Shoulder Pain Pump Not Necessarily the Best Pain Solution

Boston, MAPatients who undergo surgery are usually understandably concerned about the pain they will endure. In the case of arthroscopic shoulder surgery, an alternative to oral medications was developed to help deal with post-surgical pain. This alternative, a shoulder pain pump, was supposed to almost eliminate the pain patients felt in the two to three days following surgery. Unfortunately, the pain pump has an unintended side effect - Post-Arthroscopic Glenohumeral Chondrolysis (PAGCL).

PAGCL is an extremely painful condition that results in decreased mobility of the affected shoulder. It occurs due to damage of the cartilage, which is vital for shoulder mobility. Pain occurs when the cartilage between the humeral head and the glenoid is broken down, resulting in bone-on-bone contact.

One of the main concerns about PAGCL is that it affects people who are young and otherwise are in good health. In fact, a study of patients referred to Duke University Medical Center for severe chondrolysis showed all six patients were between the ages of 15 and 32. All patients also required shoulder replacement surgery.

Furthermore, a paper by Hansen and colleagues, referred to at Medscape Today, noted in a study that all patients included in the study who developed PAGCL had been treated with a shoulder pain pump that contained bupivacaine with epinephrine. The shoulder pain pump was the only factor found to be in common among the patients. All patients received the medication at 4.16 cc/hour for two to three days. Eighty-three percent of the patients who developed PAGCL in the study required subsequent procedures to treat the pain.

Although not a lot is known about PAGCL, some researchers believe the pain medication pumped directly into the shoulder is too concentrated, causing cartilage damage. The pain pump actually delivers medication such as bupivacaine and epinephrine to the surgery site. According to the Hansen paper, the pH of bupivacaine with epinephrine is between 3.5 and 5.5, which may play a role in the development of PAGCL.

In severe cases, patients require an entire shoulder joint replacement to manage the PAGCL. The procedure, known as arthroplasty, uses parts made of plastic and metal to replace the shoulder joint. Other patients require constant medication to manage the pain.

One study has already linked the use of shoulder pain pumps to PAGCL and further studies are underway to confirm those findings. In the meantime, doctors are encouraged to use shoulder pain pumps with caution until more information about their link to PAGCL is obtained.