Intrathecal Pain Pumps

[April]

Hi Final,

I'm so sorry you're going through this and that it's taking so long. Did they increase it on the 24th?

April

[stephanies]

Thank you for sharing your experience. I hope that you are able to get more relief as time goes on.

Stephanies

[FinalCountdown]

Hello folks,

Another long story ...

I've been going to a very large pain-management practice who (last year) recruited a surgeon who installs these pumps. I'm pretty sure they're reacting to the government's overreactions about oral opioids. Anyway, my surgeon was a very agreeable gentleman (more on this later), but my "regular pain doctor" at this practice is less-than, well, less-than stable.

I went on Jan 24th for another titration, only to be yelled at (more on this later), but the upshot is I got - with great resistance - a 20% titration. So, my current dose is .9mg basal, plus 3 x .09 mg bolus, for a total-maximum of 1.26 mg/day.

Both times I titrated up, I felt ever-so-slightly lightheaded at first, but only right after the titration, and during the very first bolus dose. There were no other apparent side-effects after these.

I was pissed off enough, after this appointment, to revisit another pain doctor who did a few procedures for me three-years ago. He told me several things that I hadn't known before (more on this later), but the one thing he said that really resonated is that the reason he stopped installing (actually installing) these pumps is because current insurance practices do not allow for an adequate test. He said, "If you inject anyone's intrathecal space, with pretty much any dose of hydromorphone, you're going to elicit a 'Wow!' response from them." However, he added, this is not an adequate test - to be tested adequately, you must be inpatient for a couple of days while they titrate you up-and-down; otherwise, you still don't know if this is going to work.

Anyway, I'm seeing him tomorrow morning, Feb 4, and he has agreed to empty/refill my pump with both hydromorphone *and* bupivicaine (Marcaine) - he says the addition of bupivicaine will produce better results. He's also very optimistic about my future; however, he said that physicians are wise to take things slowly, so I suspect I'm in for a long few weeks of appointments and titrations.

One other thing: He was pleased that my "concentration" of hydromorphone was only .25mg/ml, because he says (and I've independently confirmed) that granulomas can develop at higher concentrations (these are benign growths that can interfere with delivery, but that go away on their own if the pump is turned off or taken out; still, it's best to avoid them).

All this to say ... I don't have a whole lot to say yet. I know people here are waiting for my "Yes! Moment," but that hasn't happened yet, and I don't think it's going to happen tomorrow. Still, I *know* I'm in better hands with this new physician (let me wait until I have a success story before I give his name, okay?)

BTW, since going off all oral medications, I now realize that my back - which itched like *sin* - no longer itches. I had no idea it was a side effect from oral opioids, but I'm pretty sure now that it was.

[FinalCountdown]

I had a good visit today with my new pain doctor. He said it might take several iterations to get the medication right (I emphasize, they want to give you the absolute minimum you need).

He drained my old medication, and refilled me with a mixture of hydromorphone and bupivicaine - the procedure was quick and absolutely painless.

My basal dose is now 1 mg of hydromorphone per day, coupled with .2 mg of bupivacaine in the mixture. I only have 2 bolus doses available daily now, but they went way up to .15 mg of hydromorphone (and whatever the corresponding percentage of bupivicaine is).

I came home afterwards, fell asleep for an hour, and I felt better early this afternoon than I have in quite awhile. It wore off some, and now I can tell I'll need to titrate up again; still, I haven't yet given myself my bolus dose today (today I only get one), and I'm saving it for tonight. His goal is for me not to use the bolus dose at all except when I *really* need it.

He said to come back in two weeks if I need adjustment (I'm going to make an appointment for late next week).

Getting there ...

[87Beliz]

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