Pain Pump causing apneic events, need advice

[tvfrfireguy]

My sleep Dr. upped my pressure to 19 with no help as he suspects the morphine dispensed by the pump through a catheter to my back is the culprit. Many apneic events occur each night. He wants to order another sleep study and maybe a different machine. l am having no luck getting the pain clinic to return my queries in regards to maybe changing from Morphine to another med that will not suppress breathing. Do any of you have information that could help me out? I think if it is possible for a different drug, thousands in health care dollars could be saved. Thanks for any advice. David

[khauser]

My sleep Dr. upped my pressure to 19 with no help as he suspects the morphine dispensed by the pump through a catheter to my back is the culprit. Many apneic events occur each night. He wants to order another sleep study and maybe a different machine. l am having no luck getting the pain clinic to return my queries in regards to maybe changing from Morphine to another med that will not suppress breathing. Do any of you have information that could help me out? I think if it is possible for a different drug, thousands in health care dollars could be saved. Thanks for any advice. David

Any opioid has the potential to repress breathing. But I really have a hard time believing the relatively small dose that is delivered directly to the area needed is causing you that much trouble. I don't have a pain pump, so I'm taking 180mg daily, orally. I have to think that's more in the bloodstream than you have, even without knowing the dosing available through the pump. Everyone is different, but the 180 daily is not having a severe effect on my respiration or apneas, and these do not seem to change when I need more breakthrough meds (oxycodone).

I do not think they can change the medicine in your pump to a non-narcotic ... at least I have never heard of that being done.

Do you think the apnea only came on after the use of pain meds? I know in my case that is NOT true.

I would continue pursuing the apnea separately from the pain meds ... if you were to revert to not using them I imagine (based on my back issues) that you would get even less restful sleep, and that is a cycle to avoid (pain -> less sleep -> more pain, etc).

I think your sleep doctor is on the right path here...

[kteague]

Does your doctor suspect more obstructives or centrals? That factor seems to me to be significant in considering how you want to go forward, as it could change you options, particularly in machine choices. Don't want to change things unless you can have a reasonable expectation of it really helping. Please list your machine so others can make more targeted suggestions. You may have a machine that can give you a good idea where you stand, or you may not. A pressure increase in the presence of centrals is best not done blindly. If it's obstructives, then a pressure increase could help. Too little information for you to make an informed decision in my opinion. If the doc suspects centrals and you do not have a machine that reports centrals, then another sleep study is probably in order. Hopefully you can work through this and have both the pain relief and the sleep apnea treatment you need.

[torontoCPAPguy]

I was on 80mg. b.i.d. oxycontin at one point. Doc wanted me to visit the methadone clinic as I wanted OFF of it. I did it myself. Gradually titrated from oxycontin to oxycocet to Tylenol 4, 3 and now 2's. I take regular advil when needed (like right about now), suffer a lot, and take Tylenol 2 when absolutely needed. I have done all of the other things suggested and have relieved SOME of my chronic pain but still suffer.

I can tell you one thing. I can deal with MY pain better than I can all of the side effects of the drugs. Especially that oxycontin. MAN, that is bad S&*$%T. 11 times more addictive that crack cocaine or heroine apparently. Hated it with a passion.

They keep suggested back surgery but I'm not too excited about that.

My pain comes from back issues, started from playing sports, continued with a bad car wreck in 1972 and finished me off when rear ended at 65 MPH ten years ago where even the car sitting in front of me was totaled. The guy that did the hitting? Never charged. Walked away.

One thing I can tell you for certain is that any heavy duty pain meds are going to have an effect on your breathing, perhaps even causing severe OSA with centrals. BE CAREFUL.

[khauser]

They keep suggested back surgery but I'm not too excited about that.

Stay away from that UNLESS you are actually losing function (ie, feeling numbness or losing the ability to use a muscle). If that happens, RUN for the surgeon, but otherwise RUN AWAY from the surgeon!

They got me when I was less educated and in a LOT of pain. Neurosurgeon and Orthopedic surgeon both said do it. I did it. For three months I was a very happy man. No drugs, no pain.

Then it finished healing and scar tissue was created. Pain came back. Different than before, but actually MORE debilitating. Neurosurgeons thinks the surgery was a success. The patient (me) thinks it was a total failure.

As for the other comments, it's a YMMV thing. Plus, morphine is less of a mess to get off of. But I've stopped it several times for experimental reasons. Yes, I have to taper off (it would be stupid not to) but otherwise I didn't find it that hard.

My treatment results in an AHI of less than 1 almost always, and is ALWAYS under 2, so despite your warning, my experience is otherwise. The danger would be in suddenly increasing the dose or taking something else (including alcohol) to the extent that your brain fails to breathe ... the ultimate way too long CA. But if you are always following your doctor's advice it should never get that far.

[jwerley]

I have been on a morphine pain pump for 11 years, up until May of this year. My sleep doc told me that my apnea had changed into complex sleep apnea from taking morphine (interthecally) for so long and was about to put me on ASV. So I started thinking about my whole situation.
I started on the pain pump in 2002 because at that time I was going through a divorce and had to go back to work. My circumstances are different today as I am retired and have the time to ly down and rest as needed. I also wondered just how much pain it was controling as I think my body had adjusted. Well it is now Sept. soon to be Oct. and I have had the pump turned off for 4 months now. I have also stopped taking anything that woud slow my hear rate down. My sleep apnea has improved so much!! I have gone from an average AHI of approx. 7 to 0.1.

My pain doc did not agree with my sleep doc. The pain doc did not think the morphine was causing any sleep problems......he was wrong! Everyone's body is different and reacts differently to meds, so what works for me may not work for you, but just wanted to let you know my situation.....hope this helps!

P.S. I am going to have the pump removed after I recover from a dog bite that I got this summer....(always something!)

Take care,
Janice

[khauser]

Wow ... that's pretty convincing!

I have to admit I am very surprised by this. I am very surprised specifically that morphine delivered interthecally would cause such changes so far from the site. Maybe there is a path followed up from the site to the brain??

Still I have to wonder what your dose of morphine would have been orally to get the same treatment, and THAT I would think would be much worse.

But you've given me something to ponder!!

[jwerley]

The morphine....even though it is being delivered interthecally at a lower dose (in my case 15 mg per 24 hrs) is still systemic. I had to be taken off of it very carefully and slowly so that I would not withdraw. My system is very hypersensitive to chemicals, so that could be a factor too....as I said everyone's body responds differently.

Janice

[johnthomasmacdonald]

You may want to switch over to an ASV machine - it seems chronic opioid use can induce centrals which are treated better with an ASV-type cpap machine.


J R Coll Physicians Edinb. 2012;42(4):314-6. doi: 10.4997/JRCPE.2012.407.

Chronic opioid use: a risk factor for central sleep apnoea and successful therapy with adaptive pressure support servo-ventilation.

Fahim A, Johnson AO.
Source
Department of Respiratory, Medicine, New Cross Hospital, Wolverhampton Road, Wolverhampton WV10 0QP, UK. ahmedfahim@doctors.org.uk
Abstract

Sleep apnoea is a global health problem with significant morbidity. Obesity is a well-known risk factor for this condition, however chronic intake of opioids as a risk factor for central sleep apnoea is under-recognised. We report a case of a 47-year-old man who developed significant sleep-disordered breathing secondary to opioid use for chronic pain. A sleep study demonstrated a picture of complex sleep apnoea with a prominent central sleep apnoea component. He had no significant improvement with conventional continuous positive airway pressure therapy. However, adaptive servo-ventilation had a dramatic effect on his symptoms and compliance. This case highlights the significant risk of central sleep apnoea with opioid use and illustrates the importance of adaptive servo-ventilation in the management of sleep-disordered breathing secondary to impaired central respiratory drive.