By David K. Lord.
Acute pancreatitis is primarily treated with supportive management in the hospital. Generally, patients receive intravenous fluids and pain medication. In up to 20 percent of patients, the pancreatitis can be severe. The patient may need to be placed in the intensive care unit because of damage that has occurred to other vital organs such as the heart, lungs or kidneys. Some cases of severe pancreatitis require surgery to remove irreversibly damaged parts of the gland.
Considerations in Using Opioids for CP Pain - any complaint of pain should be recognized as a significant problem if it affects physical function or quality of life. The etiology of chronic pain is complex, and treatment usually requires both a pharmacologic and a non-pharmacologic approach. Effective management of chronic pain is important, because chronic pain is a leading cause of disability and has high societal costs. When utilized for pain management, opioids should be started at the lowest effective dosage and titrated slowly.
In addition, chronic pancreatitis can be challenging to treat. Physicians will try to relieve pain and improve nutritional and metabolic problems that result from pancreatic function loss. Patients are generally given pancreatic enzymes and insulin to supplement what is not being secreted or released by the pancreas. In some instances, blockage of the pancreatic duct would require a surgical drainage procedure.
I hope you can help. It is very scary to have a PCP insist that pain management has to be done in an ER. Especially when they tell me I will have this condition for the rest of my life. The following is a summary of my experiences and concerns to date. It is my understanding a law governing medical abandonment entailing failure to provide necessary care within the physician-patient relationship is essential for a physician to fulfill their duty to provide such care. This leaves me to conclude that I maybe a patient not receiving the appropriate treatments.
I am writing to you in the hope that something can be rectified on my behalf. I was diagnosed with acute pancreatitis in the summer of 2017 by my PCP. After testing concurred with the doctor’s initial diagnosis, no follow up treatment was implemented. He refused to write any prescriptions for pain. At that time I had private insurance with limited benefits. Without his concern for follow up, I decided not to pursue any further consultation with this clinician. Not too long after, I proceeded to seek another physician, however with no improved outcome. So from 2017-2018, I have been forced to go, and on occasion, be admitted to a hospital to relieve my pain. I believe it has been six times thus far. Repeated morphine and other pain medication utilizing additional cost reoccurrence by repeating the same tests done on each visit. My research shows me a PCP should help provide pain relief in the treatment options by utilization of lower dose opioids. The Ohio and federal law provides a physician the affordability to dispense such medication. Especially when I was advised that my condition would be with me for the rest of my life. I have been seen by three other physicians since my hospital stay due to my PCP not being available for a visit. The doctors prescribed Creon and Neurontin to aid in the treatment. I thought there was no treatment plan!
My complaint, since it was event on my last day in the hospital between on November 24, that someone, other than a doctor, with common sense helped me with after-care medication. A nurse practitioner on my medical team at the hospital had done such and provided a script for a five day opioid (Tramadol) to take home in case I had a relapse after discharge - sounds reasonable and far less expensive to me.
By this refusal of out-patient treatment, I have been forced to be treated in a hospital setting only for ongoing pain. It has cost me and the Medicaid insurance agency approximately $70,000 dollars so far. My Medicaid insurance expired November 30, 2018 leaving me uninsured until January 1st of 2019, in which I will be utilizing purchased private insurance. With a high premium and a restricted budget, it leaves me in peril if alternative treatment cannot be provided. I have spoken with my PCP on numerous occasions and it is the same response every time, “I cannot and will not prescribe pain medication, you would have to go to the emergency room”, absolutely ludacris! With chronic pancreatitis and lingering pain issues for the rest of my life, I need an advocate. Under the current guidelines that I have read - and the information I received from the NP - there should be no question as to what the patient needs. I could write further and if more information or documents are needed I would be glad to provide them.
I had pain starting to generate on Tuesday 12/11, I took my medications and decided to see my pain management specialist working for Cleveland Clinic at Euclid Hospital in Euclid, Ohio. He advised me that he will not prescribe anything because he cannot afford to have his license put in jeopardy. He prescribed Neurontin, increased the dose, and advised me to seek my gastroenterologist for further treatment. And he suggested he would be referring me to a Chronic Pain Foundation. This doctor has my medical diagnosis and still refused to help treat me with something more potent than Tylenol, claiming it would do further damage to my pancreas. Obviously, he hasn’t read the guidelines and law pertaining to dispensing appropriate medications. I cannot understand how a specialist who charges 500-600.00 dollars for short visit, then violates a person’s quality-of-life situation. It is an ethical and legal right to receive quality care. I have not, so far! I am at a dead end until another episode and a trip to the ER costing thousands of dollars instead, where treatment could be provided by a so called specialist instead, or help from an advocate.
A survey shows doctors shunning chronic pain patients… “I have been told by more than one doctor that they cannot legally prescribe over the guidelines. They are very concerned about being investigated and as a result refuse to treat pain with an appropriate dose of opioids,” said another patient. Moreover, “We have two problems in the U.S., a drug addiction problem and a chronic pain problem. We should not be attempting to treat one problem if that will also create a worsening problem in those that suffer from the other,” a primary care doctor wrote, “We need to work on a solution to the addiction problem while still allowing those with chronic pain that need the opioids in order to sustain an acceptable quality of life.” I questioned my dentist about the failure to help pain. He stated that he “writes them all the time - nobody should be in pain. As you read the hundreds of letters you would be horrified.”
What’s next, no pain relief for terminal patients? The public should be outraged - any of us could be next.