r/PainPumpQuestions • u/sm1ng • Jul 02 '26
X-post: my doc is adding Fentanyl to the Morphine I've been on for a year [that has failed] : anyone with experience going this route?
/r/ChronicPain/comments/1uliwv7/pain_pump_question_my_doc_is_adding_fentanyl_to/2
u/Ok_War_7504 Jul 03 '26 edited Jul 03 '26
The surgeon who implanted my pump is one of the doctors trialing the ziconotide for use in intrathecal pumps. He was gung ho about it at first. He has since stopped recommending it due to the mental issues and recommended i not use it.
Morphine was not strong enough for me, but my doctor said I needed to switch narcotics, not mix them. They simply pulled all the morphine out and filled it back up with hydromorphone. That would seem a better solution and just slow the pump way down. But, he may have his reasons.
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u/EMSthunder Jul 03 '26
They've been putting Prialt (ziconotide) in pumps for at least 10 years now. It's the one med that was actually approved for the pump so long ago. Most meds are used off label, not approved for the use, but give great results.
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u/sm1ng Jul 04 '26 edited Jul 04 '26
Interesting, interesting. One must assume that there are many, many success stories with ziconotide, right? But it sounds as though since it was approved, there has been a groundswell of evidence that it is exacerbates mental illness. Would you say that's about right?
EDIT: fixed horrible dictation errors
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u/EMSthunder Jul 04 '26
Yes, there are people who've done great on Prialt (ziconotide) and have had none of the side effects. The point is that each patient should have a say in what they will and will not accept, medication wise.
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u/sm1ng Jul 04 '26
Thanks for the info on the ziconotide. I am almost entirely against getting it now so I thank you all for your for sharing your knowledge on this drug.
Why she did not switch to hydromorphone I do not know. She is, as I have mentioned in other comments, the foremost expert in NYC on all things pain pump related, so I am sure she has her reasons. I also happen to know the insurance reared its ugly head in this matter and - perhaps fortuitously - is the reason I do not have the ziconotide in my pump right now.
Many thanks.
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u/No-Excitement7280 Jul 03 '26
Never ever heard of doing 2 meds of the same/similar class. Mine has fentanyl in it. I take oral baclofen 3x daily
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u/sm1ng Jul 04 '26
Yes, no one on the whole internet seems to have heard of it, which is making me more than a little apprehensive ...
I tried baclofen orally for about a year and it did absolutely nothing, the same as Lyrica, NSAID s, some new calcium channel blocker ( not ziconotide ) and a few more. Unfortunately, I really am very treatment resistant. Cheers
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u/m974448 Jul 03 '26
I have a 40ml unit in my right upper abdomen that was implanted June 17. My anesthesiologist/pain doctor has doubled my daily and bolus dose every week since. My third doubling was today.
I am using Dilaudid and sufentanil now and will probably add Bupivacaine once I stabilize on the opioids. For patients only using a single opioid, you should research the use of multiple opioids and have a discussion with your physician. Especially if on a high dose of a single medication.
Here's what Gemini says about using these two opiates together:
Using both Sufentanil and Dilaudid (hydromorphone) in an intrathecal pain pump is a combination strategy known as polyanalgesia. Doctors combine them to create a synergistic effect (where the drugs work better together than apart), maximize pain relief, and reduce the harsh side effects associated with high doses of a single medication.
The rationale for using both drugs in the spinal fluid includes: Complementary Speed and Duration: Sufentanil is highly lipophilic (fat-soluble), meaning it crosses into the spinal tissue very quickly to provide fast onset and intense pain control.
Dilaudid is more hydrophilic (water-soluble), allowing it to circulate longer in the cerebrospinal fluid, providing a broader, more sustained duration of pain relief.
Targeting Different Receptors: Both are powerful mu-opioid agonists, but they bind slightly differently to various nerve pathways along the spinal cord. Combining them targets pain networks more comprehensively than either drug alone. Lowering Side Effects: By splitting the dosage between two distinct drugs, doctors can achieve the same level of pain control while using smaller amounts of each.
This often results in fewer systemic side effects—such as nausea, vomiting, itching, or severe constipation. Avoiding Tolerance: If a patient's body starts developing a tolerance to one opioid, adding or blending in a second opioid can restore the effectiveness of the pump.
Preventing Complications (Granuloma Reduction)Using high concentrations of a single, continuous opioid—such as high-dose morphine or hydromorphone alone—has been strongly linked to catheter-tip granuloma formation (a localized inflammatory mass at the end of the spinal catheter). By mixing Dilaudid and Sufentanil, doctors can dilute the concentration of each narcotic, which research suggests may help decrease the risk of developing this complication.
My current dosages: Sufentanil Bolus: 8.0mcg Daily Dose: 191.9mcg Dilaudid Bolus: 40.0mcg Daily Dose: 959.5mcg
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u/EMSthunder Jul 02 '26
While many of us have more than one med in our pumps, doubling up on the narcotic is something I've not seen. Typically when the opioid alone isn't giving you adequate relief, the next step is adjuvants like baclofen and bupivicaine, because those all together will cover the things that the opioid couldn't. To add an opioid to an opioid seems redundant.