Pros, Cons, and Risks of an Opioid Pain Pump
Recently, in response to the article, Intrathecal Opioid Pumps: Few Pros, Many Cons, a woman shared her story with me as follows:
"I've had a morphine pump since 2005, and in Oct 2014 it malfunctioned and I had to go in and have it replaced. While the actual replacement went just fine, during the surgery they found I had a granuloma on my catheter tip blocking any possibility of morphine being delivered effectively"
Both my husband and I are very concerned over that situation. I have already been told that if they put morphine back in my pump there's a good chance (I don't know how great) the granuloma could return. Needless to say I don't want to go through what I've gone through these past 4 months if it happens again, and what if it gets worse next time or even now and the granuloma invades my spinal cord??"
She is quite distressed about what to do with her current situation. What would you do? Would you keep the pump in place and continue to use it? Or would you have the pump removed? Your answer probably depends on how good your quality of life was while using the pump for the past nearly ten years. Life may have been good enough to risk future problems with the opioid pump.
The problems encountered with the opioid pump are well known. (1) One of the worst problems is being experienced by this poor soul. She has a catheter tip granuloma. These granuloms are more common in those using high doses or concentrations of morphine in the pump. People that have had spinal surgery are more at risk for an inflammatory mass of tissue at the tip of the catheter too. (2)
In order to clear the granuloma away, this woman's doctor placed saline in her pump and she has had to survive just using oral opioid medications. While being in misery for the past four months, she has had much time to contemplate whether or not to continue using the pump once it is clear to do so. And oh what a miserable past four months it has been; she does not want to go through that again. However, there is a good chance that she will have to go through this again in another ten years if she continues to use the pump.
Had she been experiencing end-of-life, cancer-related pain, she probably would not have had to experience these problems at all considering a shorter life expectancy. The pump system probably would have out lasted her, so to speak. But that was not the case; she has non-cancer-related severe chronic pain and she has outlasted her original opioid pump system.
This type of scenario is why the studies have shown that the use of the intrathecal opioid pump is much more reasonable for cancer related pain.(3) This decision is a matter of weighing the benefits and the risks, the pros and the cons, and deciding what is best for you.
Prager, J, Deer, T, et al; Best Practices for Intrathecal Drug Delivery for Pain; Neuromodulation. 2014 Jun;17(4):354-72
Narouze, SN; Patients with History of Spine Surgery or Spinal Injury may have higher chance of Intrathecal Catheter Granuloma Formation; Pain Pract. 2014 Jan;14(1):57-63
Ver Donck, A; Intrathecal Drug Administration in Chronic Pain Syndromes; Pain Pract. 2014 Jun;14(5):461-76.
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