August 06, 2019
Brad Bartholomew has always been a car guy. His current collection includes classic muscle cars and exotic foreign models. But he was driving a much less exciting vehicle – a minivan – when he suffered a serious accident in 2001.
"I was hit by another car and flew off a 70-foot cliff," says Brad. "I blew out 18 discs in my spine and both my knees. I was in pain from my ankles to my eyelids."
Over the next 18 years, physicians at many local healthcare facilities tried to help Brad with his pain. They performed 28 surgeries, delivered spine injections and wrote opioid prescriptions.
"I was taking 60 milligrams of oxycodone every day. I couldn't sleep at night. I was in a fog all the time. And my memory was totally shot," he says.
The opioid epidemic
Brad began taking opioids around the same time many Americans did. In the 1990s, physicians often prescribed natural and semi-synthetic opioids to manage pain following surgery or injury. By the early 2000s, opioid overdose deaths were on the rise.
After that, the situation grew worse. In 2010, an increased use of the street drug heroin led to another surge in overdose deaths. Then in 2013, illicitly manufactured synthetic opioids such as fentanyl pushed the overdose numbers even higher.
By 2017, the US Department of Health and Human Services declared opioid addiction a public health emergency. Today, the statistics remain grim. Approximately 130 Americans die every day from opioid overdoses. Another 2.1 million have opioid use disorder.
A vicious cycle
Dawood Sayed, MD, is an anesthesiologist and interventional pain management specialist with The University of Kansas Health System. He sees patients like Brad every day.
"Patients start taking prescription opioids for relief from their chronic pain. It’s usually effective for the first 4 to 6 weeks. Then, they develop a tolerance to the pain medication. They need higher and higher dosages to get the same pain relief," says Dr. Sayed.
The higher the dose, the more intolerable the side effects. Many people experience breathing difficulties, constipation, nausea, confusion and drowsiness. Despite the side effects, getting off opioids can be nearly impossible. The medication crosses the blood-brain barrier creating a euphoria many people want to repeat.
Changing gears with microdosing
In 2017, Brad took stock of his life and decided it was time to end his reliance on opioids. An online search led him to the Mark A. Asher, MD, Comprehensive Spine Clinic. Dr. Sayed accepted Brad’s complicated case.
"Brad was such a highly functional person, but this chronic pain had torn his life apart. He was miserable not only from his condition, but from the side effects of the prescription painkillers," says Dr. Sayed.
In Brad's case, Dr. Sayed recommended an intrathecal pain pump with an innovative technique called microdosing. The round device – about the size of a hockey puck – contains a pump and a medication reservoir. The device is surgically implanted under the skin of the back or abdomen.
Physicians program the sophisticated pump using a handheld computer. The dosage and timing can be tailored to each person. The pump sends FDA-approved pain medicine through a small catheter into the fluid surrounding the spine.
"Since the medicine is delivered directly to the receptors in the spinal cord, it is much more effective against pain with almost no side effects," says Dr. Sayed.
To be eligible for the pain pump, Brad had to wean himself off the powerful painkillers he was using. This reset the pain signals throughout his body so he could experience relief with a fraction of the medication. Brad went from a whopping 60 milligrams of oxycodone per day to just 0.3 to 1 milligram of morphine per day.
For Brad, the implanted device works better than oral painkillers. "I used to take a pill and wait for relief. With the pump, it’s instantaneous," says Brad.
Every 2 to 3 months, when the reservoir empties, Brad returns to the spine center for a refill.
Alternative to oral opioids
The pain pump not only lowers the dose of medication needed, it also lowers the risk of addiction.
"When you give medication spinally, it does not cross the blood-brain barrier. It doesn’t give patients the same pleasurable high as an opioid pill. The only pleasurable feeling they get is pain control," says Dr. Sayed.
Another benefit of the permanently implanted pain pump is that patients cannot sell their medication on the street. According to Dr. Sayed, this single device may turn out to be a solution to 2 difficult problems: chronic pain and the opioid epidemic.
Back in the driver's seat
More than 1 year after Dr. Sayed implanted the pain pump, Brad continues to be pain free. He's working full-time again at his TV video production studio in Lenexa, Kansas.
"I feel really alert and alive. I run up and down the stairs. My memory is coming back," says Brad.
"We love to hear stories like Brad’s. We want to see people get back to their lives," says Dr. Sayed.
With pain and opioid dependence behind him, Brad can really enjoy his Ferrari. And his Mustang. And his Corvette. And his Camaro. "He’s given my life back to me," says Brad.