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VA or Medicare for Medtronic Morphine Pump ?

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  • VA or Medicare for Medtronic Morphine Pump ?

    I am a 63 year old Vietnam veteran being treated for pain from a spinal cord injury (unrelated to my service) by the VA. The VA has offered to send me to an outside doctor to have a morphine pump implanted, at no cost to me. I could also get the pump using Medicare, but they only cover 80%. The VA has adopted strict guidelines recently concerning opiates. Does anyone know how much autonomy the outside doctor has in my treatment? Will he have to do what the VA tells him in regard to things like dosage or drugs used in the pump? Or will I be treated like any other patient? It might be that I'd be better off using Medicare. Either way I think I'm going to get the pump implanted, hopefully early 2015. It would be great to hear from another veteran who has been through this. Thank you.

  • #2
    Are they going to manage the pump after you have the surgery, or will this other physician? The VA would have to authorize fee-basis for refills and adjustment visits, as well as the cost of the drugs. They may want to do the refills on-site if they have the capacity, rather than fee basis it. I would want to check this out with your primary care provider for the long term plan before deciding. It is not just the VA that is getting stricter on use of opioids though.

    Have you had test dosing with morphine into your spinal canal? In my experience, a morphine pump often does little or nothing for neuropathic pain related to SCI.

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


    • #3
      Thank you, SCI-Nurse, for your reply. I don't know yet who manages the pump following surgery. If I want to pursue this, the VA will set up a consult with the outside physician, and we'll see. What's most important to me, considering the risk involved in the surgery itself and carrying around this hardware in my abdomen, is that I have the most options available going forward. I wouldn't want the VA to put any limits on my treatment. It's discouraging that in your experience the pump often does little or nothing for neuropathic pain. In 1980, following a MVA, I had spinal fusion surgery w/Harrington rods due to compression fracture of L1,L2. Over the last 3-4 years the pain has become increasingly bad,and I've had to self-catheterize. I have stenosis and osteopenia. At the VA we have tried PT, epidural injections, Lyrica, and Fentanyl patches. I am currently taking MSContin 100mg. 3 times a day and Dilaudid 8 mg. 3 times a day. The oral analgesics are becoming less effective but I have reached the limit of what the VA guidelines will allow them to prescribe. If the test dosing is ineffective, then what? Thank you.