I have a Medtronics Intrathecal Pain Pump. The pump is pretty reserved for people that have exhausted all avenues of pain mgt and are unable to get the relief they need. I have done all kinds of different procedures and some worked for awhile and some didn't. I have a real waqcky system that does not tolerate medication well at all. I am not talking just pain meds either, blood pressure, antibiotics you name it, its a real challenge for drs to care for me because of this. With me we had ran out of options on pain medication working for me that is why I have the pump. There are so many different meds that can be used in a pump and the doseage is lower that is needed because of the way the medication is delivered to the pain receptors.
The pump itself is round and very small and its inplanted in a pocket like of skin on the side of your stomach. Then an incision is made in your lower back and a very small catheter is fed around to the pump for connection purposes and then the other end of the catheter is placed at the dura space where the pain receptors are located. Once your pump is filled with medication the drs set the rate of your meds and the medication is delivered to these pain receptors stopping the pain signal to the brain. I never saw the incision in my back but my husband did and he said I had about a 5 inch incision and the incision on my stomach was about the same. Its pretty much like any surgery as far as post op pain and ect. These pumps are not inplanted by a pain mgt dr unless he is also a surgeon. My pain mgt dr was in the operating room, along with the representative from Medtronics and the surgeon who did my surgery. My surgery was done as an out patient, which I am opposed to, I think for this a patient should be kept 24 hours just to make sure the patient is ok because that is alot of cutting no matter how you look at it. I had no problems don't get me wrong but I just think for practical purposes it should be an overnight stay.
If your Fentanyl patch is handling your pain then you would not be in need of a pump at this time. Like I said they are really the last resort for people with chronic pain. You are very fortunate in having a PCP that is good enough to handle your pain meds. Thats a real rarity as I am sure you know. If you are happy and content with how things are being handled on your part I really don't see a need for a pain mgt dr. Now, if your dr decided to no longer script your meds then yes you would need to see a pain mgt dr. One thing I will tell you is not all pain mgt drs are created equal either. Its like anything else, there are good ones and there are bad ones. I have been very forunate in having good pain mgt drs. None of them ever put me thru what alot of them get put thru in order to get their medications. My former pain mgt dr had all of his patients sign Contracts that set out what we would and wouldn't do and the same with the dr. Quite frankly, I never had a problem signing a Contract, I knew I wasn't just simply shopping for pain meds, I needed help. He also had a sign posted for they did random UA's as well. In four years of being in his care I did two UA's. Both were done right before he quit pain mgt and I feel those were done to make sure I was still that good pain mgt patient that I always had been, because he would not want to ref his pump patients to a dr if we had dirty UA's. Let me tell you, I think the random UA's are great for the drs so they can weed out the ones they already suspect are there to get drugs only. Most of these drs in pain mgt have a pretty good gut feeling when it comes to knowing a true pain patient or one after the drugs. You always knew the ones that were in there with dirty UA's because they would be bawling and squalling. My pump nurse was real good at having that feeling for a bad pain patient and she was helpful to the dr and getting them weeded out. His Contract also stated that you were to bring your meds in for a pill count, I never did and I never got asked to bring them in either. On my last appt with him he gave me a hug and told me that he had wished all his patients had been as good as me to take care of. Oh, I cried when he told me he was leaving, I trusted this man and he had helped me.
My new pump dr is a retired neurosurgeon and she is totally awesome. She only treats pump patients, she does not believe in a Contract, pill counts or UA's. I have a feeling if she thought for a moment someone was abusing their orals meds she would drop them like a hot potato. She is a very intelligent dr. She knows compounding drugs and does all of her own mixing for the meds for the pumps. She does not buy the pump meds pre-packaged. She too believes that people with pumps still need oral medications for BT pain. not all pump drs believe that, and trust me you really do need the orals from time to time if you get in a pickle. She has increased my meds in the pump by 50% which is alot and she increased my BT meds too. Right now, I feel so good, its still scarey to me cause I am afraid its a dream and I will wake up. lol I was having alot of pain but my former dr would not go up on meds. He was just as she said under educated in pumps and under educated in medication. She has been dealing with pumps for over a decade so she knows her business when it comes to these pumps. I will from time to time need increases but thats normal with any medicine used long term. Sorry this got so long...If you have anymore questions on the pump, please ask and I will try to answer them for you...Susie