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Change of medicine in Intrathecal pump for Chronic back pain

Posted by arkynut @arkynut, Jul 31, 2025

Hi, I broke my back on a Navy ship in 1982, drank alot after that to numb the pain. In 1997 I fell which resulted in a re-fracture of the same vertebrae I broke in 82 and in 1998 I had a Level 3 fusion/disc replacement. Next 7 years tried different doctor recommended things until one told me of the pump. I've had this pump for over 20 years, I've tried Marcane, Prialt, Morphine and for the past 6 years Hydromorphone, I am now considering the last thing available to me: fentanyl in the pump for my back pain. My question is, I'm so leery of trying fentanyl from what I've read/heard about it in the news/Tv and all those who've died from it, If I change to fentanyl, will I have any side effects like withdrawals from Hydromorphone or get sick at the start on the fentanyl?

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jdkohl | @jdkohl | 1 day ago
In reply to @heisenberg34 "Does anyone out there with an implanted pain pump know what their daily dose is? I..." + (show)
Profile picture for heisenberg34 @heisenberg34

Does anyone out there with an implanted pain pump know what their daily dose is? I am at 0.9 mg daily. Apparently, this is a very low dosage, so I am having it increased. I discovered that my trial with an injection of hydromorphone was about 4 mg. I know that's high, but I was told that some pump users are at a level of 5.0 and 6.0 mg daily. I am anxious to find out how much many of you are at, especially for a therapeutic dose.

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@heisenberg34 I have fentanyl in my pump. It's running at a low dose of 8.33mcg an hour. I didn't know they measured pain pump dosages in mg. I wonder why my documents always use mcg for the intrathecal pump and mg for oral?

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heisenberg34 | @heisenberg34 | 1 day ago
In reply to @jdkohl "@heisenberg34 I have fentanyl in my pump. It's running at a low dose of 8.33mcg an..." + (show)
Profile picture for jdkohl @jdkohl

@heisenberg34 I have fentanyl in my pump. It's running at a low dose of 8.33mcg an hour. I didn't know they measured pain pump dosages in mg. I wonder why my documents always use mcg for the intrathecal pump and mg for oral?

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@jdkohl A microgram(mcg) is 1/1000th of a milligram(mg). I would guess that the fentanyl must be at a higher concentration than the dilaudid in my pump. Or, perhaps fentanyl is a more potent drug and requires a lower dosage.

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heisenberg34 | @heisenberg34 | 1 hour ago
In reply to @arkynut "Hello, Thanks for your input, sorry but I don't know if I already responded to you...." + (show)
Profile picture for arkynut @arkynut

Hello,
Thanks for your input, sorry but I don't know if I already responded to you. I think I've made my mind up, to not try fentanyl. From Dec to May 2025, 5 months of hellish withdrawals from shutting down the pump to try medical marijuana which didn't help at all. I fell down a wet ladder in 1982 on the USS Proteus and injured the Lumbar area of my spine. Re-injured it in 1988 & 1997 at work. I've had 11 surgeries so far, the 1st one in 1998 fused my L1-L% & S1, wish I'd seen a neurologist instead of that orthopedic doctor. I had a 40 pump implanted in 05 and a stimulator implanted in 06. I've had Marcane/Morphine, Prialt, Morphine and currently Hydromorphone in the pump. Only thing I haven't tried is fentanyl and from what horror stories that have been brought to me, no way will I try it. I'll just go on in pain. Now that I got another 40 pump back in me, guess I'll go back way up on it and fight with the chronic constipation. I guess I can't have pain refief without that. Its just that when I was at 8 on the pump, I'd be screaming trying to have a dang bowel movement even with the constipation meds they give me. After my experience shutting down the pump I'll be happy to life whats left of my life with the pump. That's so true, we all act so different on these dangerous meds. Hope you find some relief with your pain, good luck.

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@arkynut Sorry to learn of all the problems you've had over these many years. As you may or may not know, fentanyl in a pain pump is just about as safe as morphine and dilaudid. The amounts that are administered into the space around the spinal cord are extremely small(1 gram = 1/30 0f an ounce; 1 milligram= 1/1000th of a gram). Not enough to really be concerned with. As to the constipation, these drugs do not enter the general circulation and stay within the intrathecal space until metabolized and excreted.

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