Dear Dr. Roach • I am a 79-year-old man in pretty good health who has had back problems for about 15 years. I have been to two pain clinics and four neurosurgeons in the past few years. All find that I have spinal stenosis in the lumbar region. I have had shots, physical therapy and electrical-stimulation treatments and have tried several drugs: All with no help. The surgeons say that surgery is not going to help.
The last pain clinic sent me to a doctor who specializes in pain pumps. The doctor explained how the pump works, and (after checking X-rays and an MRI) says that he thinks the pump would help me. He also suggested that I check with my primary and other doctors for their input as well as going to the Internet for information.
My four different doctors all say they have no knowledge regarding pain pumps. Several sources on the Internet had only negative information. They explain what a pain pump is but give no information regarding percentages of success and failure. I would really like to try the pump, but the negative information on the Internet (dislodged pumps requiring corrective surgery, onset of migraine headaches, malfunctioning pumps, breaking leads from pump to spine), frankly, scares me.
Do you have factual information on the success rate with pain pumps to the lumbar region? — D.M.
Answer • These are implantable, programmable devices that contain a pump and reservoir to be placed in the abdomen (which needs to be refilled regularly with medicine injected through the skin) and a plastic tube (catheter), which ends in the fluid around the spinal cord, called the intrathecal space. The pump is usually filled with morphine. The main reason that intrathecal pumps are used is to have high concentration of pain medication around the spinal cord, where there are many opioid receptors, without having high concentrations in the blood. In theory, there should be fewer side effects.
Your doctors didn’t know about their effectiveness because there is very little published information. However, a review in 2007 showed that 38 percent to 56 percent of users reported at least a 50 percent reduction in pain at six months.
You mentioned some of the complications of pumps. About 18 percent of people had at least one complication of the catheter, while 27 percent required reoperation due to equipment failure. There are many other possible complications from the medication itself, the most common being nausea and vomiting, in 33 percent.
As you can see, because of the relatively low effectiveness and relatively high complication rate, most people need to have severe symptoms before they consider these pumps.
Dear Dr. Roach • In August I had open repair of my right rotator cuff. I was told it was a severe tear with bone and tendon involvement. I am 67, and the recovery has been a long one. If you can believe it, even with physical therapy and pain management, I am still uncomfortable at times. I have a stupid question that I hope you can answer. Ever since surgery, I have had to sleep on my unaffected side. Is it OK for me to finally try sleeping on my right side? I don’t have another appointment at the orthopedic office. I am embarrassed, as it is one question I haven’t asked. — C.V.
Answer • It’s not a stupid question at all. I don’t think you will damage the surgery repair by sleeping on the shoulder now, and you certainly can try it to see if it feels uncomfortable. I also would recommend you continue the exercises your physical therapists gave you.
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475
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