Pain and Stress

[timbj]

[Nicolai]

I have finished most of my recovery from the installation of my intrathecal pump. Here are two links that may be useful: and . I am providing my insights for others evaluating an intrathecal pump for pain management.

At this point, I have to recommend this device to anyone who is experiencing severe pain. The pain relief is beyond description: complete and thorough. I am still on oral medication, and have not completely switched over to the intrathecal medication. Explore this option if you want relief from severe pain; however, note the possible side effects. Choose wisely.

As background, I have pancreatic cancer with bone metastasis in the spine. I have severe abdominal, spinal, and neuropathic pain, and I required roughly 1,500mg of Oxycontin daily, with extra immediate release medication during rough spots.

The installation consists of a trial insertion, evaluation, and then a permanent insertion of the pump. After the permanent insertion, switch from oral medication to intrathecal medication over time.

The trial insertion evaluates the catheter (a small flexible hollow tube) for efficacy. Catheter position and narcotic combination are evaluated. The test insertion left me in the hospital for several days, during that time I realized that the pump worked great (complete relief from my cancer pain), however I was prone to severe pain from pressure of the catheter onto the spinal cord. I was awake during the trial surgery. The threading of the catheter is challenging on my psyche: I felt nerve roots being pressed by the catheter. When the catheter pressed the spinal cord, I experienced more surreal pain. The surgeon used this feedback to back off and to insert the catheter in a different manner. The fear of paralysis made the feedback process challenging.

During hospitalization, the surgeon and nursing staff examined me for side effects of the intrathecal narcotic, and I evaluated the intrathecal narcotic for efficacy. We also evaluated surgical issues. I experienced severe pain in my kidneys when I tried to bear down. A temporary pump, the size of a small purse, injected narcotic into my intrathecal space. Through the intense kidney pain, I could feel all of my cancer pain dissipating, during private moments I grieved for the volume of pain I endured, as I was now aware of how poorly oral narcotics manage chronic pain for me. Then after several days the catheter is removed.

After the first surgery process was complete, I met with my pain surgeon and explained that the pressure of the catheter onto the spinal cord negated the benefit from the relief. My spine received radiation treatment in the insertion area, and there are many metastases in the vertebrae where the catheter had to travel. Insertion was at space between T10/T11, and the catheter was advanced to T8. The surgeon modified the insertion procedure for the second surgery.

During the second surgery, the insertions were more severe in sensation. During several moves up the spine, my leg felt on fire and being electrocuted. Life challenges us for every reward. After the catheter placed, I was placed under general for the insertion of the pump, and treading of the catheter to the pump. Overall, the surgery is minor in nature; the pump is secured under the skin, the catheter insertion is the most challanging aspect.

The pump is completely covered by skin. Nothing is exposed.

Then I started reducing my oral medications as the intrathecal narcotics were increased. I then hit my withdrawal wall, and vomited for a week while I found the exact level of the oral narcotic level I needed to avoid profuse vomiting.

The information I needed was how fast I clear oral narcotic, and the level of narcotic I need to avoid withdrawal. With these two metrics, I can reduce the oral narcotic, and then wait 6 days for the oral narcotic to clear my system. Then I can reduce the oral narcotic again. Apparently, the level of withdrawal and the rate of clearance are individual.

Friends who meet me noted how more alert I look, and how more alive I look. My face color seems better. I'm now interested in sex again! How wonderful!

For me, as a patient, the largest upside is relief. I have more complete pain relief. The spine pain is gone, the abdominal pain is gone.

I am so pleased to be able to have more "insurance against pain" available to me.