Chronic Pain: Implantable Pain Control Devices (cont.)

MEMBER QUESTION:
I have fibromyalgia combined with myofascial pain, which have made cysts in my joints and muscles. Are there any such devices that could benefit me? I am so sick of taking painkillers. I also cannot take the usual treatment for the fibro of antidepressants; I get a violent reaction. Are there better reactions to any drugs (anti-inflammatory) when dispersed through a pump?

KAPURAL:
It's possible, but we would have to look at all the diagnostic procedures that you have had up to now and examine you. Secondly, if it is effective, it may be effective for either of your conditions, and trials should be tried before implant. If you are already on a large amount of oral medications, you should see someone in interventional pain management.

MEMBER QUESTION:
Could someone with epidural fibrosis and degenerative disk disease benefit from these devices? I've been a chronic pain patient for over four years now and have had numerous nerve root blocks and most recently bilateral lumbar facet injections. They last about a month and then I'm back to eight or nine on the pain scale.

KAPURAL:
These are two groups of question. First, can someone that has degeneration of the disk and epidural fibrosis or scar tissue benefit from those devices, and my answer is yes. We have to look into the ratio of pain coming from the degenerative disk or the epidural adhesions. That can only be done during initial evaluation.

The second question was if you can get longer pain relief, and I understand you have had a series of injections. You can have something called facet radio frequency ablation, which should give you longer pain relief than a plain block.

MODERATOR:
What is radio frequency ablation?

KAPURAL:
This is just using a high-energy source around the tip of the radio frequency needle to ablate a small sensory nerve, which gives enervation to that particular facet.

MEMBER QUESTION:
I have had radio frequency ablation twice with no success. Will this determine if the stimulator will work?

KAPURAL:
No, unfortunately not. The initial evaluation and the trial will determine if the stimulator will work.

MEMBER QUESTION:
My pump has a kink in it. Should it be turned off or turned down until surgery? It is running at 6.552 mg/day.

KAPURAL:
It depends where the kink is. The physician who is managing the pump should determine where the kink is and if you are getting any medication. If he wants to he can convert you to oral medication until surgery and decide the next best appropriate approach during surgical procedure, because the kinks can be solved in several different ways during surgery.

MEMBER QUESTION:
I am in constant back pain, mostly sciatic right and left. I am thinking a pain pump inserted will help me. I can't take this pain much longer. I am taking Vicodin and now Percoset, which help, but I am woozy from it. How many times do they have to refill the pump if I get it? I hate taking strong pain medications and can't afford them either.

KAPURAL:
First, regarding the question about bilateral sciatica, the question is if stimulation is more appropriate than the pump. This should be decided during the trial.

Secondly, will you be better off with the pump than oral medications? Probably yes, if you require large amounts of oral medications.

MEMBER QUESTION:
I have just been diagnosed with arachnoiditis. I will be seeing a pain management doctor this month. Will a stimulator and/or morphine pump help with this problem?

KAPURAL:
Yes. A pump is more likely than the stimulator to help, if it's diffused arachnoiditis.

MEMBER QUESTION:
Is a stimulator out of the question for someone with a pacemaker?

KAPURAL:
It can be done. There are certain frequencies that we can adjust so that a stimulator can be used with a pacemaker.

MEMBER QUESTION:
How do doctors determine which medications are used in the pumps?

KAPURAL:
There's something called the panel of experts who came up with an algorithm for what to use first, second, third, and so on. We know from our clinical experience that certain medications are better for certain diseases and this is how we base our approach for intrathecal delivery systems.

MEMBER QUESTION:
Are there any side effects to internal devices like these? What risks are involved?

KAPURAL:
Any of the implantable devices that deals with either epidural or intrathecal space can possibly produce, as a complication: nerve damage, bleeding, infection, and possible headaches, which can last for relatively short time periods.


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