Chronic Pain, (CP), is pain that has persisted for at least 3-6 months as opposed to acute pain, from an injury such a cut finger, that goes away when the injury has healed. It is estimated that 100 million Americans suffer with CP and for that group, CP has become the disease and no longer a symptom.
Once it becomes the Disease of Chronic Pain, the best way to treat it needs to be investigated. Treatment often starts with Physical Therapy, Acupucture, biofeedback, and others. Since pain is so individual the treatments must also be.
Regrettably for many of these millions in CP the above do not work and other modalities must be looked at. This is where the question of taking medications or having a pain pump come in. In general doctors will start with medications which often work, at least for a time. When talking about pain medications this usually means Narcotics which can have many side effects, some of which are unacceptable and worse than the pain.
Once a patient finds a medication that works then the problem becomes how much can you take, at what dose, and for how long. It can take years, but many patients come to the point where the medications no longer work, they have reached the limit on what a doctor will prescribe, or both.
This is where a pain pump or the correct name “Intrathecal Pump”, might be suggested by the doctor. It is a difficult decision for patients. Just think of having something implanted inside of you with medication in it. There is the surgery itself, problems with surgery, more surgery to replace it when the battery dies, infections, and so on.
So, what is a Pain Pump and why would patients choose it over pills? First, the pump itself is about the size and shape of a hockey puck and is implanted just under the skin in the abdomen or back. Then a catheter, attached to the pump, goes into the Intrathecal space in the spine. The doctor will program the pump to deliver a medication or several medications at a rate and concentration determined by the trial. Scary thoughts but read on.
Patients usually go through a psychological evaluation to make sure they can handle all of this. If that goes well, there is the ‘trial’ for the pump itself where the catheter is in the spine but the actually pump is not yet implanted. At this point the doctor will try different medications and doses to see what works best for each patient. Once this is determined a success, which mean getting at least 50% pain relief, the pump is implanted.
Then comes what can be a long process of finding the right dose. While this was done during the trial is must be done again once everything is implanted. Doctors usually start with a very small dose and slowly increase it as the patient tolerates without side effects. It is important to find the lowest possible dose that gives pain relief so you have somewhere to go if your pain gets worse and you need increases. It should be noted that once the right dose it found, most patients do not need more increases for many years.
Now, the question: pills or pump? As said before, pills can have many many terrible side effects and while you are getting the same type of medications in a pump, the huge difference is with the pump the medication is such a minute dose compared to what people take orally that so are the side effects. Most patients will tell you that they went from being a “zombie” on high doses of oral medications, to being normal with the pump, and yet get the same, or better pain relief with the pump.
So, if you had Chronic Pain which would you choose? Pills or pump?
My decision was an easy one and having my THIRD pump implanted 2 years ago should prove that.