Injured state worker advocates 'pain pump'
By ADAM WILSON
Don Roller carries one of those cards people talk about but rarely see -- the kind that says he can't help but set off the airport metal detector.
The "implanted device identification card," states that Roller has a drug infusion system in his body.
It's also known as a "pain pump," a small disc-shaped gadget in his abdomen with a tube attached. It delivers a pain-relieving drug straight to his spinal cord.
"It gave me a whole new lease on life," said Roller, 63. "It isn't a miracle thing, it just takes away the debilitating pain."
But he had to battle with the Department of Labor and Industries, which had refused to pay for the pump.
And now the state is drafting a new rule, due to be released in September, because Roller won a decision in the Court of Appeals.
Roller, a Department of Natural Resources employee currently on long-term leave, has a spinal condition that causes extreme pain - the pain pump operates like an epidural, which is given to women during childbirth.
Roller first injured his back while working in 1992. He underwent six back surgeries before receiving the pump in 2002, all paid for by the state workers' compensation plan.
Labor and Industries, which runs the workers' compensation plan, refused to pay for the pump, however.
"Our position on pain pumps is that we routinely deny them," spokesman Robert Nelson said. "We think long-term use of opiates, the kind of medicine they deliver, compound the kind of problems that injured workers have. They become addicted and need more and more. We have not seen any evidence that there is a benefit to an injured worker."
Roller used his private health insurance to pay for the pump instead. His challenge, which he won last year, said that the state could have covered the pump under its rules.
Since the court ruling, worker's compensation has paid for 28 devices made by the company that produces the pain pump, but exactly how many pumps were paid for is not immediately availible, Nelson said.
The state's new rule will allow the workers' compensation program to pay for pain pumps in three instances: leading up to and after a surgery, to control muscle spasms, or for patients with long-term cancer.
"In our opinion, this is not an economic decision by us," Nelson said. "The potential for addiction, real problems, complications from surgery outweigh the relief patients may receive."
Roller took morphine by mouth for years, but the painkiller left him disoriented and addicted, he said.
"I don't know what I was feeling - my dependency or my pain. When I had the pump, it took all that away," Roller said.
Aid for device maker
Roller and his attorney - backed with public relations help paid for by the multi-billion dollar company that makes the pump - are working to change the department's mind.
Medtronics, the company that makes the pumps, has sold more than 50,000 since 1982, according to its Web site. A Medtronics representative did not respond to a call for comment this week.
Medtronics hired a public relations firm in the campaign to change Washington's rules, but not just to sell more pumps, said Bill Hochberg, Roller's attorney. Every other state workers' compensation system pays for the implants, and the company wants to see Washington do the same, he said.
"I don't think there'll be that many more people who will have the device implanted. They just want to see the right thing done," he said.
Oregon allows pump
Larry Kroesing, a medical reviewer for the Oregon workers' compensation program, confirmed pain pumps are covered for injured workers in that state.
"It's usually reserved for those that are in the worse-off conditions," he said, noting patients must have chronic pain and use the pump on a trial basis before a permanent implant is approved.
But Kroesing said the pumps are considered a safe way of delivering powerful drugs to patients.
"It's usually less this way - they have less side effects because they're taking smaller doses than the oral (method) and it doesn't have to run through the GI (gastrointestinal) tract and everything else to be effective," he said.
But the Department of Labor and Industries points to a report by the University of Washington that said existing studies on pain pumps are unreliable. There was evidence suggesting pump users eventually must increase their drug dosage again to control their pain, the study also said.
"If (Medtronics) could show us, or if studies showed that these things provided permanent relief ... we'd probably take a different position," Nelson said.
The workers' compensation program's goal is to help injured people return to their jobs, he said.
"We treat pain so that the person has the mobility to work. We don't just say, we'll treat pain for the rest of your life - unless there is cancer ... where there is not going to be a recovery," he said.
Roller did return to work for more than two years after receiving the pump, he said, but has been on long-term leave for the past two years. He is considering retirement. He thinks the workers' compensation system should help people with permanent pain because of their injures, not write new rules, he said.
"The person who wrote this, they are telling me how bad I'm going to hurt for the rest of my life," he said.
State Sen. Karen Keiser, chairwoman of the Senate Health Care Committee, said she's familiar with the dispute over pain pumps and might address them as part of larger policy changes.
"We're not going to go in there and say, 'You need to pay for this particular therapy,' open and shut the door," she said. "But it is part of the larger discussion. The gold standard again is making injured workers productive again."
How do pain pumps work?
Pain pumps, also called intrathecal drug delivery systems, are surgically implanted, battery-powered pumps about the size and shape of a hockey puck. They carry a reservoir of medication and systematically deliver it through a catheter to the cerebrospinal fluid that cushions the spinal cord and the brain.
Because the drug is delivered directly to the spinal nerves, far less is needed than an oral prescription - sometimes only 1/300th the amount.
The devices are used to treat a number of conditions, including pain relief for failed back surgery, cancer pain, and reflex sympathetic dystrophy - a nervous system disease- arachnoiditis, scarring of the protective layers of the spinal cord and other problems. By delivering muscle relaxants, the pumps can treat cerebral palsy, multiple sclerosis and stroke.
The pumps are programmed while implanted by computer. They can be removed surgically, and their batteries typically last between five to seven years.
Source: The Mayfield Clinic, based in Cincinnati, Ohio.
Adam Wilson covers state workers and politics for The Olympian. He can be reached at 360-753-1688 or email@example.com.
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Thursday, August 17, 2006
Injured state worker advocates 'pain pump'