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Microdosing Puts the Brakes on 18-Year Opioid Dependence

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.

New Technology Brings Pain Relief Without Opioids

Narrator: Car enthusiast, Brad Bartholomew, has a passion for cars, and a whole new way of looking at life.

Brad Bartholomew: I said to myself, "This is how it ends, it's over."

Narrator: In 2001, on a routine drive back from Branson, Missouri, Brad was T-boned by another car and thrown down a 70-foot cliff.

Brad Bartholomew:  There wasn't a point from my ankles to my eyelids that was not just in a lot of pain.

Narrator: For Brad, a very active man and involved business owner, this began 18 long years of recovery and pain.

Brad Bartholomew: I've had 28 surgeries total. Pretty much not a spot on my back that's not scar tissue.

Narrator: All that, on top of countless amounts of addictive and debilitating medications, Brad had had enough. He got off his meds, despite his continued pain, and went searching online for what to do next. His search led him here to the University of Kansas Hospital, where he met pain management specialist, Dr. Dawood Sayed.

Dr. Dawood Sayed: He was such a highly functional person, and this chronic pain had really just kind of torn his life apart. He was suffering from, not only the condition that he had, but also the side effects of the treatment that he was doing, which primarily at the point when he saw me, were the prescription painkillers.

Narrator: So Dr. Sayed suggested what's known as an implantable pain pump. It is surgically placed inside the body, and releases the proper dose of pain medication directly into the spine.

Dr. Dawood Sayed: It's called microdosing. What we do is we actually try to, prior to putting the pump in, to ween them down to the lowest possible dose. What we think that does is that kind of resets the pain signals and the pain receptors in the spinal cord and throughout the body.

Narrator: The device itself has been around nearly 25 years, but the technology around it has advanced significantly.

Dr. Dawood Sayed: The original versions of these were what we called continuous-flow-rate pumps. So essentially, you would just put them in and they could only just go at one rate. Now, these are completely computerized and programmable.

Narrator: For Brad, what was once a compound problem, the pain from the accident, and the unbearable side effects of the daily medications.

Brad Bartholomew: It gave my life back. Short of miraculously gave my life back.

Dr. Dawood Sayed: Not only, to me, is it that the pain comes down as a pain management physician. Really, I want to see people get back to their life and doing everything they want to do.

Narrator: For Brad, that means getting back to his toys and not taking anything for granted.

Brad Bartholomew: Now, it is like being born again.

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.

Patient testimonial: As with all treatments, individual patient results vary. It is important to discuss your treatment options with your healthcare provider.

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