The Pain Pump
The pain pump is an implantable device consisting of a reservoir and a pump attached to a catheter. The catheter is threaded into the spinal canal, and the pump implanted beneath the skin in the flank. The reservoir is filled by hypodermic needle with the opiate of choice. In theory, if not always in practice, the pain killing drug from the reservoir infuses a spinal canal blocking pain receptors and thereby relieving pain.
My patient, Ivring, suffered severe back pain from disc disease and also left lower extremity pain due to damage to the nerve roots. He entered my care in 2006, and I struggled mightily to find the anticonvulsant, antidepressant, or opiate that would relieve his pain. I failed miserably even though I gave him Oxycodone 30 mg. every four hours, a dose at that time I thought was quite high. I referred him to a neurosurgeon for a pain pump implantation. It was performed uneventfully, but no matter which opiate was used, pain was not relieved. After some three years of increasing the concentration of this or that drug, his neurosurgeon elected to remove the pump. The reasons were several. First, it wasn't working and secondly, since it was a mechanical device implanted within the body, it was subject to malfunction and the administration of too little or too much painkiller, the latter with sometimes disastrous consequences. Moreover, as a foreign material within the body, it was subject to infection. His neurosurgeon informed me of his decision and asked my assistance. The opiate being used at the time was Dilaudid, and if the pump was removed, my patient would be subject to a severe withdrawal. I provided oral Dilaudid. The pump was removed, and the patient experienced no withdrawal, but his pain continued unabated.
I returned to my first drug of choice, Oxycodone, and wrote it for him at the previous dosage of 30 mg. every four hours. There was no benefit at all. So, more knowledgeable in opiate therapy and more willing to use higher doses, I gradually increased his prescription to 60 mg. every four hours. The effect was remarkable. He told me he was better, and he looked better. His gait was less encumbered, and his affect was less depressed. Emboldened now and less fearful of high dose opiated therapy, I increased his dosage to 90 mg. of Oxycodone every four hours. A half a gram of the stuff every day. He has prospered. He looks and acts ten years younger. His family and friends all comment upon it. He smiles more readily, his speech is stronger, and his disposition is much more pleasant and positive.
Three years before I had been afraid of very high dose opiate therapy. I am much less afraid now because I have seen miracles with the unstinting, aggressive use of the drugs.
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