HomeCare I.V. of Bend Inc.

Pain Management...

At HomeCare I.V. of Bend, we specialize in intravenous and intrathecal pain management therapies. From the hospice patient who needs terminal pain relief to the post-op management of jaw surgery; failed back syndrome or chonic pain of any kind, if oral medications are inappropriate or no longer effective, you may find yourself at our office for a new therapy. Effective pain management means better quality of life!

Pain medications can be delivered intravenously via CADD-PCA pump with continuous plus "on-demand", straight continuous or strickly "on-demand" doses, such as PCA (patient controlled analagesia). In the hospital, patients often are written orders for PCA analgesia to make it more effective to control pain and put the patient in control. It is always more effective to stay ahead of pain than to let it take hold and try to catch up once you are in pain. Our home infusion patients are given the same type of order if deemed necessary by their physician and they begin with a small "fanny pack" and cassette with pump. The intravenous tubing is attached to an IV site and stays hooked up until it is time to change the cassette. Rates can be changed to adjust for pain levels and it makes pain management less stressful for patients, caregivers and family.

With the increased pressure to shorten hospital stays, more and more home infusion therapies are being chosen, even pain management.

Patients following certain surgeries may require short-term intravenous pain management in order to leave the hospital sooner than they would otherwise. For instance, post-jaw surgery when oral medications cannot be taken, or for patients who get sick from oral meds and have had knee or hip surgery. We set the patient up with their pain pump and cassette, IV fluids and anti-nausea medications to go home with and teach them how to administer everything at their home! Or a home health nurse would do the hook-up and teaching if the patient has other needs.

Narcotic pain medications can also be delivered by internally implanted intrathecal pumps. The advantages of intrathecal therapy include less sedation and fewer side effects such as constipation. These pumps are placed in the abdominal cavity and are accessed through the skin. They are invisible. The pump can be felt through the skin, but you cannot see it.

For more information, see our page on Implanted Pumps

Currently Medtronic manufacturers the pump that is being implanted here in Central Oregon. The pump is called a Synchromed II pump and can hold either 20ml or 40ml of narcotic solution. A neurosurgeon places the pump under anesthesia and the patient stays in the hospital at least overnight while they recover from the surgery and see how they respond to the intrathecal dose. Sometimes the stay is a few days until things get stable, but usually patients do very well after the operation.

Having an implanted pump helps patients live more "normal" lives, less dependant on taking oral medications every 3 to 4 hours and sufferring many side effects from systemic pain management.

Implanted intrathecal pumps are highly mechanized and can be manipulated by a trained nurse with a specific programmer which scans the pump from outside the body and takes readings. Adjustments to rate are made via the programmer.

It is often necessary to increase or decrease the rate at the beginning because intrathecal doses are 1:300 of an oral dose and there is cross-tolerance that must be taken into effect when a different drug is used intrathecally than the patient was taking orally.

Remember, the goal of effective pain management is to have pain be less than 5 on a sale of 1-10. A pain level of 3 is fairly good for a person who has suffered from chronic pain for any length of time.When a patient has been on stable oral medications, a conversion is made to intrathecal dosing, usually 25% to 75% lower than the oral dose depending on what drugs had been used and potential for cross tolerance. For example, if the patient had been on oral morphine at 300mg/day and their pain level was 4 out of 10, the intrathecal dose would be started at 1mg/day with adjustment up or down as needed. Alternatively, if a patient has been on Oxycodone and Hydrocodone for pain, the conversion would be somewhat less since they may respond to morphine more intensely than they had for the oral medications.

Most assuredly, it is not an exact science, but with patience, pain can be managed effectively and safely, with fewer side effects than high doses of oral medications.

HomeCare I.V. of Bend, Inc. has earned the Joint Commission's Gold Seal of Approval™.