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Pain Pumps and Disappearance of Shoulder Cartilage

07/2/2008
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Several companies, including Stryker, BREG, Inc., I-Flow and DJO, Inc. have manufactured and distributed high volume pain pumps. During surgery and for up to three days afterward, doctors use a variety of pain pumps to deliver anesthesia to shoulder joints. These pain pumps have catheters that surgeons can implant into the shoulder’s joint space. Because the pumps offer the advantage of being ambulatory and disposable, they are particularly attractive to surgeons. 

In principle, shoulder pain pumps seem to be a very efficient way to handle pain. Pain pumps offer pin point delivery of small amounts of anesthesia via a catheter inserted right into the shoulder joint; the procedure is relatively simple and very efficient. However, more than two years ago in 2005, scientists associated negative long term consequences with the use of shoulder pain pumps, and those scientists promptly warned manufacturers about the problem. Surprisingly, those manufacturers took nearly three years to respond with suitable warnings to doctors and consumers. Based on assurances from manufacturers, surgeons continued recommending pain pumps to their patients.

Drs. Brent Hansen and Charles Beck reviewed 177 arthroscopic shoulder surgeries, published their paper in American Journal of Sports Medicine, and concluded that until further investigation takes place concerning pain pump related PAGCL, researchers have advised surgeons and patients to avoid using pain pumps in combination with bupivicaine, with or without epinephrine, in all joints having an intact cartilage surface.

Dr. Charles Beck who co-authored the Hansen study warned doctors, immediately, that shoulder pain pumps can cause permanent shoulder damage, and Dr. Beck reported that hundreds of people were at risk for developing PAGCL. Although Dr. Beck sent results of the study to manufacturers two years before publishing findings in October 2007, those manufacturers did not timely respond to the study. Although manufacturers knew there was a high likelihood that a problem existed in 2005, they failed to take any action to warn doctors or the public of that high probability until 2008.

Symptoms of PAGCL include:

  • A reduction of the joint space in the shoulder
  • Shoulder stiffness or weakness
  • Underlying shoulder pain, whether at motion or at rest
  • Grinding of the shoulder joint with clicking or popping
  • Decreased range of motion

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