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Pain-Fighting Arsenal Includes Morphine Pump

Weapons in the war against pain are growing at a phenomenal rate.

To help patients cope with physical discomfort, many pain clinics employ a variety of psychological techniques, including hypnosis, behavioral modification and humor. Although some of the psychological approaches are enormously helpful--even critical--in treating chronic or severe pain, they often must be used in combination with physical therapy and drugs.

Among the most exciting pharmaceutical developments in the last few years have been more powerful drugs with fewer side effects and new technology for delivering those drugs into the body at lower doses. Epidural catheters, for example, can be inserted near the spinal cord to deliver morphine or other medications that block pain from reaching the brain. There also are new bandage-like patches to deliver painkillers through the skin, and long-acting narcotics that need only be taken once a day for continuous pain relief.

Perhaps the most revolutionary device is a tiny computerized morphine pump that can be surgically implanted inside the abdomen to provide continuous pain relief. Because the drugs go directly into the spinal column, they can be given at dosages one-hundredth the size required by conventional shots or pills.

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Many doctors, however, are not trained to use the latest pain-control techniques and their cost is high. But so is the cost of lost productivity due to pain.

Although estimates vary, the productivity loss associated with pain sufferers who miss work is thought to exceed $55 billion a year. The cost of one morphine pump is $16,000, installed.

“Compare that to a two-week stay in a hospital at $1,000 a day,” which a cancer patient in severe pain may repeatedly experience in the final stages of illness, said Dr. Martin Mok, director of the chronic pain management division of the USC Medical School. “Not only will the pump get the patient out of the hospital, it will get the patient out of pain and back to something approaching a normal life.”

For the pain after surgery, perhaps the most important development in recent years has been the computerized Patient Controlled Analgesia pump. Also costly, the pump allows patients to push a button and medicate themselves from their hospital bed, rather than wait for a doctor to write a prescription, the pharmacy to fill it and a nurse to administer it.

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Studies show that patients who use the pumps after surgery get more pain relief with less medication and have shorter hospital stays than those whose pain levels are allowed to fluctuate. But, according to a recent study, the pumps are available in less than half of the nation’s hospitals, and even then to only a tiny fraction of patients.

As yet, there are no uniform standards in U.S. hospitals on what basic pain services ought to be available. Only now are federal health officials attempting to draft such guidelines.


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