Life with a Pain Pump - Part 1
Why I chose a Pain Pump & the outcome of the Trial - An excerpt from my medical-memoir, "War on Chronic Pain."
For almost 15 years now, my pain management specialists prescribed well over a dozen different opioid medications for me, each with numerous upward dosage titrations until I either reached an adequate level of pain relief or until they failed. They all failed.
A common problem with long-term opioid patients is that some months after beginning a new opioid prescription, your body can quickly build up a tolerance to the new drug, and, as a result, it becomes less and less effective. After trying almost every opioid, dosage, and delivery method on the market (pills, patches, and injections), I finally arrived at what I hoped would be the last battle in my “War on Chronic Pain.”
Of all the medications I tried, none could adequately control my pain, despite high dosages and doses, which eventually led to great frustration for me and my doctor. In addition to running out of options, he was reluctant to go up on my daily dosages of oral pain medications due to my age. (Personally, I don’t see it!) At this point in my pain journey, I only had two remaining options, choose either a Spinal Cord Stimulator (SCS) or a Pain Pump. The SCS unit was my first choice, however, it was ruled out by my surgeon due to a buildup of scar tissue resulting from my three previous spinal fusion surgeries, which wouldn’t allow the electrical leads to be threaded along my spinal cord. Finally, my pain doctor told me we were out of options, and it was time to think about having a “Pain Pump” implanted. I was way past ready by that time as my pain levels were then consistently averaging between levels 6 and 8. The next step would be to have a trial to see if I would get the benefits of lower pain levels that the pump promised.
My Pain Pump Trial
Pain pump candidates include people for whom conservative treatments have failed, and the continuation of oral opioid treatments or additional surgeries is not likely to help. To determine if a pain pump is an option for you, you will need to undergo a short trial where an opioid is injected directly into the intrathecal space surrounding the spinal cord. This test gauges both the drug’s effectiveness and your ability to tolerate receiving medication intrathecally.
I was concerned that I might not be a good candidate because I’d had multiple spinal fusion surgeries (each a failure) and, consequently, a significant buildup of scar tissue resulting from those surgeries. So, before the trial could begin, my surgeon ordered a fresh set of CT scans to determine if an implant would even be possible for me. After reviewing my scans, my surgeon said that I passed this initial hurdle, and my pain pump trial was then scheduled for October of 2020.
On the morning of the test, I was positioned on a treatment table, lying in a fetal position on my left side. While viewing my spine under a fluoroscope, my pain doctor carefully and skillfully injected 0.25 mg of Dilaudid (hydromorphone) in the intrathecal space between my L4 and L5 vertebrae. At the time of the test, I was in level-7 pain due to not taking any pain meds for the past twelve hours per my doctor’s orders. He wanted me off all pain meds to properly evaluate if the tiny dose given would be effective and to ensure that I would not be subject to an opioid overdose. The entire procedure took about twenty minutes, but my doctor had me wait in an exam room for an hour to ensure that I wouldn’t have any adverse reaction to the procedure, which I didn’t. Once the doctor cleared me to go home, I was given a form and instructed to write down my pain levels to take it easy at home for the rest of the day.
Following are my pain levels on the 0-to-10 pain scale for the first eight hours after the trial:
Before the procedure 7/10 (7 out of 10)
Immediately after the procedure 5/10
1 hour after the procedure 4/10
3 hours after the procedure 2/10
6 hours after the procedure 3/10
8 hours after the procedure 4–5/10
Needless to say, I was thrilled with the outcome of the test in that my pain levels had dropped from a 7/10 to only 2/10! For me, a 2 or 3 is like no pain at all when you consider that my normal average pain is a 6 or higher. The test proved that the injection of less than one-tenth of 1 percent of my normal daily dosage of oral opioids could effectively keep me nearly pain-free for several hours. This looked promising!
With my intrathecal trial injection’s success, I decided to have a pain pump implanted. The relatively brief surgery was scheduled for February 26, 2021.
Next week in parts 2 & 3, we’ll take a look at the advantages and drawbacks of a pain pump, plus detailed information about pump technology and more about my decision to undergo implant surgery. Oh, and I’ll also let you know how the surgery went. In following weeks, I’ll also let you know what the surgery and rehabilitation were like and whether the results I ultimately attained were similar to the positive results of the trials. There’s much more to come, so stay tuned!
All the Best!
Franklin
P.S. - Thanks to Flowonix.com for the image of their “Prometra II” pain pump.