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Morphine pump questions
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mosingalong posted:
I had a pump implanted in Dec 2012. Because I choose to be part of a trial for a new pump by Infusion Systems, there is more to do during an appt. than otherwise, so there is not much time left for questions.

I can give myself a bolus dose, but I don't appear to get much relief from pain. I read last night it can take 1-2 hours for the dose to be effective. I am curious as to what others have experienced about these extra doses. Even though this is a trial pump, it is very similar to the Medtronic pump, so I would expect the extra dosing to be similar.

Thanks!
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cweinbl responded:

I used a morphine pump twice after major spine surgery. Both times it was a complete failure. Later, I tried the Fentanyl Transdermal system and achieved an 80% reduction in chronic pain.

We're all different. That which helps one of us may do nothing for another one. That's why it's so important to try each and every long and short-acting pain drug before deciding upon a course of action. More often than not, for chronic pain, the answer lies in a combination of a long-acting pain medication (Kadian, Oxy-Contin, Fentanyl Transdermal, etc.) PLUS a short-acting drug (Hydrocodone, Oxycodone, etc.) for breakthrough pain. Often times, BOTH must be used together to accomplish the desired result.

To add efficacy, anyone with chronic pain should consider an anti-depressant (Cymbalta, etc.) because anti-depressants will inhibit the reuptake of Seratonin, one of the body's natural pain-fighting chemicals.

If the patient has referent pain, add an anti-convulsant, such as Lyrica or Neurontin.

If the patient has osteoarthritis or some other auto-immune/inflammatory condition, add an anti-inflammatory (Celebrex, etc.).

After 40 years of experimentation with my trusted family physician, we have isolated the best of each of the above-mentioned medications for my unique body chemistry. Remove any of these medications and my pain comes crashing back. But used together, like a fine symphony orchestra, my pain is kept at bay and my pain is tolerable. My point here is to say that chronic severe pain often requires the concurrent administration of long and short-acting opioids, plus anti-depressants, plus anti-inflammatories, etc. It is this "cocktail" of drugs that allows us to survive and thrive. Yet, so many physicians today are reluctant to prescribe combinations of medications. I can tell you that these combinations are the only way that many of us continue to survive.

The secret to this success is to have a physician willing to allow you to try dozens of different medications, in combination, until the BEST combination is realized. This can take many months or even years to accomplish. But, when it comes to your health, it's worth it.

If all of this fails, then it might be appropriate to seek the intrathecal infusion pump or the spinal cord stimulator. But beware that the long-term success rates for both mechanisms are in the range of 60% (see http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf ). And remember that surgery is required to implant and to remove these barely-successful mechanisms. And all surgery entails morbidity. Having a machine implanted in your body with a 60% success rate seems like a very last-resort option to me. On the other hand, those who cannot benefit from oral and Transdermal pain medications might see no other alternative.
cweinbl
csw2@bex.net
 
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ctbeth replied to cweinbl's response:
While all of the above is so, some positive aspects regarding SCS is that the mandatory trial can give a really clear indication if this modality will be helpful.

Another important factor, even considering the 60%, is to have realistic expectations.

Many living with intolerable pain get sufficient relief to greatly reduce opiate meds.


Others are able to return to the work force or be more engaged in parenting, with the latter being my priority.


If the trial is not successful, you've not much invested to lose.


If it does work for you, it can change your life.


It changed mine.


It's also a very personal decision. As far as the 60% success rate, when I was considering the SCS trail, I would have been willing to take any risk for any pain relief. At that time in my life, 60% sounded like good enough odds for me.


I'd have done anything for any relief.


I was also having a very difficult time with opiate side effects. Had I tolerated the higher doses I required with less discomfort, I'm sure that my opinion about procedures with some risk and 60% success rate would have looked less appealing to me.

We are fortunate that there are options available in the field of pain management. I wish that there were more and better solutions, but we do have some.

Take care, Mr Weinbl.

Always nice to "hear" from you.

Bet
 
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ctbeth replied to ctbeth's response:
Synopsis of five long-term clinical studies on SCS:
This is from the St Jude site, but the studies are related to spinal cord stimulation, and not necessarily St Jude equipment.


http://www.poweroveryourpain.com/discovering/neurostimulation/proven
 
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mosingalong replied to ctbeth's response:
As mentioned, pain control if different for everyone. I decided on the IPS because I am allergic to anti-inflammatories (tried a lot of them), Lyrica at a very low dose sent me to the ER, and I don't do well with anti-depressants. Let's just say I have a lot of drug allergies/intolerances.

My question was about the IPS bolus dose and its effectiveness. I am still taking Norco for breakthrough pain, but the goal is to eventually need only the IPS boluses. I am currently tapering off of the Norco.

So is there anyone else using IPS who can answer the question about the approximate length of time it takes for one to feel the effects of the extra dosing?

Thanks.
 
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ctbeth replied to mosingalong's response:
Hi Mosingalong,

Sorry that I didn't adequately address your concern.

Since you are part of a trial, your information is best handled by speaking to the company rep or your MD/ surgeon who is feeding the control data to the researcher.

I hope that someone with this type of system will address your direct concern.

Be aware that there may be less respondents on the site on the weekend.

I hope that you'll get the relief that you seek.

I am mostly concerned that your MD does not provide adequate time for your relevant questions and concerns.

As an RN unfamiliar with your unit, I would suspect that an intra-thecal delivery system should provide pretty quick result.

Since your system is similar to the Medtronic, you might have a look at their web page and see if they address your concerns.

CTB
 
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mosingalong replied to cweinbl's response:
Thanks for your response. I checked out the site, and the pump efficacy is 80-100%; it's the neurostimulator that's around 60%.

Also, I have the IPS already, so it's a done deal. I just need to learn what works. What I read and was told is that it takes 6 months to a year to get to the correct dosage. Because of my allergies/drug sensitivities, the doctor is slowly increasing the dose to be safe. I choose this system bec. I can tolerate morphine, but not much else in the drug arsenal.

After 3 months, I would recommend IPS to others. My activity level has increased while my pain has decreased.
 
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mosingalong replied to ctbeth's response:
Apparently Medtronic's latest development is a pump for diabetics, so I couldn't find any info on the morphine pump. (Must be a terrific way to deliver insulin as needed.)

Thanks for the suggestion; I got tired of searching. And I would also think that the effect of the bolus dose would be pretty immediate.

My appts take about an hour, which I know in doctors' offices these days is a long time. I am going to ask this one question at my next appt. : )


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