I have a Pain pump with Morphine, I'm still in so much Pain

What kind of trial did you have? I had the injection. First one was morphine. Nothing. Two weeks later I received an injection of hydromorphone. Wow! Pain went from an eight down to about a two. Went ahead with the permanent implant. Very low dose initially, so no pain relief. I kept having the dosage increased about every three to four weeks. Still no relief. We moved to Delaware in 2023, so I had to find a new PM doc. I kept upping the dosage but still no relief. At one point in 2024, I had the dosage increased by 20%. It made me feel pretty woozy. I started to have the dosage reduced because I felt it wasn't helping. I called the original PM doc who did the trial to find out how much the trial dosage was. Anyway, I have decided to start taking the dosage back up along with four boluses. My current PM says that I was still on a fairly low dose when I stopped going up. I am hoping that I will ultimately find a dosage that will give me some relief. I know that this may not help you in your situation. I have read that Hydromorphone is about five times more powerful than morphine.

I hope you can get the new drug in your pump sooner than later. It is claimed that the pain pump is 94% successful for patients. So, make me a believer! Make US believers!

I had an interthecal Medtronic pain pump implanted for over 18 years until I had t removed. It worked very well for my chronic pain , with no side effects at all that I noticed (important to consider). Clear minded, no constipation, etc. This is not a simple issue for there are many variables. Something to consider, with the large morphine dosage (massive really, if you are correct) some pain relief should have been noticed! That leads me to believe that the catheter placement is not correct. It seems it may not be positioned at the exact location of the pain generation. I have much experience and there might be others issues to consider, but I just noticed your post and quickly wanted to alert you to that option (maybe you already knew).

@rockon79. Thanks for your post. I hope to have the catheter checked next time I get a refill. You are correct. If the trial worked, I should feel some pain relief at some point. Hard to imagine that this powerful medication going into my intrathecal space would not do something.

What I told them that I thought it wasn't working but I clarified saying I'm not getting real relief Then they had to check out the catheter with a CT scan and then a minor surgery to make sure the pump is working, I asked them to change to something stronger and again they said you need a higher dose, I don't use the boluses anymore because they don't work, I went with the pump because I didn't want to take oral pain meds, I feel really stuck with this whole situation and I do feel they should have said we are going to change you to a stronger medication, it's hard to function, I hope I don't have to switch to another Doctor.

I have had the same problem I can barely get out of bed. What kind of life am I leading

@sox6281 It is very important that you have an ideal placement of the
catheter in order for these pumps to work. As another poster here said, these pumps will not work without a proper placement of the said catheter. If the pump doesn’t deliver the medication to the right place inside your spine you will not feel anything. Moreover you say you stopped using boluses? My doc explained to me that the boluses are kinda the whole point of these pumps: boluses are supposed to flush your nerve with medication in order
to reduce the pain, ideally before it spikes. If you have chronic constant pain like I have then it makes sense to get your doc to preprogram your pump to send 6 boluses at specific times in a 24 hour period. I picked the times when I normally feel the most pain, but you can always change the times at your next appointment if it doesn’t work as planned. And when it comes to medication in the pump I would strongly suggest you ask
your doctor about a second medication to be mixed with the opioid you use. This will make it more effective. Also just know that morphine is not the most effective medicine in these pumps. It is a pretty weak opioid for intrathecal use and it also has many side effects, like incessant itching. I would suggest you maybe inquire about hydromorphone instead and also ask for a second medication such as Clonedine or Bupivacaine. But please get the placement of your catheter
checked, this might be the reason why you feel nothing as
the meds aren’t being discharged on the right nerve. Sadly many of us “pumpers” need a revision surgery down the line in order to make it work properly. And it helps to have an experienced pain management doc to maintain and fill your pump too. Also, I think it is rare for a pump to work so well that you no longer need orals. I know that I still need orals even with an optimal placement of the catheter. I just know there’s no way the pump alone could deal with all my crps pain and symptoms. To me the pump is one more tool in my toolbox against my chronic pain, and it comes in addition to my orals. I even have a spinal cord stimulator for the pain too.
There are so many aspects to consider when talking about intrathecal pumps, but the most important aspect is to ensure the medication is added to where it is needed. These pumps will simply not work at all if it the catheter tip is placed wrong

Not my experience at all. In TX, I was trialed with morphine and eventually was switched to Fentanyl at a pump refill. Doc told me in hours how much morphine was in the catheter and when to expect a difference. Took 15 hours. That was a Friday morning and by 3am Saturday morning I was in a total dissociative state. Changed back to morphine Monday morning. So 2 med changes in 4 days, no zeroing out of pain meds. I will say it was absolute hell going cold turkey before I got the pump.

@alexandercrps In almost three years I have not had any pain relief from my pain pump. It uses hydromorphone after a trial with morphine provided no relief. hydro dropped my pain down to about a 3. I have had the pump checked three times via fluoroscopy. All is well they tell me. As an aside, I had one day of great pain relief about 4 months ago. The next day all the pain was back. I am currently sitting at 3.5 mg/24 hours with six boluses. If I use all six boluses, I seem to experience just a little decrease in pain. Do you know your current pump settings? If your pump is a Medtronic, you can go to the settings on your remote to check them. I wonder if getting the catheter placement by CT is a better option. Thanks for your post. Have a blessed day.

Hey Sox- Got a few questions. In your original post, you said you were maxed out on morphine. What size pump do you have, 20ml or 40ml? How much total morphine are you getting over 24 hours? What concentration is the morphine? I was in your spot once, but I had the 20ml pump, a concentration of 20, and I’m getting 12.4mgs./day. I had that replaced in December to a 40ml unit.

@bilt4pain
40ml & I was maxed out at 14.6 mgs & it didn't do anything, I tried within the first 90 days to get Them to change me over to Hydromorphone but they kept saying that I just needed more, within the first 90 days I was receiving 400% more than what the doctor gave me during the Test, so I told them that I wanted to change, one of the nurse practitioners stated that she recommended that I go down on the morphine and received the hydromorphone except I did not receive that note until months later, so it's been five and a half months and I'm going down 30% every week and I'm down to 0.606 mg, but I have to get down to 0.1 mg for them to change me over, I say that's bullshit, when they change me over to Hydromorphone the nurse practitioner said they would remove what's in the pump & they would clean it out with Sodium Water to flush it out & fill up the pump &; and install the hydromorphone , but I was like why couldn't they do that when they refilled my Pump, I mean really it's the same process anyway I suffer everyday and understand what you're going through it's just incredible but thankfully within seven to nine weeks of receiving the hydromorphone, like I said I don't understand why they couldn't just change it like I mentioned and I've checked the clinical trials and in the clinical trials they did what I'm speaking of they took out the morphine flushed it with sodium water and put the new Hydromorphone in and the people did wonderful, Where you are regarding the daily amount you're getting, tell them you want to change to hydromorphone which is 6 to 8 times stronger, and make sure you ask them for oral pain medication like oxycodone you're only going to give you like 5 or 10 mg but go with the stuff without Tylenol and then ask them to up it later it will at least give you some relief will you be better off with the hydromorphone the clinical trials prove it, don't let them give you oral morphine to take because you already know the morphine is not working you need to make that clear man I hope the best for you, they should do the right thing, Michael