It's not that the country's leading insurance companies are against painless colonoscopies or improved at-home post-op pain relief, only that they've decided to no longer pay for these things because, they say, they're not "medically necessary" (propofol for colonoscopy) and they're "experimental" (pain pumps). We disagree.

WellPoint, Inc., the country's biggest health insurer, issued new medical guidelines last month that stated anesthesiologists' assistance in routine colonoscopies isn't medically necessary. It seems that the growing number of patients having colonoscopies under propofol sedation was inflating the cost too much.

You could argue that propofol is more of a nicety than a necessity in this case, but don't you think that the availability of propofol helps persuade more people to get screened?

In the continuing quest to send otherwise healthy patients home just a few hours after surgery, the key is controlling post-operative pain, especially during the first 24 post-op hours.

Post-op pain relief received a boost five years ago with the arrival of take-home infusion pumps, which continuously bathe surgical wounds in local anesthetic via a tiny catheter. More than 50 small-scale studies show that they reduce the need for narcotics, help patients get back on their feet sooner, recover their range of motion and physical activity, and reduce the likelihood of developing chronic pain from their surgeries.

The FDA granted I-Flow, the makers of On-Q, permission to label for this efficacy claim: "On-Q offers significantly better pain relief than narcotics and significantly reduces the need for narcotics." But mega insurers Aetna, United Healthcare and Cigna say they won't cover the $400 devices because there haven't been any well-designed, large clinical trials with published results in peer-reviewed medical journals.

I-Flow says it enrolled 100 patients in its first On-Q study, a double-blind, placebo-controlled study at Duke University. It soon became apparent which group of patients received the drug and which group received saline. The saline patients were in pain, and researchers stopped the study at just over 40 patients because they felt "it was unethical to continue." The study accomplished what it was designed to do, with fewer patients than planned: prove that patients using On-Q for delivery of a local anesthetic require significantly less narcotics and have significantly lower pain scores.

Fewer colonoscopies leads to more undetected cancer. Diminished at-home pain relief leads to more hospitalizations. Just who's winning here - patients and providers or insurers?