Chronic Pain: Implantable Pain Control Devices (cont.)

MEMBER QUESTION:
I believe doctors need to do a better job explaining the side effects; I have had nausea, bowel problems, and hallucinations since my pump was put in me in 2001.

KAPURAL:
I was referring before to the complications of the procedure itself. Continuous infusion of the pump should not produce long-term side effects. I'm saying this with relative confidence because we can do rotation in the pump, changing the medication to another medication that will not cause such a side effect. It's not necessary to have any side effects from the medication or the intrathecal pump. You should have either replacement or adjustment of the medication in your pump to some other medicine.

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

MEMBER QUESTION:
I am currently a patient at a pain management clinic. About a year ago I received a microlaminectomy/discectomy L3-4, L5-S1, and revision of a prior fusion L4-5. I was then told that I would benefit from a spinal cord stimulator and had gotten approval from worker's comp for the spinal cord stimulator (SCS). The trial stimulator was placed and I got reasonable benefit from it. Now worker's comp says they will not approve the insertion of the permanent SCS because of spinal stenosis in the whole lumbar region. The reason was that there is no evidence that an SCS will help a person with spinal stenosis. I find this to be ridiculous since the trial worked. What are your opinions on this?

KAPURAL:
First of all, if you had significant benefit from the stimulator trial, that means more than 50 percent of pain relief, I would think you would benefit from spinal cord stimulation.

As far as the diagnoses are concerned, you may have several diagnoses regarding the MRI I just heard about, so spinal stenosis may be just one of them. I do not see the reason why you wouldn't get a spinal cord stimulator system if you had this response to it during the trial.

MEMBER QUESTION:
What is the life span of a stimulator?

KAPURAL:
The current systems have different life spans. Medtronic's synergy battery can last for about four to five years; on the other hand, Advanced Bionics' system came with rechargeable batteries, which may last a little bit longer and can be recharged every week. I heard that Medtronic is coming up with a new rechargeable battery that may last 10 years.

The battery is replaced by very simple replacement surgery that just involves opening the pocket, taking the old battery out and putting the new one in.

On the other hand, current programmable pumps last about five years.

MEMBER QUESTION:
How will I know when my battery needs replacing in my pump?

KAPURAL:
With the new pumps and the stimulators, when they are interrogated using our remote programmer, we can exactly see how much life is left in the stimulator or the pump battery. Alternatively, older pumps do ring with short beeps once the battery life is coming toward the end.


MEMBER QUESTION:
Can it be used for diabetics with back pain and neuropathy?

KAPURAL:
Yes. We feel that the spinal cord stimulation, particularly, is very helpful in diabetic neuropathy. In addition, they may have another benefit: better control of diabetes. We wrote about it this year in the journal Anesthesia Analgesia .

We have two theories why patients with type 2 diabetes would benefit. First, because spinal cord stimulation releases some molecules, like nitric oxide, which induce production of your own insulin. We also think that the stimulation decreases levels of substances that will increase the glucose in the circulation.

MEMBER QUESTION:
Does this device help sciatica pain also?

KAPURAL:
Sciatica is a term; it just describes the pain that goes down the legs to the feet. There can be numerous sources of the pain and that has to be evaluated in detail before any treatment is implemented.

MEMBER QUESTION:
How do the insurance companies feel about these devices?

KAPURAL:
Interestingly enough, we don't have any problems getting approval, either the spinal cord stimulators or the pumps.

"We do implant stimulators for severe chronic pelvic pain in the female population. These are the patients who had severe endometriosis for years, were operated on many, many times, with chronic pelvic pain ongoing. We found those patients do respond well to spinal cord stimulation."


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