Tag Archives: Morphine

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.

FDA approved SynchroMed II

The new SynchroMed pump was approved by the Food and Drug Administration in April, but until last week it was released in the United States only on a limited basis.

For sufferers of chronic pain, often those with cancer or back-related woes, the pump delivers morphine directly to the fluid-filled area surrounding the spinal cord, a more efficient system than using drugs. For those with spasticity, a drug called Lioresal Intrathecal, which relaxes the muscles, is administered.

The SynchroMed II Programmable Pump, developed by Medtronic, Inc., offers several benefits to patients and physicians. Implanted just under the skin, the pump delivers medication directly to the area around the spinal cord, meaning less medication is needed and there are fewer side effects compared to when the drugs are taken orally.

The new 20 ml version is 30 percent smaller and 20 percent lighter than the previous model, and the new pump’s smaller size and contoured shape is designed to enhance patient comfort. The new pump also comes in a 40 ml version, which can extend refill intervals by up to two times the current intervals, reducing the number of office visits patients must make to have their pumps refilled. In addition, physicians can adjust the SynchroMed II pump to meet individual patient needs.

The pump costs about $10,000 to $12,000 and is covered by Medicare and major insurers.

Pain is big business, both for device companies like Medtronic and for pharmaceutical firms. Chronic pain — defined as pain that recurs or lasts more than six months — affects 25 percent of the U.S. population and costs employers more than $100 billion a year in medical costs.

Pain management products fall under Medtronic’s neurological and diabetes division, which generated annual revenue last year of $1.6 billion, an increase of 22 percent over 2002.

medtronic.com/

Florida Pain Patient Faces Decades in Prison for Pain Medication

Richard Paey, 45, of Hudson, Florida, is disabled. Injured in a traffic accident in 1985 while attending law school at the University of Pennsylvania, Paey suffered a severely herniated disk in his lower back. A first surgery failed, and a second operation, an experimental procedure involving screw inserted into his spine, only aggravated matters. It left his backbone splintered and the mass of nerves surrounding it mangled. Paey, who relies on a wheelchair for mobility, was left in excruciating chronic pain, which he treated with prescribed opioid pain relievers.

But Paey’s odyssey from being just another of America’s tens of millions of chronic pain sufferers to a Florida jail cell was about to get underway. Paey and his family had been living in New Jersey, where a physician prescribed large amounts of opioid pain relievers for Paey, but when they moved to Florida, they could not find doctors willing to provide the high-dosage prescriptions needed to fend off the pain that tormented him.

Paey, who has also been diagnosed with advanced multiple sclerosis, resorted to filling out prescription forms obtained from his New Jersey doctor and eventually came to the attention of the Drug Enforcement Administration and the Pasco County Sheriff’s Office. Investigators reported watching Paey and his wheelchair roll into one pharmacy after another to pick up fraudulent prescriptions, adding up to more than 200 prescriptions and 18,000 pain pills in a year’s time.

No one could take so many pills, investigators suspected. Paey must be a drug dealer. And they charged him as one, even though no one has ever presented any evidence that Paey did anything with the pain pills except ease his own pain. Now, after two mistrials, plea bargain offers made and withdrawn, and plea bargain offers rejected by Paey, prosecutors have managed to win a conviction. A week from today, a Florida judge will decide Paey’s fate, although if the judge follows state law, there is not much to decide. As a convicted Florida “drug trafficker,” Paey faces a mandatory minimum sentence of 25 years in prison.

In a last minute bid to win freedom for Paey, who is currently imprisoned in the hospital wing of the Pasco County Jail and is being treated with a morphine pump while in jail, his attorneys will use the occasion of next Friday’s hearing to ask that the verdict be dismissed on the grounds that Paey’s New Jersey physician, Dr. Steven Nurkiewicz, lied on the stand when he testified that he did not give Paey permission to fill out undated prescription forms.

“The state knew Dr. Nurkiewicz was lying when he said he did not provide the prescription forms and that he only prescribed small numbers of pain pills, but they said he wasn’t on trial, and they won’t charge him with perjury,” said Paey’s wife Linda. “We tried to get a mistrial, but they were still able to put Nurkiewicz on the stand knowing that he had lied,” she told DRCNet. “They feel like the end justifies the means, that my husband is a bad person, and that they’ve invested too much money in prosecuting him to let him get away. Now they will lose face if they drop the charges,” she said.

“We were so naÔve when this began,” she said. “They accused him of selling the medicine and we said no, he’s a pain patient. I thought that once they saw that was true, they would understand. But no. They not only charged him as a drug trafficker, but they harassed his doctors to stop him from getting more pain medication.”

Paey’s family and a growing number of supporters are not merely relying on the courts for justice, but taking his case to the court of public opinion. A letter writing campaign to local newspapers is underway, and the St. Petersburg Times has editorialized on Paey’s behalf. Paey has also drawn support from national organizations including the Pain Relief Network (http://www.painreliefnetwork.org) and the November Coalition (http://www.november.org), a group working to end the drug war and free its prisoners. This evening, supporters will hold a vigil outside the Pasco County Courthouse in Port Richey.

“Richard Paey is a hero, not a criminal,” said Siobhan Reynolds, founder and executive director of the Pain Relief Network, as she prepared to board a flight for Tampa Wednesday. “The more people hear about this case, the more disturbed they are. He refused plea bargains because he would not be complicit in criminalizing his own efforts to save his own life,” she told DRCNet. “This is about medicine and medical care, not about illegal drugs or drug trafficking, and it is startlingly clear that local prosecutors and the DEA have totally lost track of that distinction.”

The Pain Relief Network and other Paey supporters will ask the prosecutors to not stand in the way of the acquittal motion, Reynolds said. “We are calling on them to join the motion to acquit. This was not a real crime, only a statutory one,” she said. “We want them to do the right thing for this suffering individual.”

The conviction of Richard Paey comes as Florida is in the midst of its own version of drug czar John Walters’ war on prescription drug abuse. Alongside such high profile actions as the investigation of Rush Limbaugh and the nearly monthly arrests of pain management physicians, the Florida legislature has been at work crafting a prescription monitoring bill that would allow doctors and law enforcement to access a database showing prescriptions to all potentially addictive drugs statewide.

As part of the White House’s National Drug Control Strategy, Walters is pushing for more states to join the 15 that already have such programs. They would help reduce abuse by allowing physicians and law enforcement to spot patients seeking multiple prescriptions, Walters said. Paey’s representative, state Sen. Mike Fasano, is sponsoring the bill in the state Senate. The bill would protect patient privacy by making it a felony to unlawfully divulge patient information, Fasano told the Orlando Sentinel in February.

But Paey’s case shows the danger of such a database, said Reynolds. “Richard Paey was prosecuted three times in the very same district that is represented by Senator Mike Fasano, the sponsor of Florida’s prescription monitoring bill. Fasano’s claim that prosecutors won’t use private medical information gathered in government computers against patients in pain, is exposed for the hollow assurance it is,” Reynolds said. “Law enforcement already looms over medicine to such an extent that patients with the highest dose requirements, those with the most severe pain, can’t find medical help. Prescription Drug Monitoring Programs only ensure that the under-treatment of pain will continue to plague our most vulnerable citizens and their families.”

Still, the Senate bill and its companion bill in the Florida House are moving.

Meanwhile, Paey’s supporters are gathering for a last minute effort to bring him home.

“John Chase of the November Coalition and Siobhan Reynolds have really been working hard to get the word out,” said Linda Paey. “I couldn’t do all this myself. But we are encouraged by all the support we are finding out there. The Times editorial certainly helped. And my coworkers and neighbors have been very supportive. There are people I don’t know who pull up in my driveway and offer their support,” she said. “It’s a little shocking.” She has also had nibbles from the CBS news program 60 Minutes, Paey said.

Linda Paey is not pleased with local law enforcement and prosecutors. “They have done nothing but try to prosecute my husband, and they used the most disgusting tactics. They’re used to threatening everyone with long mandatory minimum sentences, then getting them to cop a plea and get probation,” she said. “If these people are so dangerous they need mandatory minimum sentences, why do they turn around and give them probation?” she asked.

“This case should not even be in the courts,” Paey added. “Cases like this should be given to the medical board to see if there was any wrongdoing to begin with. Instead, they assume the doctor is over-prescribing or the patient is abusing the drugs, but they don’t know that. It’s an easy way for cops and prosecutors to look tough on drugs.”

“My husband refused to plea bargain because he believes this prosecution is wrong, that this should not be happening. I haven’t been able to convince him otherwise. Now he is collateral damage in the war on drugs.”

And now Richard Paey and his supporters have only a week in which to act to prevent him from being sent to prison for 25 years. Paey’s case is not only an object lesson in the way a dogmatic war on drugs creates new victims, but also a sad commentary on the state of our nation’s judicial systems. When someone is punished for actually trying to defend himself against criminal charges, as opposed to accepting a plea bargain of guilt, something is very much amiss in the halls of justice.

To read the House prescription monitoring bill online, go to:
http://www.flsenate.gov/session/…BillNum=0397

To read the Senate version, go to:
http://www.flsenate.gov/session/…&billnum=580

Self-adhesive Analgesia Equivalent to IV Morphine

The self-adhesive unit contaning fentanyl hydrochloride is the size of a credit card, can be worn on the upper arm or chest. Fentanyl may also have an advantage over morphine in that it does not have active metabolites that can accumulate over time.

In a study with 636 adult postsurgical patients, patients were randomized to receive fentanyl hydrochloride by PCTS or IV morphine by PCA pump. Rates of withdrawal from the study were similar. Patient pain intensity scores were comparable between groups at all assessment times during the first 24 hours, as were their distribution within groups.

Avinza (morphine sulfate)

Avinza was approved by the FDA in March 2002 for the treatment of moderate to severe chronic pain in patients that require continuous, around-the-clock therapy for an extended period of time. A once-daily dose of Avinza in the extended release capsule formulation provides relief from pain for a 24-hour period. Avinza is available in 30, 60, 90 and 120 mg capsules.

Side Effects

The most common side effects reported by subjects in clinical trials were:

  • constipation
  • nausea
  • somnolence
  • vomiting
  • headache

These side effects were dose-dependent.

Mechanism of Action

Avinza is made up of two components: an immediate-release component that rapidly achieves plateau morphine concentrations in plasma, and an extended-release component that maintains plasma concentrations throughout the 24-hour dosing interval. Avinza creates and maintains the plateau-like plasma concentration profile after steady-state plasma morphine concentrations have been achieved.

Clinical Results

Controlled and open-label clinical trials were conducted to test the safety and efficacy of Avinza. A total of approximately 140 healthy subjects and 560 subjects with chronic, moderate-to-severe pain from malignant and non-malignant disease sources were involved in these studies. The duration of the controlled clinical studies ranged from seven days to up to four weeks. Subjects in the open-label studies were observed for six to 12 months.

In one study, 295 subjects with chronic pain from osteoarthritis received either placebo or once-daily treatment with Avinza 30 mg in the morning or evening. Results showed that Avinza was significantly more effective at reducing pain than placebo.

Pharmacokinetic studies indicated that the amount of morphine absorbed from Avinza extended-release formulation was similar to that absorbed from other oral morphine formulations. Furthermore, the pharmacokinetics of Avinza were shown to be dose-proportional for both healthy subjects and subjects with moderate-to-severe pain.

Read patient reviews and rate this medication at Remedyfind.com

How do you cope on the extra “Bad Days”….?

Hi all. I’m having a really “Bad Pain Day”, as my family and I have less-then-lovingly dubbed these awful days.

I can barely get out of bed, but today with ALan’s help I’ve managed to make it the 50ft. from my bed to the couch.

I watch TV or type emails or letters IF my hands will cooperate. I have to do something to keep my mind off the pain.

I think that if I focus too much on the pain, despair is surely to set in. Sometimes the depression can be as bad as the pain! I begin to focus on what my future could POSSIBLY be like… how much more hell can I take…is there a limit that our bodies and minds can take?

Unfortunately I resort to 100mgs. of morphine and a jack & coke. I know that is hell on my liver. But on days like this… that is the only way. I worry that the “gradual increases” the docs have made with my pain meds. over the past several years have brought me to the limit.

Sorry…my mind tends to run thru all the worst case scenerio’s on days like this.

I know it’s crazy, but somehow just by sharing this with someone lightens the load just a bit.

How do you cope?

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