Ask Hank

These statements reflect the experience of one individual who is receiving a Medtronic Pain Therapy for the treatment of chronic pain. Medtronic invited this person to share his story candidly. As you read it, please bear in mind that the experiences are specific to this particular individual. Not everyone who receives drug delivery therapy will receive the same results as this individual. Talk with your doctor to determine if drug delivery therapy is right for you.

Ask Hank

Hank has been receiving drug delivery therapy since 1993. Below are some of the common questions he hears from others who want to know about living with a drug pump for chronic pain, and his answers.

What things can I ask my doctor to get the most out of my drug delivery therapy?

Hank says: Something everyone should ask his or her doctor is how the Medtronic SynchroMed^® II pump can be programmed to fit pain relief needs. For example, in the past, my pain was less at night, so I received less medication, with the difference added to my day dose when I needed it most. I noticed that I'd wake up with some aches and pains. My doctor added a third schedule to give me a little more medicine an hour before I typically woke up. He didn't increase my daily amount of medication, just moved the dose around, and it helped me a lot.

It really helps to keep a pain diary – not just from day to day, but from hour to hour. Bring it with you to appointments so your doctor can see when your pain is the worst. After schedule and/or dose adjustments are made, keep a diary again to see if the change was effective.

Early on in my therapy, I talked to my doctor about lengthening the time between refills. He was able to gradually increase the concentration of my pain medication which decreased the volume I needed each day. I went from getting refills every 6 – 8 weeks as I was ramping up after my first implant, to slightly more than 4 months now. This will vary depending on your medical condition and medication, but it's worth asking your doctor.

When it's time to replace your drug pump, ask your doctor about any new innovations that are available with your drug delivery system. Over the last 20 years, the SynchroMed drug delivery system has kept up with my evolving pain needs. I've seen more programming options, more medications, myPTM^® personal therapy manager, as well as other helpful innovations. I feel confident about the system helping me long into the future!

Before traveling, do you take any special precautions with your drug pump?

Hank says: I love traveling. In the days and weeks before I leave, I determine how long I'm going to be away and whether or not I'll need a refill during that time. If my vacation conflicts with my next refill appointment—or if I return within just a day or two of the appointment—I ask my doctor to refill my pump early so that I don't have to worry about it when I'm gone.

Before going to another state or country, I use the Medtronic Physician Finder to locate a doctor in the area where I'll be staying, just in case I should need help with my pump.

It's a good idea to take along a printout of the most recent refill session. This printout has the name of the medication and the dosage in the drug pump. I bring this printout with me so that if another doctor needs to care for me, he or she will know exactly what's in my pump.

Finally, I never enter an airport without my Medtronic ID card. The beauty of this card is that anywhere I go, it tells people in a variety of languages that I have this pump. I present the card to the attendant at the metal detector.

Safe travels!

How long did it take until you reached your optimal dosage where you felt the pump controlled your pain? How do you handle breakthrough pain?

Hank says: I received my pump back in 1993. I started on an extremely low dose which definitely lengthened the process for arriving at the right dose. About three months after my implant I changed doctors.

My new doctor got me to a comfortable dose by month five. He played around with different combinations in the pump and we hit on a combination that worked well. By month seven I was at about 95% of what I needed. By month eight I was feeling pretty good and taking very little oral pain medication.

For me, breakthrough pain is usually caused by overexertion or an issue unrelated to why I have the pump – such as arthritis. It may be that I'm exerting my body beyond where the pump is programmed to relieve my pain.

I have a prescription for 4 mg of Dilaudid^® four times a day to address any breakthrough pain. I end up taking about one pill every three days.

My advice is to be patient while you and your doctor work together to find the dosage that is right for you. It's a team effort!

Now that you have a drug delivery therapy, what exercise activities keep you healthy?

Hank says: When I got hurt, not only did my social and spiritual life dwindle, so did my health. Just walking was hard to do. After my accident I was lucky if I could sit for 5 minutes without pain, but it was also uncomfortable to stand. Being in the car was hard because I couldn't sit still. It was hard to be physically active—even physical therapy was excruciatingly painful for me. I had to give up skiing, scuba diving and walking.

After I got my drug pump I took activities up again, one by one. I didn't want to overexert myself, so I gave myself time. I consulted with my doctors and got an exercise plan. I purchased an elliptical machine and now it's the first thing I do in the morning. I have a pool and I can dive in and swim from one end to the other and do some laps.

I really try to concentrate on low impact activities. I have gone skiing a couple of times and had a lot of fun. If it's cold out, I might hear my pump alarm beep because it's temperature sensitive. I love to go into the hot tub. But again, I need to be aware of the temperature and make sure it's no warmer than 102 degrees. That applies to a steam room and a sauna, too.

I just got back from a vacation. I hiked five miles outside Lake Tahoe, and at Yosemite I hiked to the top of a waterfall and to a frozen lake. This was something I've wanted to do for a long time. It took me longer than the others on the trip, but that's okay. I didn't rush.

Before my drug pump, I'd be looking at people's photographs of these outings. Now, I'm doing them myself!

Do you ever experience an overdose or underdose of medication with your pump?

Hank says: I'm so used to the pump now, I forget it's there. But if I overexert, I feel enough pain to take a bolus dose from the Personal Therapy Manager (myPTM) remote device. Early on, this caused me to experience a very sudden hot flash, breaking into a sweat severe enough for a shirt change. If this happens to you, talk to your pain management doctor about decreasing the dose or lengthening the interval over which the bolus is given. If you don't have a remote, note any symptoms that recur consistently in your daily pump schedule.

If you take oral opioids for breakthrough pain along with the pump, be cautious as well. Even though you took higher narcotic doses before having the pump, these prior levels may give you an unsafe opioid response stronger than expected. Always follow your current prescription for your medication dose. My symptoms of too much opioid included a headache that felt like a tight ring around the top of my head, foggy thinking, fatigue, constipation, sweaty palms, and overall itchiness. When those old symptoms come back, you remember all the reasons why you wisely chose a pump!

As for an underdose, I remember waking up one morning in pain. When that happens, I ask myself "What activity did I do yesterday?" This particular time there was nothing unusual. The next day I experienced another 25% loss of pain relief and I realized something must be wrong. It turned out there was a small obstruction in my catheter.

My doctor dislodged the block and within 24 to 36 hours my pain relief returned with no problems. If it seems like your pain is ramping up quickly without reason, it could be a partial or complete obstruction.

Don't ignore unusual or abrupt changes in pain or symptoms. Always check with your doctor.

Did you encounter any challenges from your insurance company or your doctor when getting the myPTM personal therapy manager? How did you overcome these challenges?

Hank says: When I learned that myPTM might help me reduce or eliminate the oral meds I was taking, I told my doctor I was interested. He resisted, saying it made scheduling refill appointments too difficult. He wouldn't prescribe it. The hand-held device allows patients to receive an extra dose of medication from their drug pump (within doctor-set limits) to treat breakthrough pain. I eventually found a new doctor who assured me that myPTM would alert me when my next refill date was necessary. I had plenty of time to call in advance and schedule an appointment. If I don't use all the bolus doses of medication that my doctor allowed, I can go longer between refill appointments. myPTM then displays the new refill date. Don't hesitate to ask a doctor about his or her thoughts on myPTM.

Different insurance companies may respond differently. Mine denied myPTM when I first requested it but they covered it fully when I got my drug pump replaced. A doctor might say he or she wants to wait on ordering myPTM until a patient's dosing is regulated after surgery. I suggest asking your doctor to order myPTM at the same time as the pump but wait to use myPTM until your doctor thinks you're ready. The myPTM programmer gives me some control over my pain and peace of mind. I've gone from taking 4 pain pills orally a day to 1 or 2 per week. I think myPTM is as essential as a TV remote. Sure I can get by without it, but do I want to?

What was your pump replacement experience like?

Hank says: I've had three replacements since my first drug pump was implanted in 1993. Although the replacement procedure is not without pain, I found it significantly less painful than the first implant. The surgery was shorter too – only about a half hour. After the pump has been in your body for a few years, a "pocket" forms and the new pump is placed in the same spot.

With each replacement, my recovery time was shorter. The first time, I was back on my feet within 72 hours. After my last replacement, the doctor gave me few restrictions on activities and I drove that night. I did feel a little ouch when bending over, however!

Your doctor will closely monitor the performance and battery levels of your pump at each of your refill appointments. He or she will let you know when it's time for a replacement. You don't want any interruption in your therapy. It's important to know that the SynchroMed II pump will last a maximum of 7 years. My pumps each lasted about 5 to 5½ years.

If you don't already have the myPTM personal therapy manager, I suggest asking your doctor if the myPTM is right for you when you talk to him or her about your replacement pump. This hand-held device allows patients to receive an extra dose of medication from their drug pump (within doctor-set limits) to treat breakthrough pain. The myPTM programmer gives me some control over my pain and peace of mind.

While Hank had no complications, there are risks associated with the procedure. The most frequently reported problems following drug infusion system implant surgery include infection, spinal fluid leak, pump inversion, skin erosion, drug side effects, loss of therapy effect, and therapy that did not meet the patient's expectations. For a complete list of adverse events that have been associated with the therapy, please refer to the Important Safety Information

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: 23 Apr 2013