be a low dose of IT meds, withdrawal was never a real issue, just increased pain whch can be managed in the interim with additonal BT meds strong enough to be effctive untill you get your pump set to a comfy position.

I've gotten dicouraged at times but over all, I am happy with my decision. I'm realistic and know nothig is going to relieve all my pain and I would still be happy to reach that 50% mark. When I dd my trails I was on meth, although I discontinued meth for the trial you still have quite a bit in your system for days later. I did a 3 day in patient trial and later the single bolus injection trial. The inpatient caused a spnal fluid leak which skewed any positive benefit from the pump. It tok me several months to akllow another needle into my spine again but wewas worth it in the long run.

So even with a 50% reduction on a trial, it doesn't give you the perfect starting dose because of meds already in your system. OxyC wears off rather fast so your trial may be abit truer if they DC the oxy and strictly use the IT pump. They do also use oral or IM meds for when the pump isn't cutting it betwen adjustments while inpatient . Just things to be aware of.
Good luck and let us know how the trial goes, Dave