I saw my pain management doc a couple of days ago. We had already discussed the possibility of using a spinal cord stimulator. My pain does not seem to be radicular, so I don't think I'm an optimum candidate for an SCS.
He floated the idea of an intrathecal pump. The receptors that are blocked by the opiates are in the brain. Systemic meds flood our bodies so a tiny percentage of the medication passes the blood brain barrier. The side effects of long term, high dose opiate use are very substantial.
An intrathecal pump delivers medications directly into the cerebrospinal fluid which is on the brain side of the blood brain barrier. Because of this, 1/300th the amount of medication is required to achieve the same effect. (according to my PM doc)
I'm still light years away from considering such an implant, but this is very interesting. My options seem to be:
1. More nerve ablations, more aggressively. (Likely to cause a permanent band of numbness that wraps around my chest. I experienced this for a few days after my previous ablations... not very pleasant.)
2. Resect rib heads. (Likely to cause the same band of numbness. I'm not sure exactly how we'll decide which ones to remove?)
3. Continue suffering. I'm getting to be very, very limited. When it's bad, I'm housebound and in severe pain for hours every day. For many months, good days are few and far between.)
4. Intrathecal pump.
5. SCS... While stimulators have been recommended as something that 'sometimes works for axial pain...not just radicular pain... I'm not inclined to try this.
I'm not quite sure where I'm headed with this... I'm going try to get through the holidays, then start up again.
Here is a pretty comprehensive discussion of the pump and related issues.
Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates
If anyone finds more useful info... please post.
Happy Holidays!
Mark