Explain the nature of this procedure and pump.

Dr. Rauck: This is a very simple surgical procedure. We don't have to go in to body cavities or other invasive places. A lot of the work is done through needles so that a doctor can tunnel this device under the skin and not have to open up the patient very much in that respect. The incisions are very small. The procedure can be done in an outpatient manor, since it's not so difficult that one couldn't go home. A lot of our patients may be debilitated or somewhat sicker and choose to stay overnight rather than going home that day.

Who are candidates for this device?

Dr. Rauck: The optimal patient is someone who is toward the end of what would be a life shortening disease process. At this point, we have looked a lot at patients who have a cancer disease diagnosis. Certainly, patients with other disease processes that have limited life expectancy would be applicable for this, as well. On a realistic basis, all these patients may have four to six months to live. However, we've certainly had some patients who lived more than a year. Some of them have approached two years with the device and have done extremely well. I don't think it's limited by those factors. I think it's been better for patients when we know their life expectancy is somewhat shorter. We're trying to give them quality of life issues that can help them during those terminal phases of their disease process.

So, this isn't in any way a treatment or an advance for helping them with their disease, but just a way to keep them comfortable.

Dr. Rauck: I think that's right for the most part. Certainly some considerations go beyond just pain relief with a lot of patients. There's been studies showing that these folks, when their pain is taken care of, often need much less morphine and can be more successful in getting their appetites back and improving sleep patterns. In fact, oftentimes life expectancy is increased in some patients.

But you're right, it's not a treatment like chemotherapy or a radiation. It's not something that's going to help the tumor by itself. I think the benefits are somewhat side benefits that we see. By and large, we can help patients significantly with their pain relief, making them more comfortable and awake because they get less medication. They can to do the things they want to do in the last months of possibly their life process.

Some patients have been bedridden before the device. They've been sleepy or groggy on their medications. What we're able to do has allowed them to get back to a functioning level. It's very important to the patients not to have to have so much pain that they're just incapacitated from the things that they want to be able to do.

Are problems with addiction a concern?

Dr. Rauck: Addiction in this group of patients is not a real problem, so that's good. This group is less of a concern once these devices are in because with this type of device, I can give somebody one-hundredth of the amount of morphine one would take by mouth or even through an intravenous line. It's such a much more potent way to deliver the morphine. Because of that potency characteristic, one is able to give a lot less medication, The patient is able to stay more awake and have much better pain relief. So really, in all facets of their life, they're better off.

Is it potent because it's right were it needs to be?

Dr. Rauck: Exactly. The beauty of this is the catheter sits right where the nerves that are causing the pain come in to the spinal cord. The spinal cord is this incredibly powerful relay station for information that heads up to the brain. If you can shut it off right there, the nerves aren't going to travel from the spinal cord to the brain and essentially the patient never feels the pain. You still have the pain there, but it never makes it up to the brain.

Is there a potential for over medicating?

Dr. Rauck: Several features that you'll see with the device protect that. One safeguard is just that they're getting a lot less medication, so that helps. There is also the fact that a built in delay with this device and also with the refill of the device, such that if the patient hits it five times in a row, he'll only get one dose. It takes about sixty to ninety minutes to refill. That's a safety feature that's built in to the device.

What kind of pain are we talking about?

Dr. Rauck: It's described as some of the most horrific pain when we asked patients to compare it with different types of pain. Obviously, since pain is such a subjective experience, it's pretty much felt by each individual and described uniquely. Having bone pain from tumors can be very excruciating, very unrelenting, very recalcitrant or difficult to treat for some of these patients. Allowing their pain is very terrible. From our standpoint, we think of Dr. Kavorkian and his somewhat less-than-palatable successes have come because a lot of people have had loved ones experience either end of life situations or other situations that were very unpleasant with pain. If you don't control pain well, it leads people to be very desperate and looking for alternatives. We like to focus rather on other solutions and look at better ways to take care of a patient's pain.

Is there anything you feel is important for folks to know?

Dr. Rauck: One of the unique features of this device is the patients can activate it themselves. They have the ability to control their own pain. That's a powerful message that people like to have. They like to know that they can have some of control over the pain. This device is the only one that can be completely implanted in the body where the patient decides when they want a dose of medicine. If they're going out to dinner or if they want to go to a movie, they know an hour before hand, so they can use this device, push the button that's under the skin, and get good pain relief for that activity. Patients are willing to accept a certain amount of pain if they know they can get relief when they need it when they choose to activate the device.

What about spinal cord stimulators?

Dr. Rauck: Patients can certainly activate spinal cord stimulators as well. For a lot of cancer patients, spinal cord stimulation hasn't been very helpful. It's a different mechanism of pain for some of the chronic nonmalignant patients. The morphine and morphine-like medications tend to block the cancer pains better than the spinal cord stimulators.

We use a combination of drugs through this device. The study that was done to possibly win the approval of the device used morphine for the first three months. However, other narcotics can be placed through this device. Technology is evolving so we have a lot of interesting compounds that again can block pain at the spinal cord level. Drugs that we historically only used for high blood pressure have turned out to be very powerful analgesics when given in to the spinal fluid.

We are now in the development phases of a product that comes from a snail. It's a toxin in a snail and has turned out to be very effective in certain types of pain states when injected in to the spinal fluid. The combination of new products that are being developed as well as new technology like this device is helping us significantly for the folks who are in some of these wars against intractable pain problems.

What other options would there be if we didn't have this particular pump?

Dr. Rauck: There often aren't a lot of other options when they get to this stage. It is certainly simpler to take a pill and we encourage patients who can get good relief to stay with simpler regiments. These types of devices aren't meant for all patients. This is a minority of patients, the five or 10 percent of patients, who either get intolerable side affects or have a hard time getting the relief they need with medications by mouth. In those patients, this is very helpful.

For patients who already are taking a lot of pain medicines, there aren't a lot of other alternatives. Before now, the options were often either staying in very bad pain or being almost anesthetized or asleep all the time. Which is not the type of quality of life we like to see for patients in these situations.

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.