From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Newsgroups: misc.handicap
Subject: epidural pump
Date: 28 Aug 92 16:10:30 GMT
Reply-To: Arthur.Saus@p160.f72.n376.z1.fidonet.org
Organization: FidoNet node 1:376/72.160 - Windows of the Worl, Columbia SC

Index Number: 24016

[This is from the Chronic Pain Conference]

Hello David!

06 Aug 92, David Venable writes to All:

 DV> Hi. My wife was injured on the job two years ago and has had hronic back
 DV> pain since. After bone scans,MRI, Cat scans and nerve induction (EMG?)
 DV> studies, they still can't find the cause. Two weeks ago they did an
 DV> epidural with .03 mg. MS and she got some relief. Now they want to implant
 DV> an epidural pump. My question is, Should she? anyone out there have one?
 DV> what are the pros and cons? Thank you,

I don't have one myself, but maybe I can tell you something about this technique.  For many patients with severe pain, this is a tremendous pain relieving therapy.  In fact, it does such a good job at relieving pain, that this is one of the main problems with it!

Do I have you thoroughly confused?  I thought I might with that
statement.  Let me explain further.  Although none of us like pain,
and usually go to great lengths to avoid it, or get treatment for
it when it can't be avoided, pain is not all bad.  Pain is an
important signal that something is wrong and suggests the need for
medical attention... at least to figure out what is wrong.  The
epidural administration of a narcotic is a powerful technique to
block pain, but it is not selective.  That is it will block pain
from a large part of the body, not just the back pain.  If she
later develops some other medical problem (such as appendicitis for
instance), there may be no pain associated with it. If there is no
pain, a problem that would normally be identified early in its
course, may not become apparent until the disease process is
farther along and much more serious.  That is, it may be much more
difficult to identify, then by the time it is identified, it may be
much more difficult to treat... or may have much more serious
complications.

One other consideration, which may or may not concern you, is that
the implanted epidural pump is expensive and requires a minor
surgical procedure to implant it.  The prices I usually see are
around $7000.00 to $8,000.00 just for the implantable pump itself.
This does not include the hospital charges and the physicians' fees
to implant it and provide medical management.  The price I quoted
is just for the hardware itself.

Now after telling you these "negatives", let me again re-emphasize
that it does indeed provide tremendous pain relief, and usually
with fewer side effects such as sedation and mental confusion than
when narcotics are administered by any other route.  This is
because the narcotic is being delivered directly to the area where
it can be the most effective in blocking pain.  Because of this, a
much lower dose can be used than if the narcotic was being
administered by some other route such as getting an injection or
swallowing a pill.

I feel like I've given you a lot of information about this
technique, but the decision about whether use of this pain
management technique is the right thing in your particular
situation must be decided by you (or your wife in this case), and
the physicians providing the medical care.

Arthur

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