I have found 3 situations where the spear can be a big help; that's camps like sebilis crypt/emp, duels when the person has ring ds on, and laid back raids like HoT when there's plenty of monks to do the pulling and no green drake around. If we are doing one of those AE wurms, I can stay in the whole fight without any outside heals by blasting lifetaps and letting that spear off between casts. It's a fun toy but its delay and skill cap will really set me back if I'm using it in the wrong situation. I always hope that there is enough for me to do that I should not have it out.
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