By Frank Schiraldi

This column is the text of a letter sent to the CDC on January 13 by Frank Schiraldi, who also contributes to the National Pain Report.

This note is regarding the use of narcotics for chronic pain. My journey in chronic pain began about four years ago when I experienced an adverse drug event when taking Victoza for diabetes. It caused pancreatitis, which is listed as a potential problem in the drug labeling. Although that was quickly resolved, I began to experience the same problem about 10 months later. The pancreatitis had returned, and expanded to cause problems with other organs in the area. I was now diagnosed with chronic pancreatitis and groove pancreatitis. I was prescribed pain medication, and it helped. At the time, I was told that treating me could involve a radical surgery called a Whipple procedure, or a nerve lock, or just continuing the pain medicine.

Since then, I have had a Celiac Plexus nerve block and two surgical consults regarding a Whipple procedure. The nerve block didn’t help very much, and my two surgical consults were of opposing positions. One in Boston suggested the surgery, while a prominent surgeon in Philadelphia said I should not have the surgery, and in fact said he would not do it. Quite clearly, in the practice of Medicine, two surgeons are allowed to have different opinions to guide the care of their patients.

I have continued with the pain medicine with great relief, allowing me to have a normal life and continue to work, until July of last year when I began pain management, and the tapering began. As the medication was tapered, my pain increased steadily. I was shocked that we had a drug that worked, yet it was being removed. I am aware of the risks associated with pain medication, much the same as I accepted the risks associated with taking Victoza when I did, along with many of the other medications I have been prescribed. Over the past four years while on these medications, I always took them as prescribed, never saw more than one doctor at a time, never asked for an early refill, and never “lost” my medicine or claimed that my dog ate the bottle. I use only one pharmacy.

I was also diagnosed with Myasthenia Gravis this past summer. Stress is a very prominent trigger to worsen MG symptoms, and I have found that the stress from pain has left me in a bad situation with my MG. I am convinced that a return to the pain medicine I had before would lead to a reduction in the MG symptoms I am experiencing. Unfortunately I was just scheduled to be admitted to the hospital for a round of Plasmapheresis tomorrow.

I understand how critical an issue pain medication overdose is, and without a doubt there has been an over-use of pain medications across the country. My main point is that I believe we can tackle that issue without absolutist measures that take an option away from people suffering with chronic pain. There are going to be cases where these drugs can be used safely and effectively. I have been reading of case after case where better judgment should be used to take care of suffering patients. Yet the actions I am witnessing are not what I would consider to be compassionate care, nor in the best interests of positive patient outcomes, which we all strive for.

Please include a provision for continued care for the chronic pain patient, without penalty to the caregiving provider.

Editor’s Note: Frank Schiraldi is a 59 year old Pennsylvania pharmacist working in managed care at a PBM. He developed pancreatitis in 2011. He since had a diagnosis of chronic pancreatitis, groove pancreatitis, avoided a Whipple Surgery, and did have Celiac Plexus nerve block. He recently learned he also has generalized Myasthenia Gravis, not yet controlled.

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