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Intrathecal Pump

An Intrathecal Pump (“Spinal Morphine Pump”)? is a specialized device, which delivers concentrated amounts of medication(s) into spinal cord area via a small catheter (tubing).

Am I a candidate for Intrathecal Pump Implant

Currently at TPM, Intrathecal Pump is offered to patients with :

Chronic and severe pain, who have not adequately responded to other treatment modalities. Some of the examples are failed back syndrome, cancer pain, RSD. These patients receive infusion of painkillers such as Morphine or Dilaudid.

Spastic disorders such as Multiple Sclerosis, Spinal Cord Injury – associated with muscle spasms. These patients receive infusion of an antispasmodic medication called Baclofen.

What is the purpose of it?

This device delivers concentrated amounts of medication into spinal cord area allowing the patient to decrease or eliminate the need for oral medications. It delivers medication around the clock, thus eliminating or minimizing breakthrough pain and/or other symptoms.

How long does the procedure take?

It is done in two stages. In the first stage, a single injection is made to assess effectiveness and screen for unwanted side effects. If this trial is successful in relieving symptoms, then the permanent device is placed under the skin. The patients have to meet certain other screening criteria before implanting the pump.

Will the procedure hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

Will I be “put out” for this procedure?

The placement of the tubing is done under local anesthesia with patients mildly sedated. The amount of sedation given generally depends upon the patient tolerance.

For the pump placement, patients are given stronger intravenous sedation and analgesia.

How is the procedure performed?

It is done with the patient lying on the side. Sometimes the tubing is placed with the patient sitting up. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needle for inserting the tubing.

Where is the tubing inserted? Where is the pump placed?

Tubing is inserted in the midline at the lower back. The pump is then placed on the side of the abdomen.

What should I expect after the procedure?

If the procedure is successful, you may feel that your pain may be controlled or quite less. The pump is adjusted electronically to deliver adequate amount of medication.

What should I do after the procedure?

This procedure is normally a day-procedure and patients are kept overnight for observation and pump adjustment.

How long will the pumps last?

The medication contained within the pump will last about 1 to 3 months depending upon the concentration and amount infused. It is then refilled via a tiny needle inserted into the pump chamber. This is done in the office or at your home and it takes only a few minutes.

The batteries in the pump may last 3 to 5 years depending upon the usage. The batteries can not be replaced or recharged. The pump is replaced at that time.

Will the Intrathecal Pump Implant (“Spinal Morphine Pump”) help me?

It is very difficult to predict if the procedure will indeed help you or not. For that reason a trial is carried out to determine if a permanent device (pump) will be effective to relieve your pain or not.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Please discuss your concerns with your physician.

Who should not have this procedure?

If you are on a blood thinning medication (e.g. CoumadinÆ), or if you have an active infection going on, you should not have the procedure. The patients also have to meet certain other screening criteria before implanting the pump.

Additional information?

More detailed information is available from the manufacturer of this device. At the time of consultation you will receive a Synchromed™ Infusion System Patient Education Booklet. Additional information is also available at the Medtronics™ Web Site @ www.medtronics.com/neuro/apt/faq.html.

In chronic pain for 14 years

It’s not something that others can easily see

by Shannon Leidig

The author is a chronic pain sufferer who lives in Washington County. She wrote this as part of the educational component of Pain Awareness Month.

Who would ever have thought that my life would change forever on Tuesday, Feb. 13, 1990? Until then, I was a normal college student, majoring in music therapy and piano at Shenandoah Conservatory.

That morning I awoke with my hand in severe pain and very swollen and waxy looking. The pain was so intense that I could not finish my piano practice. A nurse gave me ibuprofen and said if it didn’t improve, I might have to see an orthopedic surgeon.

That night, my friends and I went to Subway. Ever try to eat a sub with one hand? Not very pleasant, but necessary, because my right hand was in severe pain. I did not sleep that night or go to class the next morning. It was the worst pain I had ever felt. Little did I know it would get worse.

At week’s end, I went to see the surgeon, who thought it was carpal tunnel syndrome. She splinted my hand and gave me medication. Over the weekend the pain became even worse, so I saw her again on Monday and had a cortisone injection, which hurt like heck! I then had nerve conduction studies and was told my hand was “dead.”

I was scheduled for a carpal tunnel “release” Feb. 22. When they came to prep me for surgery, they tried to scrub my hand. I could not tolerate even the slightest touch. I was sedated so they could finish prepping me.

As I recovered from that surgery, the pain in my right hand was still intense, but then my left hand began to hurt. Even closing a cupboard door or driving over a bump in the car would bring me to tears.

My surgeon knew something was going on, but could could not understand what. She knew she had to alleviate the pain in my left hand, so I ended up having carpal tunnel surgery on that one as well.

My left hand was bandaged like a boxing glove and I still could not use my right hand. I could not feed myself, bathe or even go to the bathroom by myself – very humiliating for a 19-year-old. My father would feed me like a baby, but my mother ended up doing everything else.

I recovered at home from both of these surgeries. Then both feet started to hurt. Now, I thought, I am really starting to lose my marbles.

I ended up going to Good Samaritan Hospital in Baltimore. In late March they called and asked me all kinds of questions about the pain, the color of my skin, if it were waxy, if my extremities were red or blue or if I was sensitive to touch. They diagnosed me with Reflex Sympathetic Dystrophy Syndrome and I became a patient there.

They put me on high doses of steroids and antidepressants, stating that it would help “ease the pain.” The drugs made me eat and become a very nasty person,

I was discharged after 10 days and returned to college. Friends helped to catch me up on what I had missed. I finished the semester but it was very difficult.

My medications sent me through many mood changes. One night I cursed out my mother. I was so angry I ripped the phone out of the wall and said that I wished she was the one who was sick. I regret that comment to this very day.

By Memorial Day, the pain had spread up both arms and all the way up both legs. I could not walk, so I used a wheelchair. I became a patient at Good Samaritan again.

The doctors thought I was crazy and brought in psychiatrist after psychiatrist. Being on steroids also increased my appetite, so I went from 105 to 190 pounds. Talk about embarrassing!

I went to another physician who took me off all of the medications and began performing nerve blocks, both stellate ganglion and lumbar sympathetic blocks. For the first time in months, I had some relief.

This doctor believed me, which was a huge help. He and his staff encouraged me to go back to school and to continue to do things, being mindful of my limits due to the pain. I transferred to Hagerstown Community College and Shepherd. I was determined to obtain my degree and have a life. It took me six years, but I graduated cum laude with a bachelor’s degree in psychology, and a minor in music.

I am now 33. I still have RSD, although it has a different name now – Complex Regional Pain Syndrome. I have seen many doctors at the nation’s best hospitals. Some believed me, some didn’t! I have been on many medications. Some helped, some didn’t.

Once I almost died due to an overdose. I have had numerous surgeries and yet the pain is still here. It has never gone away!

The pain in my arms and hands is almost nonexistent now, but my legs are a different story. The pain shoots and burns, as though a volcano will erupt inside. And my legs jump inside, like jumping jelly beans. The intensity of that and the pain brings me to tears.

I do not drive much because I do not trust my legs. They are not strong and I lose sensation and would not want to cause an accident.

My career goals are not what I had originally planned, but I continue to work. One, because I can work, just not full-time, but also because of the high cost of treatments, medications and insurance.

There are days when it is a struggle to get out of bed. I walk every day because I have been told that if I do not, I will lose the use of my legs.

My family has been very supportive, especially my parents. I am so blessed to have them and am very thankful for all they have done. My faith and relationship with God has also been a huge source of strength.

These 14 years have been quite painful, not only physically, but emotionally as well. I have fought many battles. With my family, who didn’t understand what was going on and with friends, who got upset when I had to cancel plans because my body wouldn’t cooperate.

I have had to fight doctors, nurses, and the entire health-care system. Some nurses at a local hospital told me that when they know they must tend to pain patients, they do, but only do it reluctantly.

How would that make you feel? Employers do not have a clue when it comes to dealing with pain. I work from home, doing transcription, but I also accepted a job so I would have health insurance.

When employers hear the words “chronic pain,” that automatically sends a red flag, meaning lost time. No, I can work and I am willing and want to work. There is nothing wrong with my brain, just my legs. It has been a nightmare, but there have some good things that have come out of it. Even though there are days when I feel 133 and just because I have a chronic pain condition does not mean that I have to look sick.

People do not see that it takes me quite a long time to get up and moving in the morning. I do not sleep well at night and sometimes it is when “normal” people are getting up when I finally get to sleep. My sleep is not restful and there are days when I am just dragging to get through the day and pray that tonight will be the night I can finally sleep.

These 14 years have taught me a lot, too, in that I never take anything for granted. Also, if a person says they have pain, believe them. Even though each person experiences pain differently, pain is real and it does exist.

I want to try and make a difference so that the other people who suffer in pain do not experience what I have gone through. Pain is a part of me; it is not who I am. My pain is with me 24 hours a day, seven days a week. I have good days and not-so-good days. There are days when it is truly a struggle to get by, but I have my faith to get me through and friends, family, a very caring doctor and supportive nurses who walk with me each and every step of the way.

Shannon Leidig is a Washington County resident. There will be “public listening” for chronic pain patients, their caregivers and those want to support them on Saturday, Sept. 25. For directions, call 301-393-4855 or visit www.marylandpaininitiative.org.

Addiction

In considering the contemporary role of opioids it must be borne in mind that, although these substances are subject to abuse, the intention for which opioids exist is the treatment of pain. Far too often, the potential for abuse interferes with the appropriate use of pain medications for those in need. Although drug abuse is a compelling public health problem, allowing abuse potential to limit access to opioids for those with medical illnesses is an unjust response. A useful analogy is our system of using checks to pay for purchases which is circumvented when ìbadî checks are ìbounced,î —- but we donít respond by banning checks as legal tender, a policy decision that would punish everyone. If you believe in a higher power, especially one that did not put us here to suffer unnecessarily, then we can reason that God gave us the opioids and their derivatives to better cope with pain and suffering. Unfortunately, as a culture we have been tragically ineffective in distinguishing between drug abuse and the treatment of pain, and thus when it comes to pain medications, it has been a classic case of a few bad apples ruining things for the whole bunch: todayís patients with pain have become the innocent victims of a war on drugs that should have nothing to do with them.

Research consistently demonstrates that exposure to pain medications does not foster addiction. In fact, under-prescribing is more likely to fuel addictive behavior, because pain is never relieved, and patients are left feeling abandoned, left to continually seek help that becomes increasingly elusive. With chronic treatment, patients may become tolerant or accustomed to the effects of opioids (thus requiring higher doses over time), and physical dependence (the onset of withdrawal or an abstinence syndrome when treatment is abruptly stopped) may arise, but addiction, a reversible complication, is extremely rare, occurring in no more than a few per cent of patients exposed to analgesics in the course of treatment. Tolerance and physical dependence are inevitable biologic consequences of chronic opioid use, that are independent of the patientís background, values and circumstances. The onset of tolerance and physical dependence are expected, are unrelated to addiction and are not problematic since they can be overcome by simply adjusting doses pf medications gradually. Addiction, which is the same as psychological dependence, is an infrequent outcome that is highly dependent on the patientís prior history, experiences and values. Addiction involves compulsive, nonmedical use of drugs that persists despite the presence or threat of physiologic or psychological harm, and indeed is a highly disruptive phenomena. Rare in otherwise well-adjusted individuals, exaggerated perceptions of its dangers causes a great many patients with legitimate pain to be mistrusted and undertreated. Unfortunately, when pain is ignored, most other aspects of healing (rest, mood, nutrition, energy and rehabilitation) also falter. Too often, we operate from the mistaken belief that simple exposure to painkillers produces addiction, while in fact addiction appears to be much more person- and style-specific than substance-specific. Predisposition to addiction has much more to do with an individualís style of coping with adversity, stress and illness. Addicts are less functional as a result of their drug use and become more isolated from the mainstream of life, family and work, while patients using drugs appropriately are consequently more functional, less isolated, and more prone to resuming activities they once avoided because of pain.

In the course of twenty years of educating physicians and nurses, patients and their families, administrators and policymakers and other interested parties about pain management, the topic of addiction never fails to elicit great interest. As a means to convey my thinking about this complex issue and especially the thorny distinction between addiction and the treatment of painful medical disorders with drugs. I created and have come to rely on a vignette that, by employing an analogy focuses our attention in a way that may help us think more clearly about issues that appear bewilderingly complex but are perhaps more simple than they appear to be.

So….heaven forbid, your teenage child or grandchild ìborrowsî the key to the family car, say a Ford Taurus, goes on to drink a six pack of beer and then wraps said car around a tree. Fortunate enough to walk away from the event, employing another example of adolescent logic, he/she draws the following conclusion: ìFord Taurusí are bad cars.î

The obvious corollary is that drugs, in and of themselves are neither ìgoodî nor ìbad,î although their use can produce dramatically opposed good or bad outcomes depending on how they are prescribed, dispensed and taken (ìdriven,î if you will). Our culture strives to ascribe pat answers to complex phenomenon, and thus arises the oversimplistic temptation to denounce a substance as being responsible for a behavioral problem, because it is often easier than looking honestly at our own maladaptive behaviors. As we have come to recognize the dangers of alcohol and tobacco, it becomes clear that the problem of addiction transcends the domain of illicit drugs, and viewed from an even broader perspective we have come to recognize the hazards of addictions to activities as diverse as gambling, risk-taking and sex.

The recent media feeding frenzy condemning a newer opioid compound, Oxycontin is a prototypic example of how unless such hysteria can be curbed many of the advances that have been made on the behalf of patients with chronic pain can be summarily annihilated. Oxycontin is simply a preparation of an opioid drug that is slowly released over twelve hours to promote even relief without the roller coaster effects and the clock-watching associated with short-acting painkillers. The recognition by abusers that this when crushed, chewed, sniffed or injected, the safety of this miraculous ìtiny time pillî could be bypassed led major news organs to irresponsibly capitalize on the sensationalist aspects of this criminal misuse of a product that used properly has helped countless sufferers. This irresponsible journalism has not only disseminsated an otherwise obscure strategy of abuse in the minds of susceptible addicts, but has terrified patients who have been benefitting from an otherwise appropriate treatment for years, and has frightened prescribing physicians and pharmacist who are now reluctant to dispense an otherwise very helpful drug. Just like a truly resourceful burglar will find a way to circumvent even the most stringent security system, an addict who is truly intent on abusing drugs will find a mechanism to abuse almost anything. The bottom line message is not to throw out the baby with the bathwater: the answer to curbing addiction to prescription drugs is not to limit their availability, but to teach doctors, patients and pharmacists to communicate more effectively about a problem that is distressing to all of us.

Patients should be aware that while the risk of addiction is exaggerated by even (well meaning) experts, it still exists. Addiction may arise in between 0.1-10% of patients, but it is a treatable disorder, and shouldnít interfere with the consideration of trials of opioids in patients with lower risk profiles. Individuals who have had difficulties with drugs, alcohol and tobacco in the past are at high risk for addiction and are generally considered poor candidates for treatment. Patients in denial who expect a ìquick fixî and wish to eliminate rather than manage pain are also likely to encounter difficulties with treatment.

Life in Pain with CP

Fifty years ago in Puerto Rico a 33 year old American Lieutenant and his 40 year old island beauty begot a little boy with Spastic CP, with hemiplegia. He was exercised, pushed, embarassed, deprived and beaten through a College degree in Physics. The boy got married, had two children, retired, and now sits at home broken and in pain because his most powerful tool for making it was always satisfying others and playing the role. Now, he sits alone in pain from years of physical abuse to his body from pushing too hard, wondering if parents have the right to demand so much. On the other hand, would there have been anything to look back on if they hadn’t pushed?

For more detail, to chat, or to add your view on the role of parents, contact the author at [email protected]

This article submitted by Art Neill on 8/7/96

is it possible i have headaches as a result of taking chronic pain medications?

does any one get rebound headaches (migraines) as a result of taking chronic pain medications,

for my pain i am taking:
avinza 150mg per day
MSIR 15mg as needed (max 120mg a day)
zoloft 100mg a day
synthroid 50mcg a day

gabitril is one new medication i started (with a starting dose, i think it was 50mg) about 4 weeks ago, but stopped 4 day into it because of constant, but not very strong headaches, incidentally this last attack of migraines continued after stopping the gabitril.

i have been having headaches since then, with some days better and some days real bad, went to emergency room twice, done wide range of scans and checkups with out finding anything wrong with me or my head. I have an appointment scheduled with a neurologist only at the end of this month.

Living With Pain

Hi Everyone. I’m new to this wonderful site. Received an email from Vitali and have been encouraged and comforted to meet more folks and their loved ones trying to make a life IN SPITE of chronic pain.

I read Jana’s entries about her husbands experiences with Myelograms. I had my first AND LAST… in Oct.’03. It was terribly painful. I begged the doctor for even a little versed and he wouldn’t budge. WHY?!! The worst part was that the test only confirmed what we already knew WITHOUT the test!

Allow me to bore you for a moment, with a bit of MY STORY:
I was born with Spina Bifida which is a neuro-tube birth defect. But I was quite fortunate as a child and experienced much less complications than most children born with this. I walked, ran, attended school and was involved in everything from horseback riding to dirtbikes! I met the love of my life at the tender age of 16 and we were married. ANd then when I was 19, I defied the doctor’s predictions and had the first of our 3 daughters.

Unfortunately it was when I reached 30 that all “hell broke loose” 🙂 I began having increasing pain in both legs from top to bottom. I went from Dr. to Dr. and received diagnosis such as “depressed housewife”…. “just wanting drugs”….”minor arthritis”..etc. I’m gonna do my best to keep this really short, so I’ll skip ahead a few years now. AFter more than 3 yrs. of increasing pain with nothing more than Tylenol, Motrin, or if the doc was feeling REALLY generous… “Tylenol 3” (Yes, Jana… “bandaid on a heart attack”!)… finally through some miracle I met Dr. Molnar… the first Dr. to actually LISTEN to me! He NEVER treated me like a drug addict or a depressed housewife.He said “the first thing we have to do is to get you comfortable. THere’s no sense in you living another moment in pain with all of the potential treatments out there”. Back then we started with a low dose of Neurontin and some Oxycontin. ANd for the first time in years, I had some relief!! My family couldn’t belive the difference in my moods and attitudes. No more thoughts of suicide! I actually saw HOPE of actually “LIVING” life rather than just coasting along beside it! Next, Dr. M ordered a whole series of MRI’s and exrays and blood work.

Over the course of the next few years a lot would happen. In ’93 my left leg was amputated after more than 20 unsuccessful surgeries to scrape out a severe infection in the ankle bone (a.k.a.”osteomylitis”)… which the docs felt was a large source of my pain. The day after that surgery, the pathologist found that there was also a high level of Melanoma within the ankle. CANCER had been in there for God knows how long… and no one checked until Dr. M! A long stretch of rehab and treatments followed that and for a time, the pain level did improve. Bbut gradually it returned… and with a real vengeance! The Neurontin and Oxy. were like candy. So the Neurontin was increased tremendously and we added MS Contin, Baclofen, Wellbutrin and some M.S.I.R. (morphine sulphate immediate release). THe pain became bearable as long as I did not overdo it in any way. ANY slight change to my days can cause a terrible PAIN ATTACK which means 2-3 days in bed. A new series of MRI’s and exrays diagnosed more problems in ’99. As a result of the Spina Bifida, scar tissue formed around my spinal chord. This is called “Tethered Chord Syndrome”. Another common complication of Spina Bifida in adults is “Syringomyelia” which means that there are cysts…known as “Syrinx”… that form within the chord and fill with fluid. As they expand, they damage any nerves in their path…which then affects various body parts and functions. In Jan.’99 I had 2 surgeries on my lower back to attempt to decompress or release the tethered chord and to drain the cysts. The surgery was a disaster, infection almost killed me, and I spent 6 months in a rehab. facility. I did regain my ability to walk short distances there.

Now, it’s 2004. My spinal chord has “re-tethered” itself even worse than the first time. It is pulling my chord down much further into the spinal canal than it should be. I also have all new cysts within the chord as well as serious damage to the spine itself. 2 places in my neck and several in my lower spine are collapsing and crushing the chord. My pain level is barely managed with HIGH doses of 2 kinds of morphine as well as several other drugs. If my daily activities consist of anything more strenous than washing a few dishes or folding some laundry, then I have uncontrollable pain. Doctor’s in my hometown of Cincinnati told me there was NO ONE there that could offer me anything else. THey referred me to Cleveland Clinic and those docs there said they didn’t feel surgery was an option…wasn’t a high chance of success, but HIGH for complications, plus my risk of infection, etc. THey felt my only HOPE is intense rehab. to retain what mobility I have left for as long as I can. We recently moved to Phoenix where the Barrow Neurological Institute is located. I’m told that they are “The Best” there and so I have an upcoming appointment with them.

Depression is a constant battle these days. My life has changed SO drastically in the past few years! I’ve lost both my parents at the early age of 55, my health has declined, I lost a wonderful job because of it, I’m loosing my ability to walk, some of the use of my arms/hands, I have difficulty swallowing, I have CONSTANT urinary tract infections that make me very sick, AND my husband and I are both suffering from “Empty Nest Syndrome”!! So I believe that so much change can cause depression issues.

I can’t begin to tell you how much help it is to know there are others out there who “Get This”. I think you have to be a Chronic Pain Suffered OR love someone who is, in order to really grasp how all-consuming life with pain can be.

Sometimes for me, when the pain is really bad… it’s as if PAIN is all I can feel, hear, see, smell or taste. It’s like a very loud, constant SCREAM throughout my body. I know that my PAIN has had a negative impact on my ability to be a good mother, wife, daughter, sister and friend. THe PAIN rules your life. The PAIN makes the decisions of whether or not you go to the family picnic or the grocery store. The PAIN decides whether or not you take your kids to the amusement park or go to their softball game. The PAIN decides if you will sleep tonight or not… and for me, my pain even affects my appetite and ability to eat.

I AM TRYING to learn to rise above the pain… to take back the control in my life. I don’t like depending on pain meds. to keep me mobile… but if that’s what it takes to keep from just giving up and being in bed all the time, then I’ll do it. I’ve recently been thinking about the fact that PAIN “stold” a large portion of my life from me. Now, I have the chance for a whole new start… a new city, my girls have families of their own and live in 3 states, and for the first time in 23 yrs. my husband and I are ‘on our own” again. We should enjoy this time in our lives. My husband DESERVES to enjoy this time in his life!

So I’m trying some things I’ve never done before…some things I’ve wanted to do for years but didn’t have the courage. I’m going to be getting involved in a rehab. program that involves some real dedication and exercise in order to rebuild some of my muscles that have become so weak. I’m getting involved in some community projects. AND…something just FOR ME… I have (finally) found the nerve to enroll in some writing and literature courses. I’ve been writing since I was a child, I’ve always loved writing AND reading! I’ve been working on a few manuscripts for a few years and I have several other projects in mind. I’m even going to be taking an Art class!

All of these things are ALL NEW for me.Pain has tried lately to convince me that I’m fooling myself if I think I can “pull this off”… I’m not “able” to do these things. But that makes me more determined to PROVE PAIN WRONG!!

Thanks SO much to those of you who have “stuck it out” and actually read this thing to the end! ;o) It has been a bit of “therapy” for me to share this with you.

Thanks to all of you who contribute to make this site a “safe haven” to pain sufferers everywhere.
Blessings,

Denice