Clinical information related to the Medtronic SynchroMed® is © Medtronic, Inc.
HomeCare I.V. of Bend, Inc has the specialized equipment, training and experience to support patients receiving infusion therpies with the Medtronic brand Medtronic SynchroMed® SynchroMed pump, a surgically implanted drug delivery system.
The Medtronic SynchroMed® EL Infusion System is an implantable, programmable drug delivery system used to treat pain, spasticity, and cancer. The SynchroMed EL Infusion System is indicated for:
Chronic intrathecal or epidural infusion of sterile, preservative-free morphine sulfate for chronic, intractable pain of malignant and/or benign origin; (other narcotic medications as indicated)
Chronic infusion of baclofen for severe spasticity of spinal or cerebral origin;
- Chronic intravascular infusion of chemotherapy for the treatment of cancer:
- Floxuridine (FUDR)
- Chronic intravenous infusion of clindamycin for the treatment of osteomyelitis.
- Chronic administration of Prialt for pain management.
The SynchroMed pump is an implantable, programmable, battery-powered device that stores and delivers medication according to instructions received from the programmer. The primary differences between the pump models are the size of the reservoir and the presence of a side catheter access port.
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.
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.