There is a Reason Why the Use of Pain Pumps May Lead to Knee Joint as Well as Shoulder Joint Chondrolysis
Posted by
Armand RossettiOctober 29, 2008 10:40 AMRecently, Attorney Calvin Warriner posted two articles on Injuryboard. The first was about pain pumps that cause devastating shoulder injury and the second addressed a 2008 Stanford University study that showed that injectable pain medicine from pain pumps has a devastating effect on tissue. It seems fair to say that there is a common thread connected with certain episodes of pain pump induced chondrolysis; no matter which joint in the body is being treated. The knee joint cartilage is just as susceptible to toxic medication as is the shoulder joint.
The FDA and the press have been focusing most publicity concerning chondrolysis on PAGCL , which involves the shoulder, which is one of the more mobile joint systems in the body. However, when undergoing similar treatment, hinge-type joints such as the knee will sustain similar cartilage injury.
While the complexity of a joint system like the shoulder might explain a higher incidence of post surgical, pain pump induced shoulder chondrolysis, the simpler knee joint should not be overlooked as a problem synovial medication delivery site. In an editorial entitled, The Dislocated Knee, pain pump induced chondrolysis was at the top of Dr. Bernard Bach’s list for possible treatment complications to watch closely. In his editorial, Dr. Bach mentioned the study that Nechleba et al. conducted in 2005, and Dr Bach stated the following:
“What have not been determined are the effects of Marcaine/epinephrine solution on articular cartilage. Recently Beck (personal communication, Herodicus society, July 2005, Sun Valley, Idaho) identified 12 patients who developed chondrolysis after use of an intraarticular pain pump following arthroscopic shoulder stabilizations without use of thermal energy. Nechleba’s study and Beck’s report (unpublished) would give me caution to use an intraarticular pain pump.”
As the 2008 Stanford study on drug induced chondrolysis, mentioned above, has pointed out, “All anesthetics containing epinephrine (pH less than or equal to 4) were chondrotoxic and cannot be advocated for pain pump use. The use of 0.5% bupivicaine for greater than 48 hours is not recommended.” Therefore, Dr. Bach’s caution in 2005 about not using an intraarticular pain pump to palliate surgically induced pain was and continues to remain, a prescient observation.
Episodes of knee chondrolysis after intraarticular pain pump treatment seem to occur less often than like episodes of shoulder chondrolysis, but this discrepancy might be due to the physiology of the joint, itself. Exposing cartilage to specific toxic medications like epinephrine, should be totally contraindicated, as hould bupivicaine in more concentrated dosage. In any event, it seems evident that both drugs will indiscriminately affect chondrocytes found in knee cartilage as well as those found in shoulder cartilage.