Treating pain in ER

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    Do you nurses typically see patients undermedicated in the ER for pain? I had the worst experience this past weekend. I have suffered chronic pain for about 10 years and at one time was on 600mg of oxycontin a day for about 5 years. I have weaned myself off of the oxycontin and now am on 120mg of roxycondone. I recently learned I have spinal stenosis in my lumbar, along with chronic kidney stones and neuropathy. So early sunday morning, after waiting over 8 hours for the pain to let up, I finally went to the ER. The ER doctor would only give me toradol and phenergan for nausea/vomiting ( I was also vomiting blood ). Finally he agreed to give me 1 ml of dilaudid (what a nice man. gag) which literally only took the edge off of my pain for about 15 minutes. Worst experence ever. I left in about the same pain I arrived in, only not vomiting. I made it a point to tell the Dr that I unfortunatelly have a high tolerance to pain meds, but he didn't care. Said chronic pain isn't treated in the ER. I thought if someone comes into the ER in chronic pain it must be treated, regardless of the cause. I wasn't asking or and RX or narcs, as I already had that at home, just wasn't working with this severe pain. Now I know the addicts probably mess things up for us who really need the relief, but shouldn't the doctor be able to tell the difference? Just curious about what you ER nurses see with regards to the subject. Thanks
  2. 122 Comments so far...

  3. 1
    Sorry you had such a bad experience. I think the problem lies in that chronic pain is treated in ER all the time, but most of the time it's "chronic pain"...

    Also, the ER is supposed to be for acute problems- I think you wanted to address your acute pain which was an exacerbation of your chronic condition.
    psu_213 likes this.
  4. 8
    Unfortunately, the bad apples ruin it for everyone. The seekers, liars, and manipulators jade ER staff. Doctors get seriously ticked when they find out they've been played, so sometimes they take the road of giving the minimum. Nursing can be advocates but the MD gives the orders. I'm sorry you had a bad experience but how is anyone supposed to tell who is lying and who is deserving? I agree with the doc that chronic pain requires a multi-pronged approach, and there are no easy fixes. Treating you with Toradol was appropriate since you didn't have that at home, and you did have narcs. The sad fact is there are many problems and ER can't solve, and chronic pain is one of them. Patients sometimes have unrealistic expectations and don't understand the safety (i.e. legal) issues involved. People die from narcotic overdoses all the time. Once you overmedicate a patient and they stop breathing you realize what can happen so caution and safety become the most important things. Hope you feel better.
  5. 0
    I totallly unerstand your point. I welcomed the toradol because years ago (prior to the 5 years on oxycontin) after a hysterectomy and even with one of my kidney stone attacks the toradol was a God send. I happily accepted the toradol, but when it didn't even touch my pain after 30 minutes is when I asked for something else. It does suck that the addicts, bad apples etc make it bad for us. I am feeling better. Thank you for your insight.
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    Call your family doctor if you are having pain. don't let it get so bad that you need to come to ER. You need to be specific about your pain. If you're having pain in 3 different areas at the same time, it's hardly an acute condition unless it's related to recent trauma. You mentioned you had spinal stenosis, kidney stones, and neuropathy. These are all chronic conditions, and while I do believe they flare up at times, it is important that you be on the proper medicine to prevent the flare ups, and also do the appropriate things to make your life better, such as not drinking tea and eating all the Brewster's ice cream you can find. And for god's sake, stay away from the damn cupcakes and carboyhydrates if you are overweight or diabetic.

    It sounds as if you became addicted to pain killers. I probably would not give you pain medicine either to be honest. I would just be adding fuel to the fire, and you will just come back another time for the same thing.
  7. 2
    The kinds of problems you describe, especially spinal stenosis will probably cause a fair amount of pain for the rest of your life (sorry). I hope you can get with/be treated by a Pain Management specialist - that would be your best bet for future problems. Wish you well.
    canoehead and Altra like this.
  8. 8
    I am not ADDICTED to pain killers. I have developed a tolerance to them, because of chronic pain. There is a difference between addiction and developing a tolerance. I am NOT a frequent flyer by any means. The ONLY time I have gone to the ER is when I have had kidney stones. I have had over 20 lithotripsies, several ureteroscopies, a emergency nephrostomy tube beginning at age 17. So, yes, over the years I have had to take narcs, but have NEVER filled them early, ever. If I were an addict do you think I would have been able to wean "myself" off on my own??? I appreciate your honesty, but would serioulsy advise you to educate yourself better on the difference between an addict and just someone with chronic pain and who has developed a tolerance to pain meds. This was on a Sunday morning, so getting a hold of my dr would be like getting ahold of the president. I did attempt to control the pain with my perscribed meds but due to the vomiting they just came right back up. I waited 8 hours to go to the ER. The last time I did go to the ER was over 3 years ago due to yet another kidney stond. Sometimes flare ups happen regardless of what one does to prevent them. That is when I expect to be treated properly in the ER, and I am fortunate that those times in the past when I have had to go, I did get proper pain control, with the exception of this time.
  9. 0
    Quote from Isabelle49
    The kinds of problems you describe, especially spinal stenosis will probably cause a fair amount of pain for the rest of your life (sorry). I hope you can get with/be treated by a Pain Management specialist - that would be your best bet for future problems. Wish you well.
    I am currenlty going to a PM doctor and have so far had 2 nerve blocks. A couple of weeks ago I had the first of a two part series where they cautorized the nerves. Today I will get the second. So, Yea, I am doing all I know to do. I just unfortunately had a major flare up.
  10. 5
    The literature has a term for someone with a legitimate pain issue not being addressed effectively - pseudo-addiction. Once the pain is controlled the "drug-seeking" behavior disappears. I believe pain is individual and grossly mismanaged, in hospitals and in private offices. Meanwhile, people with chronic conditions are labeled and this is tragic when help is available and cheap.
  11. 0
    Although this has nothing to do with your original post, this is important.

    You have to know, you will be in intractable pain pretty often when you are a nurse. Standing all day with no chance to even take a pee until your shift is over and no dream of sitting for 10 minutes to eat something. If your back is that bad, you need to think seriously about your entering nursing school. That and the fact you will be expected to pass with clear urine, not opiate containing urine even with a prescription. Just the way it is in the real world of medicine.

    As far as your pain goes, Maybe Monday morning you could go to your PM doctors office and try to get seen? I have no suggestions for how to handle pain. It is your demon to fight with.


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