Many people suffer from shoulder pain. Whether from an acute or chronic injury, shoulder surgery may be indicated. The use of pain pumps following arthroscopic shoulder surgery has increased over the past several years. While pain pumps may help with post-operative discomfort, their use has become controversial due to the risk for potential complications. The risks vs. benefits of pain pumps following shoulder arthroscopy have prompted recent recommendations concerning their use.
History
Arthroscopic shoulder surgery is often performed on an outpatient basis, provided the patient's pain is controlled properly. The introduction of pain pumps has allowed for adequate control of post-operative pain without the requirement of an overnight hospital stay. According to "Orthopedics Today," the first pain pumps were used in the mid-1990s. Dr. William Mallon published the first study on the use of pain pumps in 1994, demonstrating a significant decrease in pain for those patients receiving a pain pump vs. those who did not. The first Pain Control Infusion Pump was officially introduced to the market in 1996. Several other companies began marketing pain pumps shortly thereafter.
Function
A shoulder pain pump works by infusing medicine directly into the joint through a tiny catheter. Often, an anesthetic (or numbing) medicine is used to relieve pain. These pain pumps are typically inserted by an anesthesiologist or by the operating surgeon at the time of surgery. Physicians choosing a pain pump for post-operative relief may leave the small catheter in the shoulder joint for 24-72 hours. The catheter may then be removed, either by a medical professional or by a caretaker at home previously trained by the medical staff.
Types
There are several different types of pain pumps. Some pain pumps are automated, dispensing a specific amount of medicine over a designated period of time. Other pumps are controlled by the patient, though safety mechanisms should be in place to prevent overdose of medication. In addition, some pain pumps infuse numbing medicines, such as Lidocaine or bupivacaine, while other pumps administer narcotic medications.
Potential Complications
Although shoulder pain pumps have been shown to lessen post-operative pain, particular uses of the pump have resulted in serious complications to the patient. Specifically, inserting a pain pump into the glenohumeral joint of the shoulder has caused chondrolysis (or destruction of cartilage) in a number of patients. Patients diagnosed with chondrolysis suffer from stiffness, pain and decreased mobility. Often these patients require further surgery, including arthroscopy or joint replacement. While current data support the use of pain pumps in the subacromial joint space, subsequent research has demonstrated a link between pain pumps infusing bupivacaine and chondrolysis of the glenohumeral joint. In many cases, lawsuits have been filed against the manufacturers of pain pumps.
Current Recommendations
In January 2010, the U.S. Food and Drug Administration (FDA) issued an updated warning regarding the use of shoulder pain pumps. Specifically, the FDA now requires manufacturers of pain pumps, as well as those of local anesthetics, to label their products with details of the possible risks involved. In addition, the FDA does not endorse the use of infusion pumps for the purposes of pain relief following shoulder surgery. Patients are strongly advised to speak to their health care provider regarding the risk for serious complications prior to using shoulder pain pumps.
