People painting

Doctors Answer Questions

Chronic Pain

How often should I follow up with my doctor after I receive my Medtronic Chronic 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.

Back to top

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 Pain Diagnostics and Interventional Care in Pittsburgh, Pennsylvania.


Back to top

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). Radiographic imaging may be ordered by your doctor to investigate suspected catheter problems. Additionally, pump malfunctions can occur. 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 Pain Diagnostics and Interventional Care in Pittsburgh, Pennsylvania.


Back to top

What should I do if my doctor orders an MRI and I have a neurostimulation system?

Dr. Provenzano says: "First, if an MRI is ordered it's important to discuss your neurostimulation system's eligibility for an MRI scan with your treating pain physician in order to effectively and safely coordinate your medical care.

Medtronic neurostimulation systems can be divided into three categories:

  1. A Medtronic SureScan neurostimulation system, which is eligible for a full-body MRI scan*
  2. A system that is eligible for a head scan
  3. A system that is not compatible with any type of MRI scan

Methods used to help identify eligibility of your system for an MRI include accessing the system information with either the patient or clinician programmer or an x-ray to identify equipment markings denoting MRI eligibility. In addition, your treating pain physician can give you a completed MRI patient eligibility form, which will provide the radiologist with information regarding the MRI scan eligibility of your implanted system."

David Provenzano, M.D., is a pain management specialist at Pain Diagnostics and Interventional Care in Pittsburgh, Pennsylvania.

MR-Conditional Icon*Under specific conditions; requires SureScan® MRI implantable neurostimulator and Vectris® SureScan MRI leads.

Back to top

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.


Back to top

What should I do if my doctor orders an MRI and 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 Pain Diagnostics and Interventional Care in Pittsburgh, Pennsylvania.

Back to top

How do you determine if therapy adjustments need to be made?

Dr. Hatheway says: " With patients who have a neurostimulation system, we have found the 6-month follow-up to be very important for optimizing therapy. Some people stop using their device for multiple reasons, forget to charge it and it goes dead. By seeing patients more frequently we can possibly avoid discharge and fix the problem that caused them to stop using it.

One reason a patient may stop using his device is that the device does not seem to be helping him, particularly in certain positions. The 6-month follow-up allows us to review the programming data and have a meaningful discussion that leads to therapy fine-tuning and optimization.

Most of my pump patients are seen every 3 months. They undergo random urine drug screening or drug screening every 6 months to verify they are not taking systemic opioids. We do a neurological exam every 3 months to rule out catheter-related problems. Also, for patients who have myPTM, we want to make sure they are using it appropriately, and, if not, reinforce how to use it.

Expectations are very important with pump patients. We continue to reinforce that complete pain relief is probably not obtainable. If they are getting 40 to 60 percent relief, that is better than they were getting before the pump was placed."

John Hatheway, M.D., is a pain management specialist at Northwest Palm Care, Inc. in Spokane, Washington.

Next: Personal Stories

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

Back to top

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.