Doctors Answer Questions

Doctors with years of experience with Medtronic Pain Therapies have answered some of the common questions their patients ask about Medtronic Pain Therapies.

How often should I follow up with my doctor after I receive my Medtronic Pain Therapy?

Dr. Wellington says: “Typically, after your device is implanted you will have one or two post-operative appointments within the first month. If your device was implanted by one doctor and will be managed by another, you may have more appointments.

The patients who do best after the surgery and during the titration phase of the pump or in the adjustment phase of the neurostimulation system are those who attend every follow-up appointment.

If you have a neurostimulator, once programming is achieved you will have routine follow up appointments with the doctor every 6 to 12 months.

If you have drug delivery therapy, your follow up appointments will be prescribed based on the drug concentration in the pump and the daily dose. The frequency of the refills also is affected if you have a myPTM™ device that allows you to administer your own bolus doses. The screen on the myPTM device will give you an accurate date for when the refill is needed.

Attending these appointments is your primary responsibility. The appointments help ensure you won’t experience an interruption in your therapy.

If you have questions about your follow-up appointments, talk to your doctor.”

Joshua Wellington, M.D., is the Medical Director for the Indiana University Pain Medicine Center at Indiana University Medical Center in Indianapolis. He is also Assistant Professor of Clinical Anesthesia and Physical Medicine and Rehabilitation at Indiana University.

What should I do if my spinal cord stimulation system doesn’t cover my pain as well as it once did?

Dr. Provenzano says: “You should seek assistance from your doctor if one of the following events is occurring with your stimulation patterns:

Stimulation has been lost in your painful area
Stimulation is occurring in an inappropriate area
Stimulation is intermittent
Stimulation has become painful in a way that can't be resolved by making adjustments with your MyStim programmer

When these events occur, there are several ways your healthcare providers can help you. First, they will check to make sure you have a good understanding of your patient programmer. If further adjustments made with your programmer do not resolve the problem, you will be asked to come to the office so the system can be checked and possibly reprogrammed.

When the system is functioning properly, additional programming can change the location and the strength of the stimulation. Often with reprogramming we are able to help people regain satisfactory stimulation patterns.

Other steps will have to be taken if reprogramming is not helpful or if a device problem is identified. X-rays can determine if the SCS system is intact and the lead is in the appropriate position. Lead migration (the movement of the lead from the original placement position) may have occurred, and stimulation patterns can change or be lost. The X-ray can also help to identify if a loose connection has developed between the battery and the lead. Revision surgery will be required when reprogramming is unsuccessful or an uncorrectable electrical problem is identified; however, in a majority of cases, simple changes in programming are successful in achieving comfortable and appropriate stimulation coverage for your painful area.

When you experience changes in pain relief, it is important that you contact your doctor to determine the cause and the optimal treatment."

David Provenzano, M.D., is a pain management specialist at The Institute for Pain Diagnostics & Care, Ohio Valley General Hospital in Pittsburgh, Pennsylvania.

What should I do if my drug delivery system doesn’t relieve my pain as well as it once did?

Dr. Provenzano says: "The major goals of drug delivery therapy are to improve pain, quality of life, and function. Once you have had a pump placed there may be times that you are not achieving the pain relief that you desire.

Possible causes include worsening of your pain state, reduction in response to the drug in your pump (tolerance), or a system complication. Initially your healthcare provider will use a clinician programmer to interrogate your drug delivery system to determine if it is functioning properly.

In a majority of cases, a dose adjustment, a bolus (a one-time additional dose of drug), or a modification in the drug delivered will improve the situation. In addition, Medtronic SynchroMed II pumps allow for patient activated dosing through the personal therapy manager (myPTM). Patient activated dosing may be appropriate if you experience intermittent pain with varying degrees of severity. Patient-activated dosing is not for everyone and requires significant education and responsibility from both the doctor and patient.

Additional causes for inadequate pain relief include complications with the catheter or the pump. The most common area for mechanical system dysfunction is the catheter. Complications that occur with the catheter include fractures, disconnections, movement, occlusions, and growths at the tip (granuloma). If a granuloma is suspected, radiographic imaging will be ordered to evaluate the catheter. Although pump malfunctions are rare, they can occur. Examples include battery depletion and component or motor failure. Catheter and pump failures will require revision surgery.

When changes in pain relief develop, it is important that you communicate with your healthcare provider to determine the cause and the optimal treatment."

David Provenzano, M.D., is a pain management specialist at The Institute for Pain Diagnostics & Care, Ohio Valley General Hospital in Pittsburgh, Pennsylvania.

What should I do before and after having an MRI head scan, if I have a neurostimulation system?

Dr. Provenzano says: “First it must be determined if it is appropriate to undergo an MRI head scan. When determining whether an MRI may be performed safely in an individual with a neurostimulation system it is important to define the type of system and the locations of the neurostimulation system and the MRI coils. Currently, it is not recommended that MRIs be conducted on any part of the body using an MRI body coil. When all the appropriate safety steps are taken, an MRI examination of the head can be performed for select individuals with specific Medtronic neurostimulation systems.

Multiple factors should be considered in the decision making process of obtaining a head MRI in an individual with a neurostimulation system. First, a head MRI should only be considered if other safer diagnostic tests will not provide adequate information. The technical specifications and settings of the MRI machine must be within the guideline recommendations. The head coil of the MRI must not cover any portion of the neurostimulation system. Individuals with leads placed in the high neck region may not be able to undergo head MRIs.

In addition, it is important that you discuss the risks and benefits with the pain specialist who is managing your neurostimulation system. There are risks associated with having an MRI when you have a neurostimulation system. MRIs use powerful magnetic fields. The powerful magnetic fields and associated electromagnetic interference may result in significant complications to individuals with a neurostimulation system.

Complications may lead to serious patient injury or death, system damage, operational changes to the neurostimulator, and unexpected changes in stimulation. The MRI may result in the transmission of electrical currents through the neurostimulation system which could result in electrical shocks and heating of the equipment. The heating of the equipment and transmission of heat to adjacent structures may result in significant tissue damage.

It is also important to coordinate your scheduled MRI with the pain specialist who is managing your neurostimulation system. Prior to undergoing the head MRI, your system should be checked to ensure that it is functioning properly, and it should be programmed in preparation for an MRI. Following the MRI, contact your pain specialist to have your device checked again to determine if the post-procedure settings are correct.”

David Provenzano, M.D., is a pain management specialist at The Institute for Pain Diagnostics & Care, Ohio Valley General Hospital in Pittsburgh, Pennsylvania.

What do I need to know about getting a massage with my implantable device?

Dr. Bux says: "Know that you can definitely enjoy a massage if you have an implantable pump or neurostimulator and it will not harm your device. However, it is advisable to wait approximately 6 - 8 weeks after your permanent implant before considering a massage. And if you have an incision that has not healed or an open sore near the pump or catheter incisions, it is advisable to wait until these have healed. Furthermore, always consult with your doctor before getting a massage.

When you schedule a massage, it is important to advise your masseuse that you have an implantable device. Show him or her where the device is located and the incision in your back where an anchoring device may be positioned. Ask your masseuse to avoid these areas during your massage, as any pressure or touching of these areas may cause pain.

If you receive a sauna or hot room massage, it is important to limit your time to 15 - 20 minutes to prevent your body temperature from going above 102° F. Temperatures above this may affect the infusion rate of your pain pump.

Again, consult your doctor before participating in any massage therapy. If you experience any pain during a massage, stop and have your implantable device checked."

Anjum Bux, M.D. is Chief of Anesthesia and Director of the Pain Management Center at Ephraim McDowell Regional Medical Center in Danville, Kentucky.

What should I do before and after having an MRI full-body scan, if I have a drug delivery system?

Dr. Provenzano says: "If you currently have a Medtronic SynchroMed II pump and are scheduled to undergo an MRI, it is important to discuss the scheduled MRI with the healthcare team that is managing your drug delivery system. Your healthcare team can help develop a plan to properly manage the intrathecal treatment before, during, and after an MRI examination.

Potential concerns associated with an MRI include patient injury, system damage, operational changes, and changes in flow rate. Tissue heating may also occur around the drug delivery system. You should immediately notify the MRI technician if you experience any uncomfortable heating sensations during the examination. When appropriate steps are taken the potential for clinical harm is low and you can safely undergo an MRI.

During an MRI the drug delivery system may experience a temporary motor stall. In most cases once the MRI exposure ceases the drug delivery system will resume its normal function. If certain post-MRI follow-up steps are not taken, an extended temporary motor stall delay may occur, which can last from 2 to 24 hours. If a temporary motor stall occurs, the pump alarm will sound. Permanent motor stall is also a serious potential complication that can develop if the drug delivery system is not correctly aligned in the MRI scanner.

Prior to arriving at the radiology facility, it is important determine that the MRI system to be used is compatible with your drug delivery system. Safety has only been established for specific MRI scanner designs and magnetic strengths. The SynchroMed II pump performance has not been established for a standing or open sided MRI. The healthcare team should also determine that the pump will have the appropriate orientation in the MRI and if delay or pause in drug delivery can be handled by the patient.

Furthermore, it is helpful for the healthcare team that is managing the pump to communicate with the MRI facility. An MRI should be scheduled in a location and during a period of time when you can follow-up with the healthcare team that is managing your drug delivery system. Upon completion of the MRI your drug delivery system should be interrogated with the clinician programmer to ensure that therapy has properly resumed.

When the appropriate steps are taken individuals with drug delivery systems are able to safely undergo MRI scans."

David Provenzano, M.D., is a pain management specialist at The Institute for Pain Diagnostics & Care, Ohio Valley General Hospital in Pittsburgh, Pennsylvania.

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The doctors listed on this page are paid by Medtronic as consultants. Medtronic asked for their statements regarding their experience with Medtronic Pain Therapies.

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.

Last updated: 30 Oct 2012