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January 26, 2010

Chondrolysis caused by pain pumps

Some medical stories make me furious. This is one of them. NY Times:

Chondrolysis has ended the athletic careers of dozens of high school and college students. In the most severe cases, it has required joint replacements. Many sufferers face lifetimes of pain and disability.

“I’ve lost so many hours of sleep over this, I can’t tell you,” said Dr. David S. Bailie, an orthopedic surgeon in Scottsdale, Ariz., who said he had seen dozens of cases of chondrolysis since 2005. “There’s nothing worse than a surgeon doing something that causes a problem, not fixes a problem.”

Although it is still unknown why chondrolysis develops, several medical studies have concluded that a likely culprit is a pain pump, a postsurgical medical device used to deliver local anesthetics to a specific area through a plastic tube.

What's really going on here?  Why are people being implanted with high-tech devices for the localized control of pain?   I've had more shoulder operations than anyone I know, and I'll tell you, shoulder pain goes away if you take demerol or morphine.  I've been prescribed these medicines on numerous occasions and they work. 

Kids are having these weird, untested, and dangerous devices put into their bodies because the medical establishment is adverse to prescribing ordinary pain killers to people in pain.   These medicines work and they are far safer than any high-tech alternatives.   Part of the interest in these devices might be lowering hospital costs because administering morphine requires an extended hospital stay.  Ultimately, a confluence of corporate interests -- manufacturers and the insurance companies -- are likely behind the interest in pushing these devices.  That's why mainly only American kids are being implanted with these high-tech devices.  

The article continues:
In late 2006, after a handful of studies indicated that the pain pumps might be causing chondrolysis, the I-Flow Corporation, the largest pump manufacturer, changed its directions in package inserts to advise doctors to avoid placing the pump catheters in joints. In 2007, I-Flow posted a bulletin on its Web site notifying physicians of the risk.

The first lawsuits against pain pump companies were filed about two years ago. It is difficult to know the exact number of suits, but I-Flow reported in November that it was a defendant in 191 chondrolysis cases involving 412 patients. Of those, the company said, 80 suits were dismissed. Kay Jackson, a spokeswoman for the Kimberly-Clark Corporation, which purchased I-Flow last year, declined to comment, citing the pending litigation.
I'm not a doctor, but over the years I've picked up a few basics of orthopedics.  First things: You don't go putting tubes into joints!   Certainly not to control pain. Any physician who would suggest doing this is an complete idiot.  (The risk of infection from the insertion of such a device is too great.  Pain-killing does not warrant such a risk.)  

These companies deserve to be sued.  The first maxim of medicine is DO NO HARM.  That means don't go experimenting with unproven techniques in order to relieve pain -- pain that has safely been controlled for many decades through the non-localized administration of low-cost prescription medication.

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