10 Things Doctors Have Reconsidered This Century


1
Use of Pain Pumps in Joints
Dr. K. Dean Willis takes an X-ray of an implanted pain pump in a patient at the Alabama Pain Center in 2014. The FDA now requires pain pump and local anesthetic manufacturers to warn against pain pump use in joints. Linda Davidson/The Washington Post via Getty Images

In the late 1990s, orthopedic surgeons began using pain pumps in some of their procedures. The postsurgical devices pump local anesthetics through a plastic tube to a specific area of the body for pain relief. By inserting pain pumps after surgery, patients were able to avoid long hospital stays. The pumps were also considered safer for pain relief than prescription narcotics [source: Thomas]. Although the Food and Drug Administration (FDA) never cleared the use of pain pumps in joints, surgeons eventually began using them in shoulder surgeries, and to a lesser extent in knee surgeries. (Physicians are permitted to use FDA-approved devices in such an "off label" fashion, which means for another purpose than that which the FDA originally indicated.)

But after they started using the pumps in joint surgeries, orthopedic surgeons began noticing many young, active patients developing post-surgical chondrolysis, a rare ailment where joint cartilage dies. The pain pumps and their medications were blamed. Those in the medical profession now say exposing sensitive cartilage to local anesthetics for up to 72 hours can destroy the cartilage, and most surgeons no longer use them in this fashion. The FDA now also requires pain pump and local anesthetic manufacturers to warn against use in joints [source: FDA].

Author's Note: 10 Things Doctors Have Completely Changed Their Minds About This Century

My older daughter had a pain pump inserted into her knee after ACL surgery and developed chondrolysis at the age of 18. She was told to expect a knee replacement as soon as she's old enough (about 40). Hopefully all surgeons have stopped using these devices in joints.

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