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   shoreline i have a question for you (Pain Management board)

12th September 2004
Hey Dana, There are only two manufacturers of IT pumps, One is made by medtronics and they are great with info if you contact them. The medtronics pump is programable and has many more features than the other called the Arrow. I'm sure the manufacturer of the arrow can be found with a search for Arrow Intrathecal pump. The link above is for hopital supplies and pumps like feeding pumps, PCA and the protable pumps used for trials and other temp med infusion like antibiotics and such. I just happened to click on it. It wasn't Crazy Bobs infusion pump wharehouse.LOL Just med supplied you see in the hopsital.

The advantage of the arrow is that it all works on a vacum principle and the amount delivered is determined by the amount of meds placed in the pump. It won't need to be replaced when the batteries die because it has none. The medtronics is programmable, has a micro processor, can be set to give bolus doses at certain times of the day, etc. It uses a battery which means you have to have the entire pump replaced every 3-7 years depending on flow rate. In 3-7 years it will be replaced by a the new synchromed 11 if all the bugs are worked out and it gets FDA aproval.

The cath can be left in place and they simply pop the old one out and repolace the entire pump. Compared to back surgery the pump was a breeze, no worse than having a couple teeth pulled. The synchromed 11 is the new meddtronics pump being test marketed right now, the big advanatge is havng a much larger resevoir. Instead of 18ml you have a 40-50 ml resevoir. Meaning much longer time between refills.

Meds in the pumps come in different concentrations like 10mgs per ml , 20 or 30 mgs per ml when using morphine. DIlaudid can be used, and a couple of the different versions of preservative free fentanyl can be used, Carfentanyl, Afentanyl and Fentanyl. The Fents are measured in Micrograms so you you would have X# of micrograms per ML. They can add numbing agents like Bupivicaine or meds for spasm or spacticity like Baclofen.

Although I have only had the pump 3 months I spent 4 years researching this and trying other methods to manage pain. There isn't a ceiling on oral opiates other than side effects and that's what I ran into and was part of the decision to go ahead.

Also only having medicare, with no script insurance, I couldn't afford LA morphine and meth was my only choice which got old after a few years. If He's disabled and has medicare, they do cover most of the cost. You have a 860 dollar copay for the surgery and 20-35 dollar copays for office visits to have it adjusted and refilled. The meds are not charged to MC or the patient or they are included in the refill billing code.

Cost of meds and copays does become a considertion unless your independently wealthy. In the beginning you are seen more often so have more copays, during titration or when meds are changed. After 3 months and a dozen adjustments, which is not uncommon because they go in small increments to be safe, I really don't know when I will be at a point where I feel like it's doing all it can for me.

I do hope they find something for your hubby. The main thing is to have confidence in your doc that he will continue to work with you untill you have reached max benefit without side effects that limit your ability to function. He shouldn't have to feel guilty calling every 2 weeks untill they get things adjusted corectly or find a med that works better than another. That's pretty much expected, nobody gets it right with the first dose or med they try. The good thing is you do get to do a trial of the pump. Either in-patient where your dose can be adjusted daily, Outpatient with a portable pump or by a single bulus injection of opiates directly into the intrathecal space.
Good luck to both of ya,
Dave

PS does your husband read here, It would probably help him to know he's not the only one and to learn all the other tricks his present PM doc may not be using. Nobody can offer everything, but a multifaceted aproach with several PM docs in a clinic setting would usually have more options than a single doc alone in practice.

HE's definitely not alone. I don't know anyone that's truly satisfied with their PM other than knowing their doc is honestly trying his best. Most PM docs have a goal of 50% reduction in pain, that's the best that can be done for many people and that still leaves alot to deal with. But a 50% reduction in pain from a pump trial is considered a success and worth proceeding. 50% is certainly better than 10%.

I've been down that road where nothing or just the bare minimum was done to prevent someone from eating a bullet. 50% is better than living like that, but still means you are living with a significant problem with many limitations for some.
Good luck, Dave
13th September 2004
Quote from Shoreline:
Hey Dana, There are only two manufacturers of IT pumps, One is made by medtronics and they are great with info if you contact them. The medtronics pump is programable and has many more features than the other called the Arrow. I'm sure the manufacturer of the arrow can be found with a search for Arrow Intrathecal pump. The link above is for hopital supplies and pumps like feeding pumps, PCA and the protable pumps used for trials and other temp med infusion like antibiotics and such. I just happened to click on it. It wasn't Crazy Bobs infusion pump wharehouse.LOL Just med supplied you see in the hopsital.

The advantage of the arrow is that it all works on a vacum principle and the amount delivered is determined by the amount of meds placed in the pump. It won't need to be replaced when the batteries die because it has none. The medtronics is programmable, has a micro processor, can be set to give bolus doses at certain times of the day, etc. It uses a battery which means you have to have the entire pump replaced every 3-7 years depending on flow rate. In 3-7 years it will be replaced by a the new synchromed 11 if all the bugs are worked out and it gets FDA aproval.

The cath can be left in place and they simply pop the old one out and repolace the entire pump. Compared to back surgery the pump was a breeze, no worse than having a couple teeth pulled. The synchromed 11 is the new meddtronics pump being test marketed right now, the big advanatge is havng a much larger resevoir. Instead of 18ml you have a 40-50 ml resevoir. Meaning much longer time between refills.

Meds in the pumps come in different concentrations like 10mgs per ml , 20 or 30 mgs per ml when using morphine. DIlaudid can be used, and a couple of the different versions of preservative free fentanyl can be used, Carfentanyl, Afentanyl and Fentanyl. The Fents are measured in Micrograms so you you would have X# of micrograms per ML. They can add numbing agents like Bupivicaine or meds for spasm or spacticity like Baclofen.

Although I have only had the pump 3 months I spent 4 years researching this and trying other methods to manage pain. There isn't a ceiling on oral opiates other than side effects and that's what I ran into and was part of the decision to go ahead.

Also only having medicare, with no script insurance, I couldn't afford LA morphine and meth was my only choice which got old after a few years. If He's disabled and has medicare, they do cover most of the cost. You have a 860 dollar copay for the surgery and 20-35 dollar copays for office visits to have it adjusted and refilled. The meds are not charged to MC or the patient or they are included in the refill billing code.

Cost of meds and copays does become a considertion unless your independently wealthy. In the beginning you are seen more often so have more copays, during titration or when meds are changed. After 3 months and a dozen adjustments, which is not uncommon because they go in small increments to be safe, I really don't know when I will be at a point where I feel like it's doing all it can for me.

I do hope they find something for your hubby. The main thing is to have confidence in your doc that he will continue to work with you untill you have reached max benefit without side effects that limit your ability to function. He shouldn't have to feel guilty calling every 2 weeks untill they get things adjusted corectly or find a med that works better than another. That's pretty much expected, nobody gets it right with the first dose or med they try. The good thing is you do get to do a trial of the pump. Either in-patient where your dose can be adjusted daily, Outpatient with a portable pump or by a single bulus injection of opiates directly into the intrathecal space.
Good luck to both of ya,
Dave

PS does your husband read here, It would probably help him to know he's not the only one and to learn all the other tricks his present PM doc may not be using. Nobody can offer everything, but a multifaceted aproach with several PM docs in a clinic setting would usually have more options than a single doc alone in practice.

HE's definitely not alone. I don't know anyone that's truly satisfied with their PM other than knowing their doc is honestly trying his best. Most PM docs have a goal of 50% reduction in pain, that's the best that can be done for many people and that still leaves alot to deal with. But a 50% reduction in pain from a pump trial is considered a success and worth proceeding. 50% is certainly better than 10%.

I've been down that road where nothing or just the bare minimum was done to prevent someone from eating a bullet. 50% is better than living like that, but still means you are living with a significant problem with many limitations for some.
Good luck, Dave


Ok Thank you very much Dave. Yeah apperently we are going to have to look into this option. I feel like we are running out of options. But thank you and i will mention this to our doc next time we go in. :wave:
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