I am so glad that you are having such a positive experience with your pump. Your experience is a testament to the flaws of evidence-based medicine. The medical evidence, including the sited article, does not account for individual differences.
(As stated, the article sited did demonstrate a benefit, "The study showed that when patients with extrememly severe pain problems are selected as pump candidates, they will likely improve with therapy, but their overall severity of pain and symptoms remains high."Intrathecal Opioid Treatment for Chronic Non-Malignant Pain: A three year prospective study; Thimineur", et al, Pain 2004). This article was also referenced in the mentioned lecture by Professor Gilbert Fanciullo, MD at Cambridge, Mass on June 21, 2011. Dr. Fanciullo is the Director of the Pain Medicine Division at Dartmouth Hitchcock Medical Center.
This lecture at Cambridge about the intrathecal opioid pumps was sobering indeed. As I sat in the lecture hall and listened to what Professor Fanciullo was saying, I remember my own experiences as a young doctor with the intrathecal pumps. What I heard echoed my own opinions formulated from my own experiences at UC Davis Medical Center over a decade ago. Yes, I have assisted in the OR with pump placement. Yes, I have filled pumps in the PM&R clinic. Yes, I have received calls from the ER about someone who just arrived at 3am with a pump alarm going off in the abdominal cavity.
Fast forward to present time, 10+ years later, in the lecture hall at Cambridge, I realized that the truth about pumps continues to be sobering and somber, but it needs to be told.
No one should be shamed for telling the truth. Shame should go to the doctors who are so drunk from the Medtronic kool-aid that they do not fully inform the patients about the reality of intrathecal pumps. (please see the comment from "Mare" below).
Dr. Christina Lasich, MD
True, this is a complete gloom and doom article. It sounds exactly like the lecture I heard at a Pain Clinic I attended in Palo Alto, Ca. I had to correct the Dr. (much to his dismay!) several times during his lecture. One of his comments was that only people on their death bed's received the pain pump. At the time, my husband's had just had his removed, and my husband was NOT on his death bed!
However, he did experience life threatening infections twice before his pump was removed. The Dr.'s in our city literally wouldn't touch him, and we live in an area where you'd think that wouldn't be a problem! They transported him by ambulance to San Francisco (45 mintues away) for treatment both times. Each time he was so deathly sick, it was terrifying! Due to the infections, his pain levels were out of control.
Withdrawals were brutal.It was actually several months before my husband recovered.
I have C.R.P.S. and Thoracic Outlet Syndrome, and my Pain Mgmt. Dr. recommended one of these for me just after my husband's was removed, and I laughed! No way in he** are you putting one of those things in me!!
Also, it's true, the pumps do not remove all of your pain. My husband still had to take a LOT of oral med's to make his pain levels tolerable.
5 years later he is still in intractable pain, and now needs bi-weekly testerone shots, thanks to the pump. Our concern is these shots will cause a recurrence of his cancer, but he has no choice. The alternative is brittle bones and other issues.
Yes, the article is very negative, but a good perentage of what was shared is very true. A pain pump is something that should be carefully considered before it's implanted. Funny, we weren't advised about the pump at all before my husband was given his. They just told us they were implanting it, after he'd been hospitalized for a month due to his pain. He'd been given an epidural and kept in that state for a week before they decided to do the pain pump.
Also, we weren't given any advice about much less help with his withdrawals.But then that's Kaiser Permanente for you!
Wow, thank you for sharing. Your husband's experience with the pump is exactly what I hope does not happen to other people. If my article can prevent just this very "doom and gloom" thing from occurring to someone else, then so be it. I will take the heat anyday for telling the truth.
Shame on his doctors for not telling him the whole truth. And good for you for standing up for you and saying "no way in h**".
Dr. Christina Lasich, MD
I believe your very negative comments about the intrathecal pump could be applied to many surgical procedures. I've used the pump for over four years and had some early catheter slippage problems resulting from excessive physical exertion but, otherwise, it continues to work fine.
Other surgeries such as a knee replacement (followed by incisional infection) and hip replacement (three subsequent hip displacements) caused much more trauma and acute pain for me than the pump system problems.
I can think of many surguries and medical treatments that I wouldn't wish on my worst enemy and certainly not for myself.
The tone of your article indicates to me that you personally or some of your patients must have experienced problems with the pump system. The vitriol used to describe the dire consequences of the implant will surely discourage someone who is contemplating this surgery if that's the intent. I believe this is most unfortunate.
I have had a pain pump since 1989 and have it changed sveral times because of the battery needed replacement. It has been a life saver for me and wouldn"t be functioning as good as I am without it. I continue to work 40 hrs a week as a nurse practitioner! It is a life long committment and not appropriate for most people but a useful tool for some.
Oh, Lordy! I just read your post on having a pain pump. I have one and had nothing but trouble with it. The first being no pain relief. Now I read about all the rest of the problems and all I can say is I can't get this thing turned off and get back on orals fast enough! Then I want it out. But what happens if my doctor refuses to accomodate me? Do I have any options?
This post criticizing intrathecal pain control pumps is way off base as to the efficacy and dangers of these internal pain control marvels. I have had an internal Medtronic pump for over five years with only one complication. This pump has helped control my pain more than any other method. Within six months of its insertion, I realized I was no longer really using the cane I had been using for the previous four years. Previously, I had been prescribed fentanyl patches for extended-release pain control, but I found the patch delivery system to be choppy and irregular. I also needed far more breakthrough medication while on the patch.
The pump malfunctioned this past October, right around the five-year mark, which is close to when the battery life is set to expire. My battery did not die, rather the catheter broke at the entrance to the intrathecal space of my spine. I am not sure how or why it broke, but I was in a car collision, and that trauma might have caused the damage. I had some difficulty post-operatively, with a fever and lung alectasis as well as a spinal headache. I am still recovering to an extent, but the pump has brought my pain under control so well that I am a new person, able to handle life again. In fact, I am contemplating attempting a return to the workforce, and my pain was so severe and constant that I was approved for SSDI with my first application.
I dislike people denigrating a therapy when it obviously works for any number of people, and is not used only by those who suffer from a malignancy. Other types of pain can be treated with the pump, and this device can be incredibly effective in the war against pain.
I just had my first pump replace after 7 years in January. I am fused from L4-S1 and C4-C7. I am scheduled to have another spinal fusion in 6 weeks. I have chronic irretraceable pain in my back, neck and shoulders, and have had for more than 25 years. I have been on every pain medication and therapy known to modern US pain clinics to include Prialt, made from a deadly sea snail. I have had nerve oblations from alcohol to lazars, and none of my previous treatments have been as effective, and had the least amount of side effects as the pump has. It all depends on who implants it and manages the medications as to the complications that arise out of it use, and once you have it you can't pretend you aren't still limited physically by what you can and cannot do. If you're bad enough to need one in the first place you shouldn't return to normal activities that most people take for granted. Yes you have to make life style changes, and the pump relieves at least 50% of my pain, but the alternative is un-thinkable pain and side effects from oral medications that are so bad you don't want to live, or your so mentally impaired that you just don't care. And that's not living! I suggest going to a pain clinic at a major teaching hospital that is on the cutting edge as I have at the University of Virginia, or some place like Duke. You can also contact Medtronics to find the best available. Do your homework and check their surgical stats before you let them cut.
I wonder if you have ever been in severe pain and had to take so much pain meds that you can barely function and still only get about 50% pain relief? I had afailed discectomy and a year later had a fusuin on L4-L5. The Dr put a battery pack in to stimulate faster healing, when I arrived at the ER with life threatening symptoms they found MRSA around the battery pack and in my spine. I lost the fusion and almost lost my life. I was on IV antibiotics for months. It scares me to have more surgeries but life is so bad now that I am willing to risk anything. I am only 54 and my husband and I thought we would always travel when our daughter was grown, but we do nothing because I can't sit for long and spend most of my time in bed. There are risk with every surgery and I believe there are alot of pros to the pain pump. I hope to have one installed soon and will report my experience when I do. I hope that more people who have had a good experience with the pump would post. And I wish you would post the pros so people can make a more informed choice!
I have a Synchromed II that was implanted in 2008 and it has saved my life. I have had no complicatations and it is the only thing that has worked in the past
30 years of living in agony. I used other methods such as methadone and the Duragesic Patch which left me nodding and brain dead . I have had wonderful doctors and one that was not too good who I left within 6 months. Did you interview a sample of people who have the pump before you wrote such a negative artcle? Ten years ago is a long time ago to judge a therapy that has changed and been updated. My pump given me my life back and I thank God that I finally found something that works.
I too love my pain pump!! I have had my pain pump over two years and have never had any problems with it.
Before my implant both my feet and legs pounded and throbbed with pain 24/7!! No Doctor wanted to treat my pain!! I was in agony. I sould not sleep or eat because of the brutal pain.
Then I found the wonderful Doctor who implamted my pain pump for me. Yes I was told about all the problems a pain pump might have but I still wanted it. To me the benefits far outweighed any problems I might have.
I now have my life back. I only take oral pain meds when I have a flare up.
The only way anyone will take my pain pump away from me is out of my dead body!!
Thanks for sharing your experience with the pain pump. I am 2 years older than you and in a similar condition. I've gone through the gamut for about 14 years with my back pain and I've had multiple epidurals at various sites, RFL, RFI, cyro, heat, PT, L5/S1 fusion in December 2005 failed and I had another fusion there via an ALIF. I have a spinal cord stimulator for 6 or 7 months including 1 surgery to to replace the battery/generator because it had moved and was on my spine causing even worse pain AND it has moved again and I'm waiting for my surgery date to have the battery moved again! I have seen so many docs, had so many procedures, various medicine cocktails, Kettamine infusions, etc, ad nauseum, and I have had no improvement - if anything, I hurt worse more than ever. My profession and my position as an executive in my company, requires me to be "on" all the time with my employees and clients and I have missed so many meetings, so much work, that I finally threw in the towel and went back on disability a couple of weeks ago. The pain pump is my last resort. If the pump does not work, I'm stuck with taking heavy doses of prescribed narcotics for the rest of my life. I too walk around in something of a stupor most of the time, I forget a lot of what I need to know, I cannot do anything physical whatsoever - my only hobby has been taking care of my beautiful yard - I used to work out every day and was in great shape. Now, I'm probably 20 or more pounds over weight; I cannot enjoy socializing or traveling as I'm in too much pain or in a stupor. My wife and I love to travel and enjoy being among other people but I am an anchor that keeps my wife to a very limited social life and she is miserable too. I can only hope that the pain pump gives me some relief to enable me to act like I am at least human and engaged most of the time. I expect to have the pain pump trial sometime this month and I look forward to the trial. The "cons" in the article about the pump are new to me as I have not heard most of those potential issues. My experience with all medical procedures is that each one has some risk - some more, some less. Heck, life itself is a risk - I fell down a flight of stairs a few days ago and I could have broken my neck or been seriously injured and, based on the logic of the article above, I suppose I should never use the stairs again, right? So, my choice is to tolerate my brutal pain for the rest of my life or try the pain pump and deal with its "cons?" I elect to give the pain pump a shot and, if it doesn't work out, I will have it removed.
Thanks to all of you that posted your experience with the pump as your sharing is very helpful for me!
You must be a very sad person to write so many negative things about something you know so little about. Instead, why don't you go to the "pumpsters" blog on yahoo and read comments from the hundreds of us that have pumps and feel that it gave us our life back. Get your information from "the horse's mouth". Have you or your sources had to think about killing yourself because of decades of pain? The pump has saved hundreds if not thousands of lives. Do your research the correct way and ask people that have them. What a novel idea.
Oh Thank You! I am scheduled to have a pain pump implant on September 11th-13th at Vanderbilt in Nashville. I beat pancreatic cancer but during the Whipple in April 2004, they had to scrape the tumor off of a vary large nerve. My oncologist has made me a case study since I metabolize pain med so quickly. It took 1200MG of MS-Contin DAILY to get me down to a Level 3 pain.
I am looking at this as a life saver. I still work full time as an IT consultant and need to be rid of the "fog". For a while I had the MS-contin, 100MCH Fentanyl patch and (6) 10/325 Hydrocodone for break through pain. When I saw the MD post that said "Few Pro's, Many Con's" it broke my heart. How could a doctor do that?
You have had a good experience? Seems like everyone has had some issue and I live 300 miles from my oncologist and Pain Management Doc. If I have a bad problem like a kinked tube or a broken catheter I am going to be in a world of hurt!
I am looking forward to your reply, or a reply from anyone in the forum with input.
Thanks!
You will a support group like "pumpsters to answers all your questions and help with your fears. Just google "pumpsters". It will take you to yahoo where they have a chat room. I asked about 100 questions before I went ahead with my pump. You join the group with just name and email and after that you never use your full name, just your first name and the state you live in when you post. They have over 1,000 members that are all overr the US, even some in England. That have sorted all the post so you could even just look up what others have written and I am positive that it has been covered before. If not then just ask. Most have pumps, some are getting them, etc. Some people have had dozens of surgeries for years. The kindest group of people you will ever never from. They all are in CONSTANT chronic pain and everyone understands. Their is a moderator so people keep it clean and you can't use Drs. names or hospitals names, etc. You will not be sorry. Do it today. Just say that you are just joining and tell your story and they will welcome you like family. I hope you do it.
You are spot on. Keep up the good work. If your writing does nothing else than cause people to stop, think, and do some research before they think that a pump is a cure all, then you have achieved something. Are there people that have had success with their pump? Sure. My loved one was in that boat for some time. And yet.... just a few weeks ago a malfunction happened that could have easily ended his life, had he had a more potent med in his pump, like fentanyl, like prialt, drugs that he USED to have. Had those meds been in his pump when it malfunctioned, he would be dead right now. Due to a malfunction. So now, after 10 years of a decent run he is left dealing with the notion of either going back on opiates (a horrid proposition), or spinning the barrel and trying his luck with Russian Roulette again by getting yet another new pump (I think this is #3) Don't discount what this doc is saying. Instead, do some research. Start by googling FDA and Medtronic. Nuff said.
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The title of the article is factually incorrect, as this physician believes there are, in fact, only "cons" to intrathecal pumps. Even in patients with terminal cancer, apparently, the benefit is apparently insufficient to warrant an attempt on her part to quantify its degree (in terms of pain score reduction) or length (in terms of number of weeks of time until the patient's inevitable death.) I only hope no patient or family member of a patient in need of an intrathecal pump comes looking for information, since there is none to be found here. There is also a typographical error, as 1 in 2000 is hardly 4%. That would be 1 in 20.
Sorry for the typographical error, the risk of death is 4%. Intrathecal pumps do prolong life in those with terminal cancer and can be worthwhile as I stated. In cases of non-malignant pain, the potential benefits rarely, if at all, outweigh any potential benefits. Someone who is considering the pump should read this article and weigh these facts very carefully.
All of this information is factually correct, is supported by the sited medical evidence, and was presented at a recent pain medicine conference at Harvard.
Dr. Christina Lasich, MD